Indian Institute of Technology, Delhi

Mess Security Refund Application

__________ Hostel
Student Details (To be filled by the Student in capital letters)

Entry No _______________________________Name of Student.___________________________________

Contact No.___________________________Home Address ___________________________________________
_____________________________________________________________________________________________
Bank A/c No.____________________________ Bank Name & Address____________________________________
_____________________________________________________________________________________________
IFSC Code______________________________ MICR Code (not mandatory)
_______________________________
Proof of Bank A/c:- Attach front page of Pass Book/Cancelled Cheque. (Mandatory)
Passed/withdrawal year_______________________ Date Hostel vacated_________________

Dated: Signature of Student

Caretakers Certificate
This is to certify that the above student has vacated the Hostel room on ___________ and handed over all hostel
materials. There is no outstanding dues towards him/her as on date. Necessary entries have been entered in the
ACSS system.

Dated: _____________ Signature of Caretaker

Certificate by Assistant Caretaker/Dues Collector

This is to certify that all entries of mess and other dues as well as deposits have been made in the student’s
ledger/ACSS System for the entire stay of the student in the hostel and final account of the student is as under.
Mess Security ____________________________________ L.F. No. ___________________________________
Mess Refund _____________________________________ L.F. No.___________________________________
Mess Recovery____________________________________ L.F. No. ___________________________________
Balance_______________________________________ Recoverable/Refundable

Signature of Assistant Caretaker/Dues Collector

Certify that all entries of mess and other dues along with deposits made by the students as entered in the students
ledger/ACSS System have been checked and found correct. Student’s ledger/Security account checked and closed
and no dues are outstanding against the student.

Passed for Rs ___________________ Rupees _____________________________________________________

Payable to the student as mentioned above out of Mess Account.

Hostel Accountant Warden

Hostel Accounts Section

Checked and pay Rs___________ (Rupees_________________________________________________________)
Date approved in ACSS System ____________________

Jr. Assistant (Accounts) J.A.O. /AR (Hostel Accounts)

Paid vide Cheque No. / Debit Advise No. ____________________ Date _________________

Accountant Warden/ Dean (Student Affairs)