Vacating Hostel Mess Refund

N.I.T. HOSTELS: TIRUCHIRAPPALLI - 620 015 APPLICATION FOR VACATING HOSTEL AND MESS REFUND Please type. SHOULD NOT fill up the application in hand writing Name ANKUSH JAIN Roll No 103111014 Course BTECH Branch CIVIL Hosel Name A!BER A Room No 1"# Commun$ca$on A%%ress Name o& he SBI Ban' SBI Ban' A(c No Ema$l I% !o)$le No *hone No Hoste Fees Det!"s +Aach a Co,- o& !IS Hosel .ees *r$nou/ Se#este$ Re%e"&t No D!te A#o'(t D!te o) V!%!t"(* t+e Hoste Roo#: Det!"s o) t+e F'$("t'$e !,!"! e "( t+e $oo#: T! e C+!"$ Cot F!( T' e L"*+t Mess Det!"s !ess Name aeo&!ess Lea $n2 S"*(!t'$e o) t+e Mess M!(!*e$ S"*(!t'$e o) t+e St' e(t I hereby request Hostel Administration to refund my hostel dues after deducting R Workers Welfare Fund and Rs.300 towards rocessing fees. S"*(!t'$e o) t+e RSC/Ste !$ S"*(!t'$e o) t+e !$ e( Fo$ O))"%e Use3 Re&un% Amoun + S' 4e%t to A' "t / Rs 55555555555555555555( S"*(!t'$e o) t+e A%%o'(t!(t S"*(!t'$e o) t+e D.R. Hostes3

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Transcript of Vacating Hostel Mess Refund

N.I.T. HOSTELS: TIRUCHIRAPPALLI - 620 015

APPLICATION FOR VACATING HOSTEL AND MESS REFUNDPlease type. SHOULD NOT fill up the application in hand writingNameANKUSH JAINRoll No103111014

CourseBTECHBranchCIVIL

Hostel NameAMBER ARoom No127

Communication AddressName of the SBI Bank

SBI Bank A/c No

Email Id

Mobile No

Phone No

Hostel Fees Details (Attach a Copy of MIS Hostel Fees Printout)SemesterReceipt NoDateAmount

Date of Vacating the Hostel Room:

Details of the Furniture available in the room:

TableChairCotFanTube Light

Mess Details

Mess NameDate of Mess Leaving

Signature of the Mess Manager

Signature of the StudentI hereby request Hostel Administration to refund my hostel dues after deducting Rs.300 towards mess Workers Welfare Fund and Rs.300 towards processing fees.

Signature of the RSC/Steward

Signature of the Warden

(For Office Use)

Refund Amount (Subject to Audit) : Rs.--------------------/Signature of the Accountant

Signature of the D.R. (Hostels)