RAJIV GANDHI INSTITUTE OF PETROLEUM TECHNOLOGY
JAIS, AMETHI, UTTAR PRADESH
APPLICATION FOR CANCELLATION & WITHDRAWAL OF ADMISSION
SESSION: _____________________
Date:
To,
The Director / Registrar
Rajiv Gandhi Institute of Petroleum Technology Jais, Amethi-229304 Uttar Pradesh
Through:
a) Associate Dean (Academic Affairs) b) Chairman UG/PG Admission Committee
c) Head of Department /Concerned Student’s PhD Supervisor
Sir, I was short listed & sec Program’s in your Institute on u
r
ed admission to the B. Tech. /M. Tech. /Ph. D./MBA/Others
______. I would like to cancel and withdrawal my candidature it due to the following reasons:
______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________
- 1)
- N
- ame of
the Candidate: Ms. / Mr.
(IN BLOCK LETTERS)
(Name)
(Surname)
2) Father’s Name: Mr. / Dr.
3)
RGIPT Registration No.:
4) IIT JEE/GATE/ Roll No.:
- C
- AT
Mubarakpur, Mukhetia, Bahadurpur, Post: Harbanshganj, Jais, Amethi-229304 (Uttar Pradesh)
Phone: 0531-3250022| Website: www.rgipt.ac.in
RAJIV GANDHI INSTITUTE OF PETROLEUM TECHNOLOGY
JAIS, AMETHI, UTTAR PRADESH
5) Residential or Correspondence Address (As registered in the RGIPT Registration
Form) ____________________________________________________________________________________________________
____________________________________________________________________________________________________ ____________________________________________________________________________________________________
PIN
Cell No.: +91
E-Mail:
- 6) Fee Paid (`)
- (in words)
No.
_
Online Transaction No. /
D
.D.
______________________________________________
D
ated __________________ Banker _____________________
___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
(a) I am enclosing the Xerox of the Fee Receipt (No. (b) I am returning my Identity Card (Original) (c) I am also returning the Study Materials
- Dated
- )
(Strike out whichever is not applicable)
Kindly direct to return my original documents and refund the fees paid as per the rules. Thanking you, Yours truly,
Signature of Candidate
FOR OFFICE USE ONLY
Amount Paid (`) Amount deducted (`) Amount Refunded (`) Cheque No. & Date Bank Particular
Mubarakpur, Mukhetia, Bahadurpur, Post: Harbanshganj, Jais, Amethi-229304 (Uttar Pradesh)
Phone: 0531-3250022| Website: www.rgipt.ac.in
RAJIV GANDHI INSTITUTE OF PETROLEUM TECHNOLOGY
JAIS, AMETHI, UTTAR PRADESH
Reference AICTE Guidelines No - AICTE/Legal/04(01)/2007, April 2007 and Circular No 698 dated 24th August 2007 issued by Pravesh Niyantran Samiti, Mumbai.
Any candidate who has been admitted to RGIPT may cancel admission by submitting an application in duplicate in the prescribed form and may request for refund of fees. The refund of fees as applicable shall be made in due course. Refund shall be made after deduction of the cancellation charges as shown below.
Sr.
- No. Situation
- Refund
1. Request Received before date of start Entire fee less ` 1000/- of academic session & seat could be filled by the Institute before the cutoff date
2. Request received after start of academic session & Seat could be filled by the Institute by waitlisted candidates
Entire fee less the Total Fees (Tuition Development & Hostel Fee) on pro rata basis
3. Request received after start of academic session & seat could not be filled by the Institute
No Refund (except Security Deposit)
Note:
Entire amount of Security / Caution Money Deposit is to be refunded to candidate.
For calculation of amount on the pro-data basis, one month shall be treated as one unit e.g. if the candidate cancels admission on third day after start of Academic Session & the seat is filled before cutoff date, then cancellation charges will be the higher amount of ( Total Fees ) / 12 or ` 10,000.00
Any dispute will be subject to the jurisdiction of the High Court of Raebareli only.
Mubarakpur, Mukhetia, Bahadurpur, Post: Harbanshganj, Jais, Amethi-229304 (Uttar Pradesh)
Phone: 0531-3250022| Website: www.rgipt.ac.in
