INDIAN INSTITUTE OF TECHNOLOGY DELHI

ACADEMIC & EXAMINATION SECTION (PGS/UGS)

NO DUES

No Dues Certificate Entry no.

Name (English) Name (Hindi) E-mail Tele. no. Thesis viva date
(PG only) Personal Parents

Certified that there is nothing outstanding against the student: 1. 2. 3. 4. 5. 6. 7. 8. 9. Head of Department/Centre Librarian President, R.C.A. President, B.S.W. President, Sports NCC / NSS / NSO
(circle one that you have done/NA for PG)

Dept/Center name: _________________

Hostel/Nalanda warden
Hostel name: ___________________

Security officer Accounts section

Academic section 10. (strike out one option) (i) Identity card (ii) Medical record book (iii) Exit information form Returned / Not returned Returned / Not returned Filled / Not filled

Certified that I have nothing outstanding against me from any other unit of IIT Delhi.
Signature of student & Date

Remarks by Superintendent (PGS&R/UG Section)

Signature & Date No dues certificate (Apr.2008) Page 1 of 2

P.T.O.

Institution and Library Security Deposits Refund The Board for Students Welfare is a body of the institute which provides financial help to needy students. We request you to contribute generously for helping your fellow students in completing their education. (Please tick mark one option and strike out the other two.) (i) (ii) I would like to contribute the entire Security deposit of Rs. 4,000/- (Rs. 2,000/- each Institution and Library Deposits) less dues, if any, to BSW. I would like to contribute Rs. ......................... out of my Security Deposit to BSW.

(iii) I do not want to contribute any amount to BSW. The entire refundable security deposit amount be mailed to me at the following address. Address for refund and further correspondence.

Signature of the student : ___________________________________________ Name : ______________________________________________________________ Date : _________________________________ ===================== ====================

No dues certificate (Apr.2008) Page 2 of 2