Payment Instalment or Fee Extension Request Form

Payment Instalment or Fee Extension Request Form
Details
Student ID Number:
Name
Email
example@example.com
Course:
Group No:
Course start date:

DayMonthYear
Date
Section 1 – Student to complete
I request an extension for payment of the following:
Invoice Number:
Amount:
Reason:
(Please attach any supporting documentation)

Cancelof
How and when you want to pay:
Failure to make a payment on the adjusted date will incur additional late fees as per the fees policy.
Section 2 – Student Declaration
Print name:
Signature
Date

DayMonthYear
Date
Financial Officer Authorization
Authorisation for Processing
Extension Date:
Comments:
Signature
Position :
Print Name:
Date Processed:

DayMonthYear
Date
Should be Empty:

Details