Refund Application Form

Refund Application Form
Student Name*

PrefixFirst NameLast Name
Student ID*
Date of Birth*

DayMonthYear
Date
Phone Number*

Area CodePhone Number
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Course Name*
Campus*
Amount Paid*
Date Paid*

DayMonthYear
Date
Reason for refund:*

Visa Refusal (a copy of letter of visa rejection required)Withdrawal and discontinue of current enrolled courseWithdrawal and discontinue of future scheduled courseOver payment of course fees
If withdrawal/discontinue, please provide explanation and attach this to refund form, including any supporting documents (e.g. medical certificate, flight ticket, visa rejection letter from Department of Home Affairs etc)
Refund of OSHC (Overseas Student Health Cover)
Where AICSE arranges the OSHC on behalf of a student and the student has not arrived and has never resided in Australia, AICSE will claim the OSHC refund from insurance company on behalf of the student and will forward the OSHC refund to the student upon receiving the refund from the health insurer. Where the student has arrived or resided in Australia, it will be the responsibility of the student to claim the OSHC from the health insurer.
Mode of refund payment
Australian Bank Transfer:
Bank Name
Account Name
BSB
Account Number
International Bank Transfer
Bank Name
Bank Address
Account Holder's Name
Account Holder's Address
Account Number
Swift Code
IFSC Code
For India Nationals Only
Country
Declaration

I declare that the information provided by me is true and complete and that it is my responsibility to provide all necessary documentation to support my request for refund. I agree and have read and understand AICSE Fess and Refund policy for international students.
Signature*

Clear
Supporting Documents

Browse Files

Cancelof
Full Name*

First NameLast Name
Date*

DayMonthYear
Date
NOTE:

If the refund is to be paid to another account, other than that of the student, AICSE would require a letter with the student’s signature to authorize payment of the refund paid to another account.
Should be Empty: