Request to Refund Course Fees Form - For (Either / Both) Parents Death Due To COVID-19
Important Instructions:
    * 1. All fields are mandatory
       2. Death Certificate(s)/ Identity Proof to be Attested by one of the following:
  •     -DCOs Heads/Regional Heads/Officer-in-charge of the Branch.
  •     -Principal under whom such student is registered for Articleship
  •     -Central Council Member / Regional Council Member / Managing Committee Member of the Branch.

Student Details - As per the SSP (Self Service Portal of ICAI)
Student Registration No. (SRN in SSP):* :
Students Full Name (As per SSP):* :
Date of Registration*
Applicable Date is 1st April 2020 (Onwards) (As per SSP): :
Select Course:* :
Mobile No. used for SSP Registration:* :
Email ID used for SSP Registration:* :

Father and Mother Details
Request Type:* :
Father's Name:* :
Father's Date of Death:
As Mentioned in the Death Certificate:
Mother's Name:* :
Mother's Date of Death:
As Mentioned in the Death Certificate

Bank Details for Refund
Name of the Account Holder:* :
Bank Account No.:* :
Bank Name:* :
Bank IFSC Code:* :
Account Type:* :

Upload Readable Death Certificate of Father in PDF/JPG: :
Upload Readable Death Certificates of Mother in PDF/JPG: :
Upload Readable Cancelled Cheque of the Bank Account Mentioned Above in PDF/JPG:* :
Upload Readable Passing Certificate of Class X or XII in PDF/JPG:* :
Upload Duly attested Identity Proof of Father / Mother in PDF/JPG:* :

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