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Indian Institute of Technology Kanpur Dean of Students' Affairs Office

This form is for students of the Indian Institute of Technology Kanpur to request a refund of excess fees paid. It requests information such as the student's name, roll number, program, department, amount deposited, actual fee amount, excess amount to be refunded, and supporting documents. The bottom section is for office use only to verify the request and approve the refund amount.

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Priyanka Verma
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176 views1 page

Indian Institute of Technology Kanpur Dean of Students' Affairs Office

This form is for students of the Indian Institute of Technology Kanpur to request a refund of excess fees paid. It requests information such as the student's name, roll number, program, department, amount deposited, actual fee amount, excess amount to be refunded, and supporting documents. The bottom section is for office use only to verify the request and approve the refund amount.

Uploaded by

Priyanka Verma
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

INDIAN INSTITUTE OF TECHNOLOGY KANPUR

Dean of Students’ Affairs Office

EXCESS FEE REFUND FORM

Academic Year: _____________________ Semester (I / II / Summer): ____________________

Student Name: _____________________________________ Roll No: ____________________

Programme (B. Tech. / M. Tech. / Ph. D. / M. Sc. (2-yrs) / M. Sc. Intg.): ___________________

Department: _______________________________ Category (GN/SC/ST): _________________

Room/Hall No: ____________________ E-mail: ____________________________ @iitk.ac.in


(Please write clearly)
Bank Account No. (UBI/SBI):_____________________________________________________
(Please write your Bank account no.)
Amount Deposited Rs. _________________ By Draft No./Cheque No. ____________________

Actual Amount of Fee Rs. _______________ Excess amount to be refunded Rs. _____________

Enclosure in support of proof:


1. Copy of Fee Receipt.
2. Copy of Demand Draft etc.
3. Any other documents please specified.

Signature of student
Date:

FOR DOSA OFFICE USE ONLY

Checked by: _______________ Verified by: _______________ Dated: ____________________

Approved for the payment of excess amount Rs. ______________________

Dean, Students’ Affairs

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