Application / Declaration

To

M/s HCL Training & Staffing Services Pvt. Ltd.

Sub.: - Request to refund the training Fee / Hostel Fee paid

I, Tushar Singh, took admission in your training centre and paid the fee of Rs. 10,000 (Training Fee of
Rs. ___________ + Hostel Fee of Rs. __________).

Payment details are as follows:

Mode Amount Date (DD/MM/YY)

DD _________ ___________

Bank Transfer 10000 28/07/2022

Cash _________ ___________

Loan _________ ___________

I have not availed / fully availed the training services/ hostel services from your organisation and no
certification has been taken by me. The reason of non-provision/not taking of service are as below: -
(Tick the correct option)

1) Health concerns & other personal issues

2) Eligibility criteria\Performance issue ✔️
3) Financial constraints\Loan not sanctioned

In view of above, it is requested to refund my money (including service tax / GST) as per standard
refund Policy of HCL TSS. Please refund my self-Paid amount to the account details shared in the
refund form and amount Paid through loan to my Axis Bank/IDBI Bank loan account directly.

Refund Amount: Total (Program +Hostel) Rs. 10,000

Self-Paid: Rs. 10,000 Paid through Loan: Rs. __________________

After receipt of above amount including Service Tax / GST, I have No further claim on the amount of
training fee/hostel fee including tax paid by me.

Thanking you

Yours faithfully

Tushar Singh
(Name of the Student)

(Signature)

S/D of Narendra Kumar Singh

Admission Reference ID- HCLTB0167685

1Candidate Details
Date of Request
Name of the Candidate Tushar Singh
  PRO/HCL-TSS-LK/ITSDG/0722/050

Reference No.
Reason for not enrolling in the program Not Eligible
Mobile Number of the candidate 8429470028
Email ID of the candidate tusharsinghupvns@gmail.com
Amount to be refunded 10,000
Transaction details (DD/NEFT Number;

Copy of cash deposit receipt)

 
Bank Name Bank Of Baroda
Branch Details DLW Varanasi
Account Holder Name Narendra Kumar Singh

Account Number 26420100012483

IFSC (Code) BARB0DLWVAR