Application for Refund Form

Application for Refund
This form is lodged with the CEO. Each refund request is reviewed on a case by case basis and a response will be given to you within twenty-eight (28) business days.
Applicant/Students Personal Details
Full Name*

Given Name(s)Family Name
Student ID No
Original Campus ID Number (if applicable)
Date of Birth*

DayMonthYear
Gender*

MaleFemaleOther
Phone Number*
Please enter a valid phone number.
Email address*
example@example.com
Postal Address*

Street Address

Street Address Line 2

CityState/Territory

Post Code
Bank Account Details

Please enter the details for the Bank Account where the refund will be deposited.
Please select the location of the bank account where the refund will be paid:*

AustraliaOverseas
Payment Details
BSB Number
Account Number
Account Name
Please upload a document issued by your bank showing your bank details.*

This is to ensure that the bank account details provided are correct.
Cancelof
Refund Details
Amount being claimed
This is the total amount being claimed minus any non-refundable fees and administration fees.
Amount being claimed *
This is the total amount being claimed minus any non-refundable fees and administration fees.
Which course are you enrolled in?
Reason for Refund (please select ONE)*

Visa RefusalCompassionate/CompellingWithdrawal from current enrolled courseProvider DefaultWithdrawal from future scheduled courseOther
If you selected "Compassionate/Compelling" or "Other" as the reason for refund, please provide more details below:
Please upload any documents which may support your reason for seeking a refund

Cancelof
Signature*

Clear
Date*

DayMonthYear
Date
OFFICE USE ONLY:
Received by
Staff Member Name
Refund Number Issued
Authorised by
Staff Member Name
Outcome
Approved or Refused
Refund Date

DayMonthYear
(if refund was issued)
Amount Refunded
AUD$
Original Campus | RTO Code 45322 CRICOS No 036681

Shop 207, 673 La Trobe St, Docklands VIC 3008 | Phone: (03) 9042 0682
Should be Empty:

Application for Refund

Applicant/Students Personal Details

Bank Account Details

Refund Details

OFFICE USE ONLY: