REFUND FORM

Date: _______________
 Excess Fees
 Excess Deposit
 Hostel Deposit / Other
(Please indicate as applicable)

 Student No. (SAP NO.)

 Student’s Name

 Student’s Address

 Student’s contact number

 Course-Program-Batch

 Email ID of the student

 Bank Details :- A/C No.

Account Holder Name:

IFSC Code :-

BANK Name :-

BRANCH Details :-
[Attach the Cancel Cheque Copy]
 Collection by Student
 On behalf of Student
[In case of collection on behalf of student,
Authority letter required]

(Signature of Student)
Attachments Required

 Excess Fees/Excess Deposit Refund

o Excess Fees/Excess Deposit - Original Receipt along with photocopy of Fees Receipt/Deposit Receipt.
 Hostel Deposit Refund
o Original Hostel Deposit Receipt signed by Hostel-in-charge-
 Laboratory Deposit Refund
o Original Laboratory Deposit Receipt signed by Laboratory In-Charge/Dean

Deputy Registrar Joint Registrar Director

SVKM’S NMIMS-Bengaluru SVKM’S NMIMS-Bengaluru SVKM’S NMIMS-Bengaluru