Refund Application Form

REFUND APPLICATION FORM
Note: Before you start filling this form, please click here and read Refund Policy carefully to understand your eligibility for the refund.

Please Note: Payment made via Credit Card initially, refund will be credited back onto the same Credit Card ONLY (Refund cannot be processed if you do not fill up this section correctly)
Part A. Student Details:
Student ID:
Given Name:
Family Name:
Address:

Street Address Line 2
Mobile Number:
Format: (000) 000-0000.
Email Address:
Part B. Course Details:
Course Name:
Course Start Date:

DayMonthYear
2 digit day, 2 digit month, 4 digit year
Part C. Reason for the Refund:
Please select the reason:

Other
Please state why you wish to apply for a refund:
Part D. Payment Record:
For how much refund you are applying?
Which date have you paid this fees?

DayMonthYear
2 digit day, 2 digit month, 4 digit year
How did you paid this fees?
Please specify:
Please attached payment receipt or evidence of payment:

Cancelof
Part E. Refund Payment Institute:
How do you want your Refund?
Bank Name:
Bank Address:
Account Name:
BSB Number:
Account Number:
Bank Name:
Bank Address:

Country
Account Holder Name:
Account Holder Address:

Street Address Line 2
Account Holder Contact Number:
Format: (000) 000-0000.
Account Number:
SWIFT Code:
Branch Code:
Card Type:
Credit Card Name:
Credit Card Number:
Expiry Date:
SCV:
Part F: Student Declaration:
- I am aware of the academic and financial consequences of the above request and have sought appropriate advice on these matters.
- I understand that withdrawn units will appear on my academic record.
- I understand and agree to be bound by the college’s policies and deadlines for the processing of refunds.
- declare that the information I have given on this application is correct and understand that by knowingly making false or misleading statements that I may be liable for prosecution.
- I also authorize the College to gather and obtain any necessary information pertaining to this application.
Student Signature:
Date:

DayMonthYear
2 digit day, 2 digit month, 4 digit year
Should be Empty:

Part A. Student Details:

Part B. Course Details:

Part C. Reason for the Refund:

Part D. Payment Record:

Part E. Refund Payment Institute:

Part F: Student Declaration: