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    SW 02

    Uploaded by

    Deepak Krishnan
    This document is a form for existing students at the Indian Institute of Technology (Indian School of Mines) Dhanbad to request a refund of excess fees paid. It collects information such as the student's name, admission number, category, institute email, mobile number, amount paid, excess amount to be refunded, bank account details, and details of transactions made. It also has sections for office use only to verify the fee paid and required, note the refund request date, sanction the refund amount, and get approval from the Dean of Students Welfare. Upon completion, it is to be emailed to refund@iitism.ac.in along with proof of payments.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    SW 02

    Uploaded by

    Deepak Krishnan
    54 views2 pages
    This document is a form for existing students at the Indian Institute of Technology (Indian School of Mines) Dhanbad to request a refund of excess fees paid. It collects information such as the student's name, admission number, category, institute email, mobile number, amount paid, excess amount to be refunded, bank account details, and details of transactions made. It also has sections for office use only to verify the fee paid and required, note the refund request date, sanction the refund amount, and get approval from the Dean of Students Welfare. Upon completion, it is to be emailed to refund@iitism.ac.in along with proof of payments.

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    Refund

    Original Title

    sw-02

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    This document is a form for existing students at the Indian Institute of Technology (Indian School of Mines) Dhanbad to request a refund of excess fees paid. It collects information such as the student's name, admission number, category, institute email, mobile number, amount paid, excess amount to be refunded, bank account details, and details of transactions made. It also has sections for office use only to verify the fee paid and required, note the refund request date, sanction the refund amount, and get approval from the Dean of Students Welfare. Upon completion, it is to be emailed to refund@iitism.ac.in along with proof of payments.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    54 views2 pages

    SW 02

    Uploaded by

    Deepak Krishnan
    This document is a form for existing students at the Indian Institute of Technology (Indian School of Mines) Dhanbad to request a refund of excess fees paid. It collects information such as the student's name, admission number, category, institute email, mobile number, amount paid, excess amount to be refunded, bank account details, and details of transactions made. It also has sections for office use only to verify the fee paid and required, note the refund request date, sanction the refund amount, and get approval from the Dean of Students Welfare. Upon completion, it is to be emailed to refund@iitism.ac.in along with proof of payments.

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    © All Rights Reserved
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    Form No: SW-02

    INDIAN INSTITUTE OF TECHNOLOGY (INDIAN SCHOOL OF MINES) DHANBAD


    OFFICE OF THE DEAN (STUDENTS WELFARE)
    FORM FOR REFUND OF EXCESS FEE PAID BY THE EXISTING STUDENTS
    (Candidates are required to send the duly filled-in form with enclosures to refund@iitism.ac.in)
    1. Academic Year

    2. Admission No Semester

    3. Category UR / SC / ST / OBC / PWD / EWS

    4. Name of Student

    5. Institute E-mail ID

    6. Mobile No

    7. Applicable Fee Amount that was required to be paid by the student Rs.

    Mode of payment Net-Banking / Debit Card / Credit Card / Online-Wallets / UPI / Others
    8.
    If Others (pls specify)

    9. Excess Amount to be refunded back to the student Rs.

    Student Bank Account details where the money to be refunded:


    10.
    Bank A/c No Bank Name
    Bank IFSC Code Bank Branch Code
    11. Remarks (if any):

    12. Details of Bank Transactions made by the student:


    Proof of
    S. Amount Deposited* Order No (Mandatory for Online payment) UTR Date of Payment
    No. No./ Reference No. (For Offline payment) Transaction enclosed
    (Yes / No)

    1
    2
    3
    4
    *To be verified by Finance & Accounts before processing refund

    Enclosures in support of claim:


    1. Proof of Payments (Transaction Slip / Bank Statements).
    2. Any other document (please specify)

    Date: Signature of the Student:

    1|Page
    FOR OFFICE USE ONLY

    1. Fee Paid by the student: Rs.

    2. Fee amount required to be paid by the student: Rs.


    3. Fee waiver case: Yes ; No. , If yes then percentage
    4. Refund Amount: Rs.
    5. Refund request received on

    Dealing Assistant S O (SW) AR (SW)


    Date:- Date:- Date:-

    DR (SW)
    Date:-

    *Sanctioned Rs.

    Dean (SW)

    Date:-

    * To be verified by Finance & Accounts before processing refund.

    2|Page

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