Central University of Himachal Pradesh
(Established under Central Universities Act 2009)
PO BOX: 21, DHARAMSHALA, DISTRICT KANGRA – 176215, HIMACHAL PRADESH
SECURITY REFUND FORM FOR UNIVERSITY SECURITY DEPOSIT
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 should be submitted/sent to concerned Head of the Department, 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 Security Refund Form.