MALAVIYA NATIONAL INSTITUTE OF TECHNOLOGY JAIPUR
APPLICATION FORM
to MBA
[For refund of Excess fee paid by SC/ST students for admission
ramme during the session 2014-15
To be filled bv the student
2. StLrdent ID:
l. Name of the applicant
-).
MALE /
Gender
6. Mother'sName
5. Father's Name
7
/
ST
:
Mobile No.
E-rrail ID
Contact details
8. Details
4. Category: SC
FEMALE
of amount to be refunded
Amount Paid
Transaction ID
Date of
payment
Amount to
Amount chargeable
be
refunded
as per norlrls
this application.
9. Students are advised to submit photocopy of the proof of the fee deposited along with
10. Bank Account Details of the student
,\ccount No.
:
lJranch Name:
Bank Name
Type of Aic: Saving / Current
IFSC Code
Signature of aPPlicant
Date:
FOR OFFICE USE
Admission status & category of the student to be verified
by the concerned dealing staff
Withdrawn/On rolls
Category (SC/ST)
YE,S / NO
& Signature
Dealing Staff
Name
Amount to be refunded
Name
& Signature
Accountant
Superintendent
Dy" Registrar (Academic)
AD (UG/PG)