Application for Cancellation of Admission and Refund of Fee for the Year 2023-2024
To,
The Principal
Smt CHM College
Ulhasnagar 421003

Respected Sir/Madam,
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Email *
Phone No *
I am a student of your college in this Academic Year and I wish to cancel my admission from Class *
due to the following reason: *
therefore, I request you to cancel my admission and refund the fee (If any). My Particulars and Details are as under: *
Required
Full Name (Starting with Surname OwnName  FatherName)  Eg. ROY PRIYA RANA *
College Application No *
Receipt No. *
Fees Paid (Amount In INR) *
Date of Payment of fee *
MM
/
DD
/
YYYY
Transaction ID No/Cheque No/ *
Mode of Payment *
Fees Paid in Installment? *
My Bank Account or My Guardians Bank Account for Refund of fees (If any) is as Under: *
Disclaimer:* Kindly Recheck Accounts Details for Refund of Fees before submission of this application, accordingly, The Refund will be made by the college in this account only. incase of discrepancy or incorrect account details provided by the applicant, the college does not take any responsibility for the refund of fees and the applicant will be solely responsible for the same.
Name of the Account Holder (Staring with Name & Surname Name) Example: Priya Roy *
NAME OF THE BANK *
IFSC CODE *
BRANCH *
Self Declaration *
The Information above is best of my knowledge and true, if any information found to be incorrect, I will not blame college for the same. Further, I say that I am aware that considering current situation the refund of my college course fee will take appropriate time.
Required
A copy of your responses will be emailed to the address you provided.
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