APPLICATION FORM FOR REIMBURSEMENT

Date: 23-08-2023

Respected Registrar Ma'am,

This is to notify that the team comprising of Satyam Jain (UID SM0121067), Rudrakshi
Rai (UID SF0121052) and Rohit Yadav (UID SM0121051) of Batch 2026 participated in
the XII ILNU Antitrust Moot & Conference, 2023 organized by Institute of Law, NIRMA
University, Ahmedabad from 24th to 26th February, 2023 and bagged the award for 'Best
Memorial - Appellant Side'. The participation had been allotted in MCC/Comm.3/13/12/2022.

It is respectfully submitted that our team was required to pay another amount of Rs. 4000/- as the
registration fee after the Memorial Qualification Results were announced in addition to the
previously paid amount of Rs. 3000/- as the initial registration fee, as also mentioned in the Mail
of Memorial Qualification Results attached along with this mail. Our team was also required to
submit 7 spiral-bound colored copies of both the memorials, as mentioned on Page 9 of the
Rulebook attached along with this mail; owing to which, print expenses were incurred at our end.
In addition to this, our team had no choice but to resort to booking air tickets to and from
Ahmedabad owing to no trains running on the required dates since accommodation had been
provided to us only from the evening of 23rd February to 26th February, i.e., Thursday to
Sunday. It is to be noted that the only viable train option that our team had was the Train No.
15636 operating from Guwahati to Ahmedabad which is a 51-hour journey ending on the
afternoon of Wednesday which could not suit the competition's itinerary since our team was not
provided with the accommodation before the evening of Friday. Moreover, only one train, i.e.,
Train No. 15635 operates from Ahmedabad to Guwahati in the week which is a 57-hour journey
and starts on Friday which could not suit the competition's itinerary since accommodation had
been provided only till Sunday.

We would thus like to request you to process our reimbursement as soon as possible. We are
attaching herewith the following documents for your reference,

1. Certificate of Participation
2. Certificate of Merit
3. MCC Communique
4. Mail of Memorial Qualification Results
5. Rulebook of the Competition
6. Registration Fee Payment Receipt
7. Print Expenses Payment Receipt
8. Air Ticket Payment Receipt
9. Cab Payment Receipt
10. Application Form for Reimbursement

We, hereby, request the University to transfer the amount to the Bank Account mentioned below,
Account Name: Satyam Jain
Account Number: 4926000100036719
Branch Name: SDVM PANIPAT
IFSC Code: PUNB0492600

We, as a team, have NO objection if the reimbursed amount is transferred to the

mentioned bank account.

Team Members and Signatures

1. Satyam Jain (UID SM0121067)

2. Rudrakshi Rai (UID SF0121052)

3. Rohit Yadav (UID SM0121051)

Thanks & Regards

Satyam Jain
B.A., LL.B. (Hons.)
National Law University and Judicial Academy, Assam | 2026
(+91) 74043-94401 | jsatyam2004@gmail.com | LinkedIn