To,
The Chairman,
Central Admission Committee,
Office of the Registrar, KLE University, Belagavi.
Respected Sir,
APPLICATION FOR CANCELLATION OF SEAT / WAIT-LIST / SEAT WITH WAITLIST
Particulars of the applicant:
Name of the Candidate
TAT No
Rank No
Waitlist No
Category [ General / BRD / KTC ]
Contact Details
Correspondence Address
Contact Numbers
Mobile No
Tel.No with STD Code
E Mail Address
Request of the Applicant : ( Tick whichever is applicable )
a) Cancellation of Seat
b) Cancellation of Wait List
List of documents to be attached : - ( Tick whichever is applicable )
a) Original Seat Allotment letter
( for cancellation of seat)
b) Original fee amount deposited
receipts ( for cancellation of seat)
c) Original Wait-list acknowledgement
( for cancellation of waitlist)
d) Original preference filled
acknowledgement form
( for cancellation of waitlist)
e) Original Wait-list Amount deposited
receipt ( for cancellation of waitlist)
f) Original fee Amount deposited
receipt ( for cancellation of seat)
g) ID proof copy with photograph issued by
the Government.(PAN/Aadhar card)
h) Self-addressed envelop duly affixing
Indian postal stamps of Rs.39/applicable only for Wait-list Demand
Draft refund through post.
Requisition for mode of payment for refund of the amount (applicable only for
admitted candidates):
a) By way of Demand Draft
b) By way of NEFT / RTGS
If NEFT / RTGS Provide Details:
1)
Candidate Account No:
2)
IFSC Code:
3)
Bank Name and address:
_____________
Date
_______________________
Signature of the Parent/Guardian
____________________
Signature of the candidate
DECLARATION
(Cancellation of Seat / Wait-list)
I hereby cancel my seat/waitlist which was alloted to me and I hereby declare that I am fully aware of the Rules
and Regulations of the University as regards to admission process for MEDICAL / DENTAL courses and also the
refund policy as detailed in the
KLEU-PGAIET-2015 which has been disseminated on the University website.
I also hereby declare and confirm that after submission of the cancellation of seat/waitlist application, I shall not be
considered for any subsequent rounds of counseling for admission process either for MEDICAL / DENTAL seats and
also lose my claim over the aforesaid seats and wait-list.
Date
Signature of the Parent/Guardian
Signature of the candidate
DECLARATION
(Cancellation of seat and continuation of Wait-list)
I hereby cancel my seat and continue my waitlist which was alloted to me and I hereby declare that I am fully aware
of the Rules and Regulations of the University as regards to admission process for MEDICAL / DENTAL courses and
also the refund policy as detailed in the KLEU-PGAIET-2015 which has been disseminated on the University website.
I also hereby declare and confirm that after submission of the Cancellation of seat and continuation of Wait-list
application. I will lose all the claim over the seat allotted to me which has been cancelled / withdrawn by me.
However, my wait-list shall continue as per the rule of preference counseling process.
Date
Signature of the Parent/Guardian
Note: The candidates shall sign the declaration whichever is applicable
Signature of the candidate