TEZPUR UNIVERSITY
APPLICATION FOR REFUND OF CAUTION MONEY & REFUNDABLE FEES
To,
The Controller of Examinations
Tezpur University
Sir,
I have completed / relinquished my study at Tezpur University. Please arrange to refund me the caution
money and other fees as stated below deposited at the time of admission to the university.
1. Caution Money ------------------ Rs.
2.
3.


Date : Signature of the student
Programme : …………………………………………
Name in full :…………………………………………………. Enrolment No : …………………………………………
Postal Address :………………………………………………..… Department : …………………………………………
………………………………………………….. Hostel : …………………………………………
………………………………………………….. (If any)
……………………Pin Year of Passing: …………………………………………
(Please attach original fee receipt & Identity card) (If applicable)
(Hostel clearance)
Mr. / Ms……………………………………………………………………….…has no outstanding dues / liability.
Warden / Asstt Warden
.…………………..Hostel
(Clearance from the Library)
Mr. / Ms………………………………………………………………………… has no outstanding dues / liability.
Librarian / Asstt. Librarian
(Clearance from the Department)
Mr. / Ms………………………………………………………………………… has no outstanding dues / liability.
Head, Deptt of……………………………………
(Academic Section)
Forwarded to Finance Officer for release of Caution Money and other refundable fees stated above in favour of the
applicant
Controller of Examinations / Asstt. Registrar (Acad)
Refunded Rs…………………………………………………………..………………………….…as recommended.
Finance Officer / Asstt. Finance Officer Jr. Accountant / Cashier
Pre-receipt
Received Rs. ……………………………………………………….…………….. from the university.
Signature
on
Revenue
Stamp
I shall receive the refund amount transfered to my SBI A/C No. ..........................................,
in person / by post (Please)