Refund Request Form

REFUND REQUEST FORM

*Required Field

PERSONAL DETAILS

Student Number (if applicable)

First Name(s) *

Last Name *

Date of Birth *

Postal Address *

Suburb/City *

State *

Country *

Postcode *

Contact Number *

Email *

Please select: *

VET

HE Diplomas

Undergraduate

Post Graduate

Are you an International Student *

Yes

No

Reason for requesting a refund *

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? *

Yes

No

Bank Name *

Bank Address *

Branch *

Branch Number (BSB) *

Account Name *

Account Number *

Swift Code *

Indian Financial System Code (IFSC) *

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 *

DECLARATION

I understand and accept the refund policy and procedures of Alphacrucis College *

Yes

No

I declare that the information provided herein is true and accurate. *

Yes

No

Please sign in the box below *

clear

SYDNEY AUCKLAND BRISBANE

PO Box 337, Parramatta NSW 2124, Australia PO Box 12747, Penrose, Auckland 1642, New Zealand PO Box 554, New Farm QLD 4005, AUS

P +61(0)2 8893 9000 l F +61 (0)2 8893 9099 P +64 (0)9 580 1500 l F +64 (0)9 579 5150 P 1300 775 502 l F +61 (0)7 3373 4899

info@ac.edu.au l ABN: 13 072 747 187