SVKM’s Narsee Monjee Institute of Management Studies (NMIMS)

(Declared as Deemed-to-be University under Section 3 of the UGC Act, 1956)

Mukesh Patel School of Technology Management & Engineering
Shirpur Campus
Date: _ _ / _ _ / _ _ _ _ _

APPLICATION FOR HOSTEL DEPOSIT FEES REFUND

To,
The Associate Dean,
MPSTME,
Shirpur Campus

I, Mr./Ms. _______________________________ was admitted for _______________

Programme on/ batch year _____________ and paid the Academic, Academic &
Hostel Deposit fees Rs._______________ vide Receipt No./No.s ____________,
Dt.____________ .

I am hereby requesting you to kindly refund the deposit fees as per the rules of
SVKM’s NMIMS on completion of course, cancellation/ transfer of admission.
The Cheque/ DD should be drawn in favor of ______________________________
___________ payable at _______________ & posted/ couriered to me at below
given address: __________________________________________________________.
Pin: ________________________
Enclosure: 1. Original Fees Receipts

________________________
(Signature of the Student)
Contact No.: ____________________________/ ___________________________
Date: Place: Time:_____________________
For Office Use Only
Date: ________________
Application received for excess fees refund at Shirpur on Date: _____________
Receivers Name:______________________________ Signature: ______________

Application forwarded to A/c’s for refund of fees as per the rules of SVKM’s NMIMS.

____________________________ ____________________________
(Seal & Sign of Head of the School) (Deputy Registrar/ Asst. Registrar)

Shirpur: Babulde, Bank of Tapi River, Mumbai Agra Road, Shirpur, Dist: Dhule, MS – 425405
Tel: 91 – 2563 – 286545 to 286554, Fax – 91 – 2563 – 286552, E – mail: sptmshirpur@nmims.edu