Withdrawal / Refund Application Form

Withdrawal / Refund Application Form

Instructions: Please complete sections A-D.

Applications are assessed primarily on the independent supporting documentation provided to demonstrate your circumstances. The documentation should be provided either as originals or as certified original copies on official letterhead. Please note that all documentation must include the appropriate dates of any relevant events i.e (DIBP Visa Refusal Letter or illnesses). Incomplete applications will be rejected.

Part A: Student Details

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Intructions: Please complete sections 1-5.
Applications are assessed primarily on the independent supporting documentation provided to demonstrate your circumstances.
The documentation should be provided either as originals or as certified original copies on official letterhead. Please note that all
documentation must include the appropriate dates of any relevant events i.e (DHA Visa Refusal Letter or illnesses). Incomplete
applications will be rejected.

CURRENT: Which course would you like to be refunded?

August 2018 ?
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February 2018 ?
November 2017 ?
September 2017 ?
August 2017 ?
August 2017 ?

Part B: Withdrawal/Refund Details

  • Overpaid tuition fees / OSHC
  • Withdrawn from course (refer to refund policy in the application)
  • Transferring to another Education Institution (attach proof)
  • Medical reasons (attach proof)
  • Visa Refusal ( copy of Refusal Letter is required)
  • Other (Please state the reasons in the box below)

Part C: Refund Details ( How did you pay for your tuition fees ?)

The refunds,if approved, will be paid to the person or institution who/ which originally paid the fees. We cannot transfer fun ds to any other party. Please note that the beneficiary name can only be the name of the person or institution who/ which paid the original tuition fees. 

*Unless payment was made by Bank Cheque, Bank Deposit, EFTPOS and TT, refunds must be credited back to the same Credit Card acc ount. Please include a copy of your Credit Card statement as evidence of card details and payment. An online transaction history cannot be accepted as a form of verification. For any other payment method, please supply your bank account details.

I certify that the information provided above is true and correct. If I currently have any fines or fees that have not been paid, I agree that my refund will first be used to pay these debts.

Part D: Bank & Credit card details

Details for Credit Card Refund

August 2018 ?
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February 2018 ?
November 2017 ?
September 2017 ?
August 2017 ?
August 2017 ?

Bank details

  • I declare that to the best of my knowledge the information supplied on this form is correct and complete, and I agree to abide by the regulations of English Language School In Sydney.