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Hostel Withdrawal Form

The student requests a refund of their hostel security deposit. They provide their student details including name, father's name, hostel room number, permanent address, contact information, bank account details, and no dues clearance from relevant departments. The accounting department notes the refundable amount and payment details once approved by the Director.

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anurag dwivedi
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782 views1 page

Hostel Withdrawal Form

The student requests a refund of their hostel security deposit. They provide their student details including name, father's name, hostel room number, permanent address, contact information, bank account details, and no dues clearance from relevant departments. The accounting department notes the refundable amount and payment details once approved by the Director.

Uploaded by

anurag dwivedi
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

The Director, S.No.:…………..

Institute of Management Studies-Hostel, Dated:………..


Ghaziabad,
Sub: Refund of Hostel Security
Sir,
I was/am the student of Branch/Course…………….during the academic
session……………..and my University Roll no:……………….It is requested to kindly
release my security at the earliest. I am enclosing Hostel Receipts with the form.

Name of Student :…………………………………………………………............


Father’s Name :…………………………………………………………............
Hostel Room No :………………Residing from……………To………...............
Permanent Address :…………………………………………………………………
…………………………………………………………………..
………………………………Pin code………………………...
Contact No E-mail …………………………………………………………………..
Student Bank A/c No :…………………………………………………………………
Bank’s Branch Name :…………………………………………………………………
IFSC Code :…………………………………………………………………
Bank Address :…………………………………………………………………

Your Faithfully

(Student Signature)

No Dues Certificate
(1) CHIEF WARDEN :………………………………….………................................

(2) HOSTEL WARDEN :………………………………………………..........................

(3) SPORTS OFFICER :………………………………………………..........................

(4) A/C DEPTT.(HOSTEL) :……………………………………….……….........................

(To be filled by A/c deptt.)


REFUNDABLE AMOUNT Rs.……………CHEQUE.NO...........................DATED…………

(CHECKED BY) (ACCOUNT OFFICER) (DIRECTOR)

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