Student Refund Request Form
This form is used to request a refund of all or partial program fees. It must be completed and submitted to Ausinet Administration. Requests will be responded to within 14 days of submitting this form. Ausinet reserves the right to refuse a Refund Request. The non-refundable enrolment fee is $250.
Given Name:
*
Surname:
Address:
*
Contact Number:
*
Email:
*
example@example.com
Current Qualification Name:
Total Amount of Fees Paid to Date:
*
Amount of Refund being Requested:
*
Original Payment Method:
*
Credit Card
Direct Debit
Cash
Reason for Refund Request:
*
Signature:
Date:
*
-
Month
-
Day
Year
Date
If the refund is approved the payment will be processed within 30 days to the nominated account:
Direct Deposit into Bank Account:
BSB No:
*
Bank Name:
*
Account No:
*
Account Name:
*
OFFICE USE ONLY
Date Request Received:
Request Approved:
Yes
No
Refund Amount Approved:
Refund Requested to Finance:
Yes
No
Name of Ausinet Approval Officer:
Signature:
Notes:
Attached Letter ofResponse:
Yes
No
Updated in Xero:
Yes
No
Scanned &Uploaded into Student Refund Register:
Yes
No
Submit
Should be Empty: