ACEM Examinations Withdrawal Form

Name*

First NameLast Name

Email*

example@example.com

ACEM ID*

Please select the Examination you are withdrawing from:*

Primary WrittenPrimary VivaFellowship WrittenFellowship OSCE

Sitting (e.g. 2025.2)*

Reason for Withdrawal:*

Information for Candidates:

Pursuant to Regulation G5, candidates wishing to withdraw from an examination, must do so using this form. Verbal notification will not be accepted.
You can formally withdraw up until the day of the examination and it will not count as an attempt.
Withdrawal prior to the application closing date of the examination will not result in any fees.
If you withdraw after the application closing date of the examination, you are still liable to pay the examination fee unless there are exceptional circumstances related to your withdrawal. Any paid application fees will not "hold over" to a subsequent sitting of the examination.

I am planning to submit an application for request for refund for this examination:*

YesNoN/A

Refund Information: Withdrawal after application closing date

To apply for a refund of the examination fee, please complete a request for refund form and email it to primary.exam@acem.org.au or fellowship.exam@acem.org.au along with supporting documentation.
Once submitted approval will be determined by the Chair of the Examination Committee.
If you have been invoiced and not yet paid this fee, please contact the Examination Operations Team for guidance in this situation. primary.exam@acem.org.au or fellowship.exam@acem.org.au

Reason for Request for Refund*

Supporting information / documents attached?

YesNoNo - Currently awaiting supporting documentation - will send to relevant ACEM team via email once acquired.

If 'Yes' - please list the information/documentation attached in support of this application and the ground(s) on which it is made.

Upload any supporting information / documents:*

Signature*