Student Refund Request Form - International Students Use

Student Refund Request Form - International Students Use
Section 1: Student Details
Name

First NameLast Name
Student ID
Date of Birth

DayMonthYear
Date
Course Name
Passport Number
Visa Type
Phone Number
Please enter a valid phone number.Format: (+61) 000-000-000.
Email Address
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Section 2: Refund Request Details
Reason for Refund Request

Other
Date of Withdrawal or Visa Refusal

DayMonthYear
Date
Reason for Refund Request
Section 3: Bank Details for Refund
Refunds will be made only to the account from which the payment was received unless otherwise approved.
Account Holder Name
Bank Name
Bank Address
SWIFT/BIC Code
IBAN or Account Number
Country
Section 4: Declaration
I declare that the information provided is true and correct. I have read and understood the Institute's Fees, Charges, and Refund Policy and Procedures and understand that this request is subject to assessment and approval.
Date

DayMonthYear
Date
Signature
Submit supplementary documents if applicable

Cancelof
Section 5: Office Use Only
Date Received

DayMonthYear
Date
Processed by
Refund Approved (Yes/No) and Amount
Reason for Decision
Authorised by
Date Processed

DayMonthYear
Date
Should be Empty:

Section 1: Student Details