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Examination Re Evaluation Fee Refund Form PDF

The document is a refund form submitted by a student to the Finance Officer of H.P. Technical University requesting a refund of exam/re-evaluation fees. It contains details such as the student's name, course, form number, exam details, payment details, bank account details, reasons for refund, and certification that the student did not contact their bank regarding the payment and will refund any extra amount received in error. The form also lists terms and conditions for refunds including that refunds are only for students unable to generate exam forms after payment, the form must be submitted within two months, and refunds will only be made after reconciliation with the bank.

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Prikshit Sharma
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337 views1 page

Examination Re Evaluation Fee Refund Form PDF

The document is a refund form submitted by a student to the Finance Officer of H.P. Technical University requesting a refund of exam/re-evaluation fees. It contains details such as the student's name, course, form number, exam details, payment details, bank account details, reasons for refund, and certification that the student did not contact their bank regarding the payment and will refund any extra amount received in error. The form also lists terms and conditions for refunds including that refunds are only for students unable to generate exam forms after payment, the form must be submitted within two months, and refunds will only be made after reconciliation with the bank.

Uploaded by

Prikshit Sharma
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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To

The Finance Officer,


H.P. Technical University,
Gandhi Chowk, Hamirpur (HP) 177001

Subject: Exam/Re-evaluation Fee Refund Form.


Sir,
Kindly refund the fee deposited in HPTU as per particulars given below:
1. Name of Candidate
2 Email Address Mobile:
3 Father’s Name
4 Course/Branch/Semester
5 Form No.
6 Exam with Month/Year
7 Mode of Payment Txn.No. Amount Date
(Mention all transactions)
Debit/Credit Card
Net Banking
Offline PNB Challan

8 Amount of Refund: Rs.


9 Reasons for refund

10 Particulars of Account Holder for refund:


1. Name
2. Name of Bank & its
Branch
3. IFSC Code
4. Account No.
5. Mobile No.
6. Have you contacted your
bank customer care for YES / NO
problem in online payment ?
Certified that :
1. I have not contacted the customer care of the Bank after my payment is deducted from my bank
account.
2. I will refund the extra amount to HPTU received erroneously from HPTU Account, at a later date.

Dated: Signature of Student: …………………………..


Name of Student: ……………..……………….
Registration No :………………….……………
College: …………………………………
…………………………………
Terms & Conditions for refund:
1. Refund is payable to such students who are not able to generate exam form after
making online payment and deposit extra fee through online/offline against the same
form.
2. Refund form is submitted by the student himself within a period of two months after
the last date of the filling the exam/re-evaluation form.
3. The refund will be made only after reconciliation with the Bank.
4. The HPTU reserves the right to hold the result of the student in case refund is already
made by the Bank at its own.

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