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 :…………………………………………………..

Must be sent to NHFDC within 20 days

Receipt

Scholarship Awarded to the Students Under Scholarship Scheme (Trust Fund)

Received from National Handicapped Finance and Development Corporation (Ministry of Social Justice and Empower, Govt. of India) NHFDC, PHD HOUSE, 3RD Floor, 4/2 Siri Institutional Area, August kranti Marg, New Delhi-110016 a sum of Rs. …………………./-(Rupees…………………………………………………….. …………………………………………………………………..….) for Scholarship for the Academic Year 20__ __-__ __ under Scholarship Scheme (Trust Fund) in my A/c No. ……………………………………………. IFSC code…………………………….at.………….… …………………………………… Branch …………………………..………. dated ………………………

The details of Scholarship are as follows: i) Non-Refundable Fees : Rs. ……………………../-

ii) Maintenance allowance : Rs. …………………… /- iii) Books/Stationery allowance : Rs. ……………………./- iv) Aids and Appliance Amount : Rs. ……………………../- Total : Rs. ………………………./-

Signature of Recipient: ………………………….. (On revenue Stamp)

Registration no.: TF/__ __/__ __ __ __ __. Name : ……………………………………………………………… Address : ……………………………………………………………..

……………………………………………………………...

………………………………………………………………

………………………………………………………………

E-mail : ………………………………………………………………. Mobile No. : ……………………………………………………………...

In case of Assistive Device component of scholarship released: - It is certify that the student has utilized/purchased the Assistive Device for the purpose for which scholarship released by NHFDC. (Proof of purchase of Assistive Device enclose: Bill/invoice)

Place: …………………….

Date: ……………………….

Countersigned by

Head of the Institution

l= 2017&18

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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).

3- Search/Track Student Record , Status of application 2016-17 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 6- Photo copy of Bank A/c Passbook (Only Syndicate Bank,Sharda Nagar/RDC

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