St. Xavier's College
ST. XAVIER'S COLLEGE [AUTONOMOUS]
30, MOTHER TERESA SARANI, KOLKATA - 700 016

MANDATE FORM FOR REFUND OF ADMISSION CANCELLATION

(FILL IN THE FOLLOWING INFORMATION IN CAPITAL LETTERS)
Student Name :
Department :
Course :
Year of Admission :
College Roll Number :
Mobile No. :
Email ID :
Bank Details
Name of the Account Holder :
Name of the Bank :
Name of the Branch :
Address of the Branch :
Account Number :
Type of Account (SB / CA / OD / Loan Account) :
IFS Code : (11 character)