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Caution Money

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Riya
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31 views1 page

Caution Money

Uploaded by

Riya
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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To

The Vice Chancellor


JIS University Date: _________________
81, Nilgunj Road, Agarpara,
Kolkata-700109.
Sub: Refund of Caution Money

Name : _________________________________________________
Student ID : _________________________________________________
Degree & Stream : _________________________________________________
Registration Number : _________________________________________________
Roll Number : _________________________________________________
Email ID : _________________________________________________
Contact No. : _________________________________________________
Full Address : _________________________________________________
_________________________________________________
ST
BANK DETAILS (STUDENT’S OWN / JOINT WITH PARENTS) [ATTACH BANK STATEMENT/ 1 PAGE OF PASSBOOK/CANCELLED
CHEQUE]
Name of the Account Holder : ________________________________________________
Bank Account Number : ________________________________________________
Type of Account : tick the proper- Savings/ Current/ Overdraft
Bank Name & Branch : ________________________________________________
IFSC Code : _________________________________________________
NO DUES CERTIFICATION:
Concerned Department & laboratory Signature from HoD with Seal

Library Signature from Library Head with Seal

Exam cell Signature from Exam cell with Seal

Hostel Clearance Signature from hostel warden

Accounts Department Signature from Accounts Dept. with Seal

Registrar’s Office Signature from Registrar

Declaration form student:


 All the information provided above is true and complete in all respect.
 If the mentioned details will be found incorrect due to any reason (incl. Writing ETC) ,I shall be completely responsible
for any loss such as non-receipt of Caution Money.
 The College authority won’t be responsible in any ground if I’ll give wrong bank details as above and on such
case I won’t receive caution money back.
 All Charges related to transfer of Caution Money (applicable by transfer by Bank) will be borne by me.

Signature of Student

For Office Use Only


(Office to verify and check whether Form is Complete in all respect before accepting)

Signature of In-Charge A/c dept Seal of the University Signature of Vice Chancellor

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