Application /Declaration
To
Pvt. Ltd.
M/s HCL Training and Staffing Services
Sub: Request to refund Training Fee
took admission in your Training Program vide
HARSH RAJ
LOI dated o / / 2 4 and paid the requisite Training Fee including applicable taxes.
Payment details are as below:
Mode Amount Date (DD/MM/YYYY)
DD
Fund Transfer
Ps13, ula2o2
Bank Loan
This is in reference to Fee waiver as mentioned in my above referred LOI for TechBee Scholars and, it is
requested hereby to release my entitled amount as per the terms and conditions of the Training. Please
process refund into my bank account details as shared below in the Refund form (in case of Self
payment) or to be paid to my Axis Bank Loan Account directly (in case of bank Loan).
Eligible refund amountINR 1,00 cn-(Ps. na Lakh pnly
I had Paid fees through (please tick correct option)
Self Payment through Loan.
I have read and understood the related terms of waiver and agree that after receipt of above amount, I
have no further claim on account of Fee Waiver.
Thanking you,
Horu aj- (Signature)
HARSH LATName of Student)
SHTV PUTAN STNGH(Name of Parent)
HCLSITsS- LKLal21lao5
(Ref ID from the Letter of Intent)
Bank Details
Full Name
HARSH RAJ
Reference ID HLLSDITSS-LK 612i|oo5
Amount to be refunded
1,co, oo ma Lak)
Transaction details (DD/NEFT Number) No11211369+816 20
Bank details of Account in which amount should be refunded
Bank Name STAT E BANRK OE NDIA Se1)
Branch Details
Banch MANDERT4339)
Account Holder/ Holders Name/s HARSH RAJJ
Account Number
he&2 25 225T
IFSC Code SBINool4334