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  • Hostel Withdrawal Form

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    anurag dwivedi
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    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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    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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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    Download as pdf or txt
    82 views1 page

    Hostel Withdrawal Form

    Uploaded by

    anurag dwivedi
    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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    © All Rights Reserved
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    of 1

    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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