Visvesvaraya National Institute of Technology, Nagpur

No Dues Form 2022-23

(All Entries must be in Capital Letters only; student shall submit this form for collection of Final Grade Card/TC)

Name of Student (as per grade card) ……………………………………………………………

……………………………………………………………
ID No ……………………………………………
Year of Admission to First Year ……………………………………………
Program of Study – Tick– [ √ ] ……………………………………………………………
B Tech / B Arch / M Tech / M Sc
Branch ……………………………………………………………
Enrolment No ……………………………………………
Date of Birth ……………………………………………
Last Exam attended Summer-………………….Winter-……………………
Earned Credits / CGPA till last exam attended ……………………………………………
Faculty Advisor ……………………………………………
Mobile No ……………………………………………
E Mail Id ……………………………………………
Bank Account Holder Name ……………………………………………
Bank Name & A/c No ……………………………………………
Bank IFSC Code ……………………………………………
Clearance from – (Student to obtain signatures from offices below)
Library …………………………… Sports ……………………………

Hostel …………………………… Head of Deptt ……………………………

Academic ……………………………

Note – Students are appealed to donate library / caution deposit to Student Aid Fund.
Tick the Option below – [ √ ] No Tick will be treated as option of transfer to Student Aid Fund
1) Transfer to Student Aid Fund 2) Refund
Special Note – (I) Student must deposit the Identity Card along with this Form.
(II)Bank Account mentioned above must be of student’s only for expedite the refund process; NO CASH / Cheque
/ DD will be issued for the payment of refund amount.

Address ………………………………………………………….
………………………………………………………………………. Student’s Signature
Dist / City ……………………………Pin…………………... Date
State ……………………………………………………………...