Family Name *

Given Name *

Student Number *

Course Code and Name: *

Date of Birth

Email Address *

Contact Number *

Agent Name (if applicable)

Invoice number

Amount Paid to Date (In AUD) *

Amount of Refund Requested (In AUD)

Reason for Refund Request *Discontinuing studiesTransferring to another providerWithdrawal from enrolled units; orWithdrawing for other reason (please specify)Visa refused or rejected

Attach the rejected visa letter *

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Upload file

Please specify the reason. *

Cancellation or transfer to another provider been approved? Please explain what evidence you can provide *

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 *

Country *

PLEASE NOTE: Once the request is processed, students will receive the refund within 30 business days from the commencement of the Unit of Study or the Course of Study to which the refund applies as outlined in the process detailed in the Student Withdrawal and Refund Policy and Procedure.

For full information on the refund amounts and the refund process, please refer to the Student Withdrawal and Refund Policy and Procedure.

Student Signature *

Student Refund Request Form

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Tuesday 8:30 – 17:00

Wednesday 8:30 – 17:00

Thursday 8:30 – 17:00

Friday 8:30 – 17:00

Saturday Closed

Sunday Closed

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Nova Anglia College is a trading name of Nova Anglia College Pty Ltd