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APPLICATION FOR SEAT SURRENDER
Session: ………………………
To
Principal/Dean Academic,
Name of College:………………………………………………………………………………………….
Sir/Madam,
Respectfully, I submit that I want to withdraw my admission from your esteemed Institute. Please allow
me to surrender my seat and refund the fee deposited amount after deductions as per University rules.
My admission details are as follows:-
1. Name of the Programme: (like B.TECH./M.TECH. etc.) …………………………………………….
2. Name of the Student (Mr./Ms.) (In Block Letters): ………….……………………………..………...
3. Father’s Name (In Block Letters): ……………………………………………………………………
4. Course/Branch Allotted: …………………...………………………………………………………….
5. College Allotted: ………………...……………….…………………………………………………
6. Mode of Counselling: IKGPTU Centralized / MRSPTU Centralized / MRSPTU Direct Online
(Tick the appropriate) Registration ID ……………………………………………………………
7. Category of Admission: Gen./SC/ST/OBC/ Others : …………………………………………….
(Tick the appropriate) Fee Waiver/Scholarship/PMS/CMSS/PMSS:……………………………
Punjab State Quota 85% / Outside State 15% ..…………………………..
8. Date of Allotment of Seat: ……..……………………………..………………………………………
(Attach copy of allotment letter)
9. Date of request for seat withdrawn (Date of receipt of application in the university shall be
counted as date of withdrawal): ……………………………………..…………..............................
10. Reason for Withdrawal of Seat: ………………………………………………………………………
Detail of Admission Fee Deposited:
Mode of Payment (Cash/Online/Draft/Credit Card/Debit Card) …………………………………….
Amount of fee Deposited: ……………………… Receipt Number & Date : ……………..………..
(Attach proof / Receipt of fee deposit)
11.
Name on which refund of fee Required
(by Draft/RTGS/NEFT)
: ………………………………………………………
IFSC code ………………………………....................
Account No……………………………………….…
(Attach cancelled cheque / photocopy of cancelled cheque)
12. Address where Cheque / Draft to be sent: ……………………………………………………………
………………………………………………………………...………………………………………
13. Mobile Number : ……………………….. Telephone Number ……………….…………………….
Date: …………….. (Signature of Student ) (Signature of Parents/ Guardian)
Note: Scanned copy of the application along with fee receipt & seat allotment letter be forwarded to the
Dean Academic, MRSPTU, Bathinda, through email ([email protected]) on the same day, mandatorily
as a proof of date of applying for refund.
