APPLICATION FORM FOR FEE REFUND

Date: D D M M YY YY

Academic Session: 2020-21

Ref. No. :

D D M M YY YYCourse Commencement Date:

Due to the reasons under mentioned, I am unable to continue my studies at RESONANCE:

Illness Yes No Refund Amount:

Name:

This is to bring to your kind notice that I am a student of RESONANCE having following particulars:

Roll No.: Batch:

Signature of Student: ____________________________ Signature of Parent/Guardian

Contact No.:___________________ (Please See Overleaf)

Course Name: Code: Study Centre: _____________________________

Zoology Yes No ____________________

Obediently Yours,

The Manager,Resonance Eduventures Limited

Respected Sir/Madam,

(I) Faculty Problem Yes No For Office Use:

(If Yes, then Subject) Physics Yes No Deposit Amount:

CG Tower-2, IPIA, Behind City Mall, Jhalawar Road, Kota

Chemistry Yes No ____________________

Mathematics Yes No Deduction:

Botany Yes No ARF:

(II) Problem with medium of Instruction ____________________

English Yes No ____________________nd(III) Personal Reasons (If Yes, then mention) II Installment

To,

Father's Name:

st Hindi Yes No I Installment

Home Sickness Yes No ____________________

Lack of Self Confidence Yes No ____________________

Selection in other Exam Yes No

(IV) If any other, then please specify, _____________________________________________________________.

Hence, I request your good self to kindly refund my Fee as per the rules and regulations of the Institute (as per session 2020-21).

Thanking You,

Contact No.: ___________________________________ Name: _______________________ Place: ___________

_____________________________________________________

_____________________________________________________

Place : __________________________ Place : __________________________

Note : Kindly attach Original Fee Receipt & ID Card with this form.

Postal Address: ________________________________________

I wish to join the Distance Learning Programmes (DLP) of Resonance: Yes No (If Yes, then please fill the enclosed form)

DECLARATION

I am leaving the Institute on my own accord. I am satisfied with the refund I have received as per the norms of the Institute. I

shall not claim either for any refund or right of admission in the institute for rest of the Academic Session 2020-21.

Signature of Student Signature of Parent/ Guardian

Date of Submission: _____/_____/_____ Name : __________________________

NATIONAL ELECTRONIC FUNDS TRANSFER (NEFT) MANDATE

Branch: ___________________________ Date: _________________

Beneficiary Details (Account Detail)

Ref. No.: ACKNOWLEDGEMENT RECEIPT

Enclosed one cancelled cheque

I/we hereby authorize Resonance Eduventures Limited to credit my bank account, as per details furnished herein above, the due amount of refund.

(Signature of Parents)

Beneficiary Name - Parents/ Guardian only

4. The dispatch of Cheque & NEFT will be made after completion of 14 Working days of receiving of the Application for Refund of Fee at the Fee Window. If the Cheque does not reach within 15 days from dispatch, then the student can make an enquiry by phone on 0744-2777769, Toll Free No.: 1800 - 258 - 5555, at Study Centre or email to us at pccp@resonance.ac.in. Please mention your reference number and date of submission of application while making an enquiry.

3. The Cheque will be dispatched at the Permanent Postal Address of the parent(s) as mentioned in the Application Form.

We acknowledge the receipt of Mr./Miss__________________________________________________ Roll No : __________________________

1. The Application for Refund of Fee will be accepted only when any of the parents sign the application.

Batch : _______________ Course Name : __________________ Course Code : ____________________ Study Centre ______________________

Note:

2. We issue the Fee Refund in the form of A/c Payee Cheque & NEFT only in favour of students father (In case is the Father is not alive then it shall be made in the name of mother or in case if both are not alive then it shall be made in the name of Real Guardian).

Date: ______/______/______ Place: __________________ Authorized Signatory

DLPD opted: (Yes/No): ________ DLPD Course opted _______________________________ Refund Amount (Rs.)__________________________

Enclosures Please Tick

Original Receipt of Fee Deposition

(Issued by Bank/ Institute)

Identity Card (In Original)

Coupon Booklets for Modules (3 No.)

Beneficiary Name (Account Holder Name)

Beneficiary Bank Name

IFSC Code

Beneficiary Account Number

Beneficiary Branch Address