Settlement of Hostel Account Form - 2021

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ENGINEERING COLLEGE HOSTELS

ANNA UNIVERSITY, CHENNAI-25


APPLICATION FORM FOR SETTLEMENT OF HOSTEL ACCOUNT

Name (In Capital Letters)


Hostel Admission No: Block/Room No
Name of the Mess Bank/Ac.no ( CB / SBI )
Roll No Course/Branch/Semester
Mobile Number
Reason for vacating the hostel Discontinued / Course Completed
Communication Address

Signature of Resident with date

This is to certify that Thiru / Selvi------------------------------------------------------


Has vacated the hostel on-----------------
Signature of Resident Counsellor with date

FOR OFFICE USE


Date of vacated and surrender of Mess Card----------------------------------------------------
Particulars Amount Receipt No. /
Date
Mess Deposit
Block Deposit
ADD: Advance for the month of

Total

LESS: Mess Dues for the Month of

Balance to be Refunded

CLERK ACCOUNTANT
Permitted to issue a cheque for Rs.------------------
(Rupees---------------------------------------

-------------------------------------------------------------------) and settle the Hostel Account.

Deputy Warden (Accounts) Executive Warden

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