Application for Refund
Student Name
*
First Name
Last Name
Date of Birth
*
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Day
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Month
Year
Date
Student ID
*
Course Details
Course Code
*
Course Name
*
Course Start Date
*
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Day
-
Month
Year
Date
Course End Date
*
-
Day
-
Month
Year
Date
Refund Request
Reason for Refund:
*
Please Select
Visa refused (attach documentary evidence from DHA)
Withdrawing from course due to compassionate or compelling circumstances
I am changing education providers and I have a valid Letter of Offer from a new education provider
I have failed to meet entry requirements/conditions on the International Student Contract
Withdrawing from course due to academic difficulties
Withdrawing from course due to personal reasons
My enrolment has been cancelled due to a breach of Student Rules
Other - must give details below
Provide Details
List Documents Attached
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File Upload
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Student Bank Details
Bank Name
*
Branch Code Number
*
Bank Address
*
Account Name
*
BSB
*
Account Number
*
Bank Phone Number
*
International Banking Code
IBAN/SWIFT Code
Student Signature
*
Date
-
Day
-
Month
Year
Date
Office Use Only
Admin Officer
Date Received
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Day
-
Month
Year
Date
Action taken/referred to for action
Refund Details
Amount paid by the student
Amount eligible for refund
Refund paid
Refund not paid, provide more information below
Comments
Refund Date
-
Day
-
Month
Year
Date
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