Debit Authority Letter for Post-Matric fee reimbursement

Provided by Social Welfare Department (Mandate to debit the Account)

Name of the Bank, Syndicate Bank Syndicate Bank, Rama Dental College, Kanpur.

Customer Name: ..........................................................................

Customer Account Number: ........................................................

The Branch Head, Syndicate Bank, Sharda Nagar / RDC, Kanpur

Dear Sir,

I irrevocably authorize Syndicate Bank, Sharda Nagar /Rama Dental College, Kanpur to debit my SB Account No: ...................................................................... By /- only (......................................................................................... 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 (20____-____) to Director, Dr. Ambedker Institute of Technology for Handicapped, U.P. Kanpur.

(Name of the institution) Account No 86982150000025 maintained at Syndicate Bank, …………………………………………………………..………………, Kanpur (Name of the Bank & Branch).

(in case the beneficiary account is with some other bank)

RTGS/NEFT (IFSC) CODE of the beneficiary Bank……………………………………………….…………….

Name of the Bank & Branch: …………………………………………………………………………………………….., Kanpur

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 per RBI, RTGS/NEFT Scheme.

Signature of the Customer

Name :…………………………………………………..

Date :…………………………………………………..

Place :…………………………………………………..

Branch/Year/Category :…………………………………………………..

l= 2019&20

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1. Photo copy of High School & Intermediate mark sheet and Certificate with Board

Verification (UP Board/CBSE/ICSE/others).

2. Photo copy of Income Certificate, Caste Certificate, Domicile Certificate with Verification

by Board of Revenue website (www.bor.up.nic.in) and (http://edistrict.up.nic.in).

3. Search/Track Student Record, Status of application 2018-19 Certificate from

SWD website.

4. Father’s employer’s Certificate/Pension Receipt/pay slip/gram pradhan income

certificate/ Ration Card with khatauni (for farmers).

5. Photo copy of Aadhar card of student, Father and Mother.

6. Photo copy of Bank A/c Passbook (Only Syndicate Bank,Sharda Nagar/RDC

lakhanpur).

7. Photo copy of Last year passing mark sheet or internet result copy verified by

HODs.

8. If old students are filling online fresh application form SWD then affidavit is

required regarding reason.

9. Photo copy of fee receipt of session 2019 - 20(not applicable of SC / ST / Zero Fee

students)

10. Self-attest all the enclosures.

11. UPSEE Counseling Letter (Photocopy) compulsory.

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I/II Lateral Entry = 72,800/- II/III/IV B.Tech. = 67500/=

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www.scholarship.up.nic.in

12. PAN Card of Father.

I/II Lateral Entry (PH) = 57,800/-

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