Withdrawal Application Form

Withdrawal details

Withdrawal No : 399776

Form No : 11323826

Withdrawal Date : 07 Jul 2023

What is the reason for your withdrawal?

I intend to take a gap year

Do you feel you are losing precious academic time .

No

Amity's academic classes are starting shortly on various dates. Amity offers options for proportionate fee payment.
Would you be interested to know more?

No
Student details

Withdrawal No : 399776 Form No : 11323826

Withdrawal Date : 07 Jul 2023

Enrollment Number : A1833323036 Name of the Student : Mr DIVYANSH RATHI

Program Name : BBA (International Business) Semester / Batch : 1/2023-2026

Admission Year : 2023 Date of Fee Payment : 12 Jun 2023

Commencement Date : Date of Registration :

Father's Mobile No : 9810644503 Mother's Mobile No : 9810644503

What are your plans Are your parents aware

after withdrawing from : Any other plan of your withdrawal : Yes
Amity University ? decision?

Please specify your plan : i want to prepare for ipmat and cuet

Contact Details

Correspondence Address Permanent Address

B-901, EXPRESS GREENS, VAISHALI, SECTOR-1, PLOT-1, NEAR B-901, EXPRESS GREENS, VAISHALI, SECTOR-1, PLOT-1, NEAR
ANSAL PLAZA,GHAZIABAD,UTTAR PRADESH-201010 ANSAL PLAZA,GHAZIABAD,UTTAR PRADESH-201010

Telephone : 201010 0120 9810644503

Bank details

Refund through : Online Transfer Beneficiary Name : ANUJ RATHI

A/C No : 5911623966 Bank Name : Kotak Mahindra Bank

Branch Name : 19, Netaji Subhash Marg New Delhi IFSC code : KKBK0000219

____________________________________ ____________________________________

(Signature of the Student) (Signature of Father/Mother)

Name ________________________________ Name _______________________________

Mobile No: __________________________ Mobile No: _________________________

We note with regret about your choice to finally withdraw from Amity. You are requested to fill in your bank details for
your refund and also attach a copy of a cancelled cheque. Please note that Amity offers only electronic transfers and no
cheques / demand drafts will be issued towards your refund.

Please take a printout all pages of this form, sign and send them along with cancelled cheque, by registered post/speed
post to:

Amity Fee Section,

Amity University Uttar Pradesh,
Plot No. 4, Sector 125, Noida.

On receipt of your physical documents your withdrawal request shall be processed.