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REFUND REQUEST FORM
Personal Details
Student Number (if applicable)
First Name(s)
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Last Name
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Date of Birth
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+
Postal Address
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Suburb/City
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State
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Country
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Postcode
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Contact Number
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Email
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Please select:
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VET
HE Diplomas
Undergraduate
Postgraduate or Higher Degree Research
Are you an International Student
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Yes
No
Reason for requesting a refund
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Released from AC to transfer providers
Visa rejection
Unable to commence course due to compassionate or compelling circumstances
Offer of a place is withdrawn by AC
The course which was applied for ceases to be offered by AC
Other
Please provide further information as to why you are requesting a refund
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Please upload any relevant documents. (E.g. AC Letter of Release or Visa Refusal from the DIBP)
Account Details
Are you using an Australian bank?
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Yes
No
Bank Name
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Bank Address
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Branch
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Branch Number (BSB)
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Account Name
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Account Number
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Swift Code
*
Are you using an Indian bank?
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Yes
No
Indian Financial System Code (IFSC)
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🛈
Please select whether you are providing an ABA Routing Number
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Yes
No
ABA Routing Number
If you are requesting for your fees for be refunded into an account that is not under your name, please submit a signed letter confirming this.
Additional Notes:
Refund Amount
Please read through the Refund Schedule on the
Refund Policy
to determine how much you are eligible to be refunded.
Initial Payment
Deduction (E.g. non-refundable $200 application fee for International Students)
Total amount to be refunded
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Student Declaration
I understand and accept the refund policy and procedures of Alphacrucis College
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Yes
No
I declare that the information provided herein is true and accurate.
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Yes
No
Please sign in the box below
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