Central University of Himachal Pradesh
(Established under Central Universities Act 2009)
PO BOX: 21, DHARAMSHALA, DISTRICT KANGRA – 176215, HIMACHAL PRADESH
SECURITY REFUND FORM FOR HOSTEL SECURITY
Name of student: _____________________ Roll no. : ______________________________
Father’s Name______________________________ Programme of Study: ______________
Year in which admitted: _______________ Year in which passed out: _______________
Name of the Bank in which the security is to be deposited: __________________________
Bank A/C No.: __________________________
Branch Name: _________________________ IFSC Code: ____________________________
UNDERTAKING
_______________________________________________________________
I hereby declare that I have paid all my University dues. I further declare that I will be liable to pay if there is anything due from me.
Signature________________________
Name of the Student: ______________________
Correspondence Address___________________________________________________
__________________________________________________________________________
Pin Code: _______________ Email Address: Mobile N0. :
Instructions:
1. Duly filled up Security refund form for refund of Hostel Security should be submitted/sent to Provost, Temporary Academic Block, Central University of Himachal Pradesh, Shahpur, PIN 176206, District Kangra, Himachal Pradesh
2. The security refund will be deposited in the personal account of the student as given by him or her in the Form.