Clone of UK English Enrolment Application Form

UKEnglish Refund Application Form
Student Name*

PrefixFirst NameMiddle NameLast Name
Student ID*
Course Name*
Date of Withdrawal*

DayMonthYear
Date
Refund Application Form
YesNo
If no, date of scheduled commencement as listed on Confirmation of Enrolment

DayMonthYear
Date

Student’s circumstances and reason for refund

Rows	Please tickbox
I was refused a student visa (please attach evidence)
I currently owe fees and want them reconsidered
Course was cancelled by UK English College
Other (including Compassionate and Compelling Circumstances, if appropriate – please attach description and evidence)

Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Please provide the bank account details for deposit of your refund, if approved:
Account name:
Name of bank:
Branch:
Swift Code:
For Offshore Students Only
BSB:
Account number:
TOTAL REFUND AMOUNT :
(Please attach invoice of payment sent to UK English College)
By signing this form, you agree:

 The information provided is true and complete.

 That you have attached all required supporting documents.
Signature
Date

DayMonthYear
Date
Please submit this completed form to UK English College in one of the following ways:

 In person: UK English College

Level 8, 140 Elizabeth Street

Sydney, NSW 2000 Australia

 By postal mail: UK English College

Level 8, 140 Elizabeth Street

Sydney, NSW 2000 Australia

 By e-mail: admin@ukenglishcollege.nsw.edu.au

Please send the following documents as part of the refund application:

1. Fully completed, signed, and dated Refund Application Form

2. Visa Refusal Letter (if visa refusal is the reason for refund)

3. Proof of Tuition Fee paid to the College- Clearly showing the Amount paid and Date of payment

For Office use only
Processed by:
PEO Signature:
PEO Printed Name:
Date

DayMonthYear
Date
MeSomeone else
If someone else, please provide the following information about your nominated recipient
Should be Empty:

UKEnglish Refund Application Form