UNITED INSTITUTE OF MANAGEMENT, PRAYAGRAJ
APPLICATION FOR REFUND OF CAUTION MONEY THROUGH BANK TRANSFER
For Students passing out in year 2025
Section “A” ( To be completed by student)
(Please complete application form in BLOCK LETTERS except email address)
Student Name : ………………………………………………………………………….……. Student ID : ………………………………..…
Course & Branch of Study : ………………………………………………………………. University Roll No. : …………………………………..
E-Mail Address : ……………………………………………………………………………….. Mobile No. : …………………………………..
I apply for refund my caution money through Bank Transfer. My Bank Account details are given below:
(Change in account information is not permitted later)
Bank Name : ………………………………………………………………………………………………………………..…………..
Bank Branch : ……………………………………………………..…….. District : ……………………….…………………
Bank Account No. :
Note: Please fill leading Zeroes if consisting in Account No.
IFSC Code : 0
ZERO
Account Holder Name : …………………………………………………………………………………………..…………………
(Should be same as the name of student)
DECLARATION
I hereby declare that the details mentioned above are correct and true to my knowledge.
I understand my caution money application will only be processed after I complete my course without pending backlogs
Once the college has remitted the refund in my above detailed account, the college is absolved of it’s responsibility.
Date: ……………………… Signature: ………….…………….
Section “B” (For Office use only)
Certified that student passed with …………………………………………………………. Division. Sign. & Date: …………………………..
Academic & Other Dues Rs. ………………………………. Sign: ………………………………Date: ……………………………….
Hostel & Mess Dues Rs. ………………………………. Sign: ………………………………Date: ……………………………….
Library Dues Rs. ………………………………. Sign: ………………………………Date: ……………………………….
Other ________________ Rs. ………………………………. Sign: ………………………………Date: ……………………………….
Total Deductions Rs. …………………….……….
Caution Money Amount to be refunded Rs. ……………….……..
(Rs. In words ……………………………………………………………………………………………………………………………………………………………….)
Assistant Registrar Registrar
