Full Name of Student :

Provisional Internship Certi.No.:

To,
The Principal
C. N.Kothari Homoeopathic Medical College
& Research Centre, Vyara

Sub. :- Application for Refund of College / Hostel Deposit Regarding.

Respected Madam,

With reference to the above, you are requested to note that I am student of your college. I completed
my internship (Internship Period ……………….. to ………………) OR left college/hostel on . I
had paid my College / Hostel deposit as per details below at the time of admission (College / Hostel Deposit
receipt/s and copy of bank Cancel Cheque/passbook attached herewith).
COLLEGE DEPOSIT (Receipt Attached) HOSTEL DEPOSIT (Receipt Attached)
Receipt No. Date Deposit Amount Receipt No. Date Deposit Amount

BANK DETAILS (Copy of Cheque/Passbook Attached)

Name as per Bank Account Number IFSC Code Name & Branch of Bank
Account

Please do the needful and refund of my college / hostel deposit.

Thanking you.
Yours faithfully,

Encl. : 1) Original Receipt of College / Hostel Deposit

2) Copy of Cancel Cheque / Bank Passbook Sign & Name of Student

RECEIPT

Name : Received with thanks from

C.N.Kothari Homoeopathic Medical College & R.C. Vyara, College Deposit Rs…………… + Hostel
Deposit Rs……………… Total the sum of Rs………………….. (Rupees
) by Cheque /NEFT/UTR No.
Bank , on Date

Sign.
on
Stamp