Refund Request Form

Student Name *

Student Number *

Email Address *

Contact Number *

Select Your Course *Select CourseCHC30121 – Certificate III in Early Childhood Education and CareCHC50121 – Diploma of Early Childhood Education and CareAUR20220 Certificate II in Automotive Air Conditioning TechnologyAUR30320 Certificate III in Automotive Electrical TechnologyAUR30620 Certificate III in Light Vehicle Mechanical TechnologyAUR31120 Certificate III in Heavy Commercial Vehicle Mechanical TechnologyAUR40216 – Certificate IV in Automotive Mechanical Diagnosis

Agent Name (if applicable)

Invoice number

Amount Paid (In AUD) *

Refundable Amount (In AUD)

Do you wish to proceed with the cancellation of your studies? *YesNo

Reason for Refund Request *Discontinuing My StudiesTransferring to another training ProviderWithdrawing for other Reason

Please specify the reason. *

Once approved, I wish to receive the refund amount by one of the following: *Bank DepositI wish to authorise someone to collect the payment on my behalf.

Note: Authorised person must have a valid photo identification.

Authorised Person Name *

Choose location of your bank: *AustraliaOverseas

Account Name *

BSB *

Swift Code (Overseas only) *

Bank Account Number *

Address of Account Holder

Street No *

Street name *

City/Suburb *

State/Province *

ZIP / Postal Code *

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Declaration *

• I have read and understood the policies and procedures related to this form before submitting.
• I acknowledge that the submission of false, incorrect or incomplete information will result in delaying the processing of this form.

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