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Update Noduse Format

The document is a No Dues Form for students at Harcourt Butler Technical University, requiring certification of no outstanding dues from various departments and sections. It includes sections for hostel, accounts, and library dues, along with a refund application for caution money. Students must provide personal details and signatures to confirm the absence of dues before receiving any refunds or certificates.

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pranjalmishra446
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50 views2 pages

Update Noduse Format

The document is a No Dues Form for students at Harcourt Butler Technical University, requiring certification of no outstanding dues from various departments and sections. It includes sections for hostel, accounts, and library dues, along with a refund application for caution money. Students must provide personal details and signatures to confirm the absence of dues before receiving any refunds or certificates.

Uploaded by

pranjalmishra446
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

HARCOURT BUTLER TECHNICAL UNIVERSITY

KANPUR-208002
NO DUES FORM
Name of Student: Course:
Department: Roll No.

Certified that during the academic year I was concerned with those teaching
department/sections whose S.No. is ticked (✓) below. I am aware that if the information
furnished by me is found incorrect. I shall be liable to any penalty imposed by the Institute.

Signature of Student

Sr. Name of Dues Signature of Sr. Name of Dues Signature of


No. Department in Rs. Head No. Department in Rs. Head
1. CH 10. OT
2. CE 11. PT
3. CS 12. PL
4. EE 13. IT
5. ET 14. MATH
6. ME 15. PHY
7. LT 16. CHY
8. BE 17. MBA / BBA
9. FT 18. MCA

1. USAC : There is no dues/dues amounting Rs._______________ in the name of student.

Signature of Physical Instructor


2. (a) HOSTEL: The student was resident of Hostel ________________ and has no dues in
his/her name.
Signature of Hostel Warden
2. (b) Deans Office: The student is hosteller/non-hosteller and has no dues/dues amounting
Rs. _______ in his/her name.

Signature of Asst. Dean of Student Welfare


3. Account Section: Mr./Ms. ________________________ of class ___________________
has no dues/dues amounting Rs. _____________________ in his/her name.

Signature of A.A./F.O./F.C.
4. Library: Mr./Ms. ___________________________ of class _______________________
has no dues/dues amounting Rs. ___________________ in his/her name.

Signature of Librarian
HARCOURT BUTLER TECHNICAL UNIVERSITY
KANPUR-208002
ACADEMIC SECTION
APPLICATION FORM FOR REFUND OF CAUTON MONEY
1. Name of Student : ________________________________
2. Course with Branch : ________________________________
3. Roll Number : ________________________________
4. Father’s Name : ________________________________
5. Year of Admission : ________________________________
6. Year of Leaving : ________________________________
7. Class & Branch (Which admissted) : ________________________________
8. Reason for leaving Institute : ________________________________
9. Amount of Caution Money deposited : ________________________________

Date :
Place: Kanpur (Signature of Student)

Report of Librarian

1. There are no Chargeable Dues.


2. There is Rs. __________________ against the student.

(Signature of Librarian)
Release Order
Accounts Officer

Please release the amount after adjusting the dues by deductions, if not already paid
to student concerned at address given below:
Address of which the amount to be sent: (Details Fill in CAPITAL Letters) * Compulsory
Account Name of Account Type of IFSC MICR
Holder Name* Bank/Branch/ No.* Account* Code* Code*
Address* (Passbook copy
attached)

Current Mailing Address with Pincode for Speed Post your Marksheet & Degree Cert.
(Fill in Capital Letter):

Mobile No.:

Verified By : ___________________________

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