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INDIAN INSTITUTE OF TECHNOLOGY KANPUR

Student Caution/Security Money Refund Request

To,
The Dean of Student's Affairs
IIT Kanpur

I was registered for UG Student in the year 2019


I have now completed the programme and enclosing clearence certificate including Hall of Residence
HALL6 and current room number GHTA-610 where I was staying.

I request that the Hall Security Money after adjustment of dues if any be regulated as per my options
appended below.

OPTION (B) The amount of Rs.5000 deposited by me as Institute Security Money may kindly by refunded
to me after adjusting dues and send me the balance.

Student Details

Roll No: 190121 Name: AMRAPALI


SANTOSH PAWAR
Migrated Status: No Migrated RollNo: N/A
Department: Chemical Engineering Program: BTech
Parental Phone No: 9503888875 Non-IITK Email: dakshanaamrapali@gm
ail.com
Permanent Address: A-101 , Pawar EleganceMobile: 7666928675
Address Line2 Kunwarbav Address Line3 Ratnagiri
State: Maharashtra Pin Code: 416702

Student Accounts Details

Bank A/c No: 20443843652 Bank Name: STATE BANK OF INDIA


IFS Code: SBIN0001161

Generated through online office automation portal


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