DE-REGISTRATION FORM

PLACEMENT CELL – RK UNIVERSITY

DECLARATION:

I, ________________________________ student of B.Tech/MCA/MBA/M.Sc./Pharmacy/Diploma _____

semester, ________________ branch, Enrollment No: _________________, request you to deregister my name
from availing services from Placement Cell, RK University. I understand that by deregistering my name I will
be not eligible to apply for any campus drive opportunities coming to our campus.

I further request you to deposit my caution deposit amount to my bank account, if I am eligible for the same.
Details of my bank and current employment status are given below.

Reason for Deregistration (Please tick the appropriate answer):

_____: I got job

_____: I want to go for higher studies

_____: I want to start my own business

_____: Other: ________________________________________________________________-

If you got a Job then, provide below given details:

Name of the company : ______________________________________________________________

Job Location : ______________________________________________________________

Designation : ______________________________________________________________

Have you submitted the offer Letter? _____: Yes _____: No (If no then Submit Copy to T&P Cell)

Please provide below given details of your bank to refund you caution deposit amount.

Name of Account Holder : ______________________________________________________________

Account Number : ______________________________________________________________

Bank Name : ______________________________________________________________

Bank Branch : ______________________________________________________________

IFSC Code : ______________________________________________________________

Date : ______________________________________________________________

Place : ______________________________________________________________

Signature of Candidate: Parents Name:

Mobile No: Signature:

Email ID: Mobile No.:

(NOTE: If candidate any of the above details are missing then he/she is not eligible to get the caution amount.
So kindly fill up the details appropriately and candidate is sole responsible for his/her incorrect information)