Debit Authority Letter for post-matric fee reimbursement

Transcription

1 REG NO: COURSE (BRANCH): SESSION: Debit Authority Letter for post-matric fee reimbursement provided by Social Welfare Department (Mandate to debit the Account) Name of the Bank.. ALLAHABAD BANK..... Customer Name..... Customer Account number.... The Branch Head, ALLAHABAD BANK, LODHIPUR RAJPUT (Name of the Bank) Branch LODHIPUR RAJPUT (Name of the Bank) Dear Sir, I irrevocably authorize ALLAHABAD BANK (Name of the Bank & Branch) to debit my SB Account No. by Rs. only (Rupees only) provided by the State Government as reimbursement of fee under Scheduled Caste/ Scheduled. Tribe Post-Matric Fee reimbursement Scheme provided by Samaj Kalyan Department & remit this amount to IFTM UNIVERSITY (Name of the Institution) account No. maintained at ALLAHABAD BANK, LODHIPUR RAJPUT (Name of the Bank & Branch). (In case the beneficiary account is with some other Bank) RTGS/NEFT (IFSC) CODE of the beneficiary Bank ALLA (Name of the Bank & Branch) ALLAHABAD BANK, LODHIPUR RAJPUT I / We request you to make the above remittance. It is being understood that the remittance is to be sent at my/ our risk and my / our responsibility and on the distinct understanding that no liability whatsoever is to attach to the Bank for any loss or damage arising or resulting from delay in transmission, delivery or non delivery of the message or for any mistake. I / We also hereby undertake to refund to bank any over remittance, which is made by mistake in beneficiary s account. I / We also understand that remittance would be made as RBI RTGS/NEFT Scheme. Signature of the Customer (Name of the Customer) Date: Place:

2 REG NO: COURSE (BRANCH): SESSION: Debit Authority Letter for post-matric fee reimbursement provided by Social Welfare Department (Mandate to debit the Account) Name of the Bank... PUNJAB NATIONAL BANK Customer Name..... Customer Account number.... The Branch Head, PUNJAB NATIONAL BANK, LODHIPUR RAJPUT (Name of the Bank) Branch LODHIPUR RAJPUT (Name of the Bank) Dear Sir, I irrevocably authorize PUNJAB NATIONAL BANK (Name of the Bank & Branch) to debit my SB Account No. by Rs. only (Rupees only) provided by the State Government as reimbursement of fee under Scheduled Caste/ Scheduled. Tribe Post-Matric Fee reimbursement Scheme provided by Samaj Kalyan Department & remit this amount to IFTM UNIVERSITY (Name of the Institution) account No. maintained at PUNJAB NATIONAL BANK, LODHIPUR RAJPUT (Name of the Bank & Branch). (In case the beneficiary account is with some other Bank) RTGS/NEFT (IFSC) CODE of the beneficiary Bank PUNB (Name of the Bank & Branch) PUNJAB NATIONAL BANK, LODHIPUR RAJPUT I / We request you to make the above remittance. It is being understood that the remittance is to be sent at my/ our risk and my / our responsibility and on the distinct understanding that no liability whatsoever is to attach to the Bank for any loss or damage arising or resulting from delay in transmission, delivery or non delivery of the message or for any mistake. I / We also hereby undertake to refund to bank any over remittance, which is made by mistake in beneficiary s account. I / We also understand that remittance would be made as RBI RTGS/NEFT Scheme. Signature of the Customer (Name of the Customer) Date: Place:

3 REG. ID STUDENT NAME FATHER NAME MOTHER NAME COURSE NAME BRANCH YEAR ACCOUNT NO. MOB. NO. D.O.B.

4 Scholarship Form Documents Checklist o Income Certificate Internet Copy (Revenue Dept Verification Report- bor.up.nic.in) o Income Certificate Tehsil Copy o Caste Certificate Internet Copy (Revenue Dept Verification Report- bor.up.nic.in) o Caste Certificate Tehsil Copy o Domicile Certificate Internet Copy (Revenue Dept Verification Report- bor.up.nic.in) o Domicile Certificate Tehsil Copy o High School Documents o Intermediate Documents o Graduation Documents o Affidavit o Aadhar Card (Photocopy) o Photocopy of Bank Account Passbook छ व त फ म द त व ज़ च क ल ट o आय म ण प इ टरन ट क त ल प (र ज व वभ ग स य पन रप ट - bor.up.nic.in) o आय म ण प तहस ल क त ल प o ज त म ण प इ टरन ट क त ल प (र ज व वभ ग स य पन रप ट - bor.up.nic.in) o ज त म ण प तहस ल क त ल प o नव स म ण प इ टरन ट क त ल प (र ज व वभ ग स य पन रप ट - bor.up.nic.in) o नव स म ण प तहस ल क त ल प o ह ई क ल क द त व ज़ o इ टरम डएट द त व ज़ o न तक तर क पढ़ ई क द त व ज़ o शपथ-प o आध र क ड (फ ट क प ) o ब क ख त प सब क क फ ट क प

5 Session COURSE- ¼mRrj izns k ljdkj }kjk fu/kkzfjr½ ifjf k V&x vuqlwfprtkfr@tutkfr n keksrrj Nk=o`fRr ¼vuqj{k.k HkRrk,oa kqyd izfriwfrz½ gsrw vkosnu i= ¼vH;FkhZ }kjk Hkjh tkus okyh izfof V;ka½ REG. NO - ¼vkosnu i= fgunh esa Li V :Ik ls Hkjk tk,½ f k{kk l= Nk=@Nk=k dk uke ¼gkbZLdwy izek.k i= ds vuqlkj½ 2- dk uke ekrk dk uke tue frffk Nk= dk LogLrk{kfjr o lalfkk/;{k }kjk izekf.kr QksVks 4- fyax ¼iq: k@efgyk½ gkbzldwy mrrh.kz djus dk o kz cksmz dk uke gkbzldwy dk vuqøekad fo ky;@lalfkk dk uke o irk ikb;øe ds izfke o kz esa izos k dh frffk ikb;øe dk uke ikb;øe dh o kz ikb;øe dh vof/k ¼v½ ikb;øe dk izdkj % ¼laLFkkxr@i=kpkj½% ¼c½ ikb;øe dh kzd@okf kzd½ 10- vh;fkhz ds lsokjr gksus dh flfkfr esa O;olk; o okf kzd vk; vkoklh; LFkk;h irk i= O;ogkj dk irk eksckbzy ua nwjhkk ¼vfuok;Z½ firk dk O;olk; okf kzd vk; ekrk dk O;olk; okf kzd vk; fof/kd vfhkhkkod dk uke o;olk; okf kzd vk; ¼;fn ekrk@firk thfor u gks½ 16- tkfr mitkfr /kez ¼1&vuqlwfpr tkfr]2&vuqlwfpr tutkfr½ 17- tkfr izek.k i= dk izekad fnuk d vk; izek.k i= dk Øekad fnuk d fuokl izek.k i= dk Øekad fnuk d d{kk esa izos k dk izdkj % ¼Qzh lhv@loforr iksf kr ;k ism lhv½ Nk= dk [kkrk la csad dk uke kk[kk dk uke vkbz0,q0,l0lh0 dksmz ekbdj dksm ¼ ksf{kd lalfkk esa flfkr csad [kkrk½ 22- fo ofo kky;@cksmz esa iath;u Øekad fo ofo kky;@cksmz dk uke IFTMU vkoklh; Mk=@fnok Nk= ¼mYys[k djsa½ ¼vkoklh; Mk= dh flfkfr esa izek.k i= layxu djsa½ 25- vk/kkj dkmz la[;k

6 ikb;øe gsrq l{ke izkfo/kdkjksa Lrj ls vuqeksfnr okf kzd uku fjq.msfcy vfuok;z kqyd dh /kujkf k ikb;øe dh l{ke izkf/kdkjh kqyd lsjpuk dk fooj.k layxu djsa vfuok;z okil u dh tkus okyh kqyd dk lseslvjokj okf kzd fooj.k f k{k.k kqyd lseslvj@o kz f k{k.k kqyd Be@v Be lseslvj@o kz ;ksx& kqyd dh nj kqyd fu/kkzj.k gsrq l{ke izkf/kdkjh 27- xr o kz esa izkir Nk=o`fRr dh /kujkf k ¼d½ vuqj{k.k HkRrk ¼[k ½ kqyd xr o kz dk ijh{kkqy ¼vad i= dh izekf.kr izfr layxu djsa½ mrrh.kz@vuqrrh.kz izkirkad dk izfr kr fof k V igpku i= vk/kkj dkmz la[;k ¼oSdfYid½?kks k.kk i= es,rn}kjk ;g?kks k.kk gwa fd mijksdr izfof V;ka@lwpuk,a lgh gs o esjs }kjk gh Hkjh x;h gsa] eq>s fdlh mu; lzksr ls nwljh Nk=o`fRr izkir ugha gks jgh gs rfkk esa dgha Hkh lsokjr ugha gwaa ;fn lsokjr gwa rks esjh,oa esjs ekrk firk vfkok laj{kd dh dqy okf kzd vk; :0 nks yk[k ls de gsa esaus bl lalfkk ds vfrfjdr vu;= dgha izos k ugha fy;k gsaesa lalfkk ds ksf{kd funsz kksa,oa fu/kkzfjr miflfkfr dk leqfpr vuqikyu d:axk A vkosnu i= esa nh x;h ;fn dksbz lwpuk vfkok layxu fuokl] vk; o tkfr izek.k i= ;k vu; vfhkys[k xyr ik;s tk;s arks Nk=o`fRr ¼vuqj{k.k HkRrk,oa kqyd izfriwfrz½ dh /kujkf k 18 izfr kr okf kzd C;kt ls okil dj nwaxk@nqaxha ;fn,slk djus esa es vlqy gksrk gwa rks fohkkx eq>ks izkir jkf k dks jktlo ns;ksa dh Hkkfra olwyh djus gsrq,oa esjs fo:} fof/kd dk;zokgh gsrq Lora= gksxka ekrk@firk ds glrk{kj@vaxwbk fu kku ¼ekrk@firk dh e`r;q dh n kk esa vfhkhkkod½ Nk=@Nk=k ds glrk{kj ¼fgUnh es½ Student Signature (In English) uksv& 1& ik= vh;fkhz }kjk mijksdr izi= ij lwpuk,a Hkjdj kifk i= o lhkh layxudksa lfgr vkosnu i= fu/kkzfjr vfure frffk rd f k{k.k lalfkk esa izlrqr fd;k tk,xkk] ftldh ikorh fu/kkzfjr izi= ij f k{k.k lalfkku }kjk lacaf/kr vh;fkhz dks iznku dh tk,xha 2&fdlh Hkh fu;e dh tkudkjh Nk=o`fRr izca/ku dh osclkbzv scholarship.up.nic.in vfkok fohkkx dh osclkbzv dirsamajkalyan.in ij viyksm vuqlwfpr tkfr@tutkfr n keksrrj Nk=o`fRr fu;ekoyh 2012 ls dh tk ldrh gsa