Refund Format

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Application for Refund of NISM Exam and ARN Fee

To,

IMI Incubation Foundation

Bhubaneswar

Dear Sir,

Request for refund of my NISM Mutual Fund Distributor Exam Fee and ARN Fee. Details
are as follows:

Name of Candidate……………………………………………………………………….……..

Training Period……………………………………………………………………………..…..

NISM Registration Number…………………………………. ..….……………………………

NISM Enrolment Number…………………...……………..……………(Enclose Admit Card)

Marks Obtained………………………………..………………………….(Enclose Marksheet)

Passed / Failed ………………………………….………………..….(Enclose Pass Certificate)

Applied for ARN …………………………………...…………………………………………..

ARN Number…………………...………………...………………………(Enclose Document)

Total Amount …………………………………………………………………………………..

Bank Details

Bank Name………………………………..Branch Code………………………………………

A/C No……………………………………..IFSC Code……………………………………….

E MAIL …………………………………………… WHATS APP……………………………

RESIDENTIALADDRESS…………………………………………..…………………………
……………………………………………………………………………..……………………

SIGNATURE DATE

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