FORM: FIN04.004 Refund Application Form Version No. 3.1

Refund Application Form
Please submit your completed form to the institute or forward to info@wic.edu.au No refunds will be paid to a third party unless it is indicated at the time the refund application is lodged, that any refunds due is payable to a third party. Refunds are processed in line with the Refund Policy. If the application for course amendment is approved by the institute, and the student is eligible for a refund, any refunds are processed within 28 days of receiving the written request via the Refund Application Form.
STUDENT DETAILS:
Name *

First Name Family Name
Student ID *
Date of Birth *

Day Month Year
Date
Phone Number *

Area Code Phone Number
Email *
example@example.com
Address *
Original Payment Method *

Credit Card Direct Deposit Other
Payment Date *

Day Month Year
Date
Reason for Refund *
If you require more space please attach a separate sheet. Please include independent, original or certified documentary evidence in your application (e.g. medical certificate).
REFUND PAYMENT DETAILS: Refund will be processed in Australian Dollar.
*

I Agree for the institute to refund to a third party other than my student personal account.
Requested Amount *
Please Enter the Amount in Australian Dollar
BSB No. *
Account No. *
Account Name *
Bank Name *
Branch Address
SWIFT Code (Overseas)
** The Institute will NOT be held responsible if any of the following details are incorrect. Refund to oversee account will subject to $50.00 international transaction fee. **
STUDENT DECLARATION:
I have read the refund policy and understand the terms and conditions. I am aware of the academic and financial consequences of the above request and have sought appropriate advice on these matters. I understand and agree to be bound by the institution policies and deadlines for the processing of refunds. I 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 authorise the Wells International College to gather and obtain any necessary information pertaining to this application.

I agree to the conditions of this Refund Application and declare that I am the person to whom this refund is to be paid.
Student Signature *

Clear
Date *

Day Month Year
Date
FINANCE DEPARTMENT USE ONLY
Please be advised that your request for refund of tuition fees has been approved according to the following reason.
Course Commencement date

Day Month Year
Date
Withdrawal notification date

Day Month Year
Date
Days of notice provided in writing
Reasons

Visa refused prior to course commencement (except for fraud, forge or misleading documents). *Full refund lee an administration fee of $200*. Withdrawal at least 28 days (prior to the initial course agreed start date) * 50% refund of tuition fees less and administration fee of $200. Withdrawal less than 28 days (prior to the initial course agreed start date) *No Refund* Withdrawal after the initial course agreed start date. *No Refund* Visa or CoE cancelled due to student breach of their visa conditions or misbehaviour by the student. *No Refund* Incorrect, fraudulent or misleading information or document submitted by the student or the authorised education agent. *No Refund* Does not commence (i.e. does not arrive, or has not arranged with us for a later start because of health or compassionate reason). *No Refund* Visa extension is refused after course commencement. *No Refund* Withdrawal from any continuing study, including any continuing CoE. *No Refund* Compulsory Health Insurance (Student visa holders only)/ Airport Pick-up / Homestay placement fee. * Refer to the Terms and Conditions of Third Party Service Providers*
Other Reasons

Wrong payment Payment without CoE Issue Other
Note:
- Initial course agreed start date is the date of the first Confirmation of Enrolment (CoE) issued to the student, prior to any deferment, suspension or revisions.
- In the event where enrolment fee was waived at time of application, WIC shall withhold an amount equivalent to WIC's published enrolment fee from any refund made
REFUND CALCULATION TABLE:
Tuition Fee Paid
Administration Fee
Fee Withheld (50%)
International Transaction Fee
Other Refundable Fees
Total Refund
(AR)Prepared by
Refund Amount
(AP)Review and Process by
Date

Month Day Year
Date
FORM: FIN04.004 Refund Application Form LAST UPDATED: March 2021, Version No. 3.1
Should be Empty:

Refund Application Form

STUDENT DETAILS:

STUDENT DECLARATION:

FINANCE DEPARTMENT USE ONLY

REFUND CALCULATION TABLE: