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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
*
+
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
*
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Offer of a place is withdrawn by AC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
*
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
*
Branch Number (BSB)
*
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
*
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.
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 $100 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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