(A Scheme of Ministry of Human Resource Development, Government of India)
COORDINATING INSTITUTION eksrhyky usg: jk’Vªh; ÁkS|ksfxdh laLFkku bykgkckn bykgkckn & 211004 ¼m0Á0½ Hkkjr Motilal Nehru National Institute of Technology Allahabad Allahabad – 211004 (UP) INDIA
REFUND REQUEST FORM
Name of the Applicant : DASA-2018 Application ID : Applied Category : CIWG / Non-CIWG (SAARC) / Non-CIWG (Non-SAARC)
Amount deposited in _________ (INR / USD).
Amount deposited for category : Amount ______________________________. (Attach complete payment proof separately) Status of the candidate : Tick mark the appropriate box 1) Seat is not allotted in any round. 2) Seat Allotted in ____ round, but declined / No response is given within stipulated time. 4) Fees deposited for Non-CIWG category but allotted a seat in CIWG category. 6) Withdrawal (Mention the date of withdrawal on DASA-2018 through email along with stage at which withdrawn) Date :________________________ Stage :________________________
Account details for refund
(Preferably the account mentioned at the time of form filling or Indian account instead of foreign account)
Name of Account Holder :
Bank Account Number : Bank Name : Branch Name : IFS Code : SWIFT Code (in case of Foreign account) :