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ANNA UNIVERSITY

CENTRE FOR DISTANCE EDUCATION


CHENNAI 600 025

APPLICATION FOR REFUND OF CAUTION DEPOSIT


Roll No. : 2130MBA0446 No.SET 30/MBA/48-746/14-02-2024

Name of the Student : MOHAN RAJ S

Name of the Study Centre : ALAGAPPA COLLEGE OF TECHNOLOGY

Mobile No. : 8220641327

I have completed / discontinued MBA Degree Programme through Distance Mode.Kindly refund the Caution
Deposit paid by me at the time of admission and arrange to credit the amount into my Bank Account.Required
details are furnished below :

Name of the Account Holder Name of the Bank Branch

MOHAN RAJ S ICICI Bank THIRUPORUR

Account No. Account Type IFSC Code

155401515372 SAVINGS ICIC0003226

Date : Signature of the Candidate

Note : Please enclose photocopy of the Front Page of Bank Pass Book along with the application for refund of
caution Deposit.
Discontinued students should enclose their ID Card in addition to the above along with the application form.

RECOMMENDATIONS OF THE COORDINATOR OF THE STUDY CENTRE

1. Mr./Ms MOHAN RAJ S (Roll No : 2130MBA0446) has completed Viva-voce/discontinued his/her studies.

2. He / She has no dues to the Study Centre.

3. Caution Deposit may be refunded.

Date : Study Centre Seal : Signature of the Coodinator

14th February 2024 Page 1/1

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