SCIC - Provider Transfer (Release) Application Form

Application checklist
1. a completed Provider Transfer (release) Application Form (this form)
2. a detailed statement (in the space below) describing reasons for release request
3. an Offer Letter from new provider
4. payment record of $300 is applicable to process all transfer requests
5. other supporting documents to support your release application
Student's details
Student ID
Full name (as shown on passport)*
Residential Address*

Street Address

Street Address Line 2

CityState / Province

Post Code
Email*
example@example.com
Contact phone number*

+614XXXXXXXX
Current course*
Conditions

PLEASE READ THE FOLLOWING CONDITIONS CAREFULLY

You agree that:
- You continue to attend classes and meet all course requirements while your application is being processed.
- SCIC may inform the Department of Home Affairs of your cancellation which may adversely affect your visa.
- Evidence such as flight tickets, medical certificates, death certificates must be submitted with relevant requests.
- A fee of $300 is applicable to process all transfer requests. This fee is an application fee only and does not guarantee that the requests will be approved.
- For all requests to be processed, you must have paid all tuition fees up to the date of the request.
- An application for release does not guarantee the grant of release.
- SCIC will assess and reply to your request in writing within ten working days from the date of submission of all required documents and information.
- Failure to provide adequate documents may result in further enquiries from SCIC which will delay the processing of your application.
- All refunds are subject to SCIC's Refunds Policy.
- All requests are subject to relevant SCIC policies and procedures.
- You have read SCIC's Provider Transfer Policy & Procedure. Declaration Ideclare that all the information

Reasons for transfer request
A detailed statement must be provided to support your application for release to another provider.*
Proof of payment (A fee of $300 is applicable to process all transfer requests)*

Cancelof
Offer Letter from new provider*

Cancelof
Additional supporting evidences

Cancelof
Declaration
- I have given above is correct and complete.
- I confirm that I have read SCIC's Provider Transfer Policy & Procedure and agree to abide by the process described in this document.
- I have provided supporting documentation to support my provider transfer application.
- I understand and accept that, if any information provided by me as part of this application is false or misleading, it may result in me being subject to disciplinary proceedings.
Student Signature*

Clear
Provider Transfer Request Form V1.0 (Updated23.02.2024)

This document is uncontrolled when printed. (Printed on: 29/02/2024)
Should be Empty:

Student's details

Reasons for transfer request