| REFUND REQUEST FORM | |||
| Learner Full Name | |||
| Course Title | |||
| Reason for Refund | |||
| Mobile | |||
| Learner Signature | Date | ||
| METHOD OF REFUND (Select only one method) | |||
Bank Name: | |||
Bank City/Country: | |||
Account No. (in full): IBAN no.: | |||
For International Accounts: ABA Routing no. or Swift Code: | |||
| TO BE COMPLETED BY THE ADMINISTRATOR | |||
| Amount | Release (Date/Day) | ||
| Approval Signature: | Date: | ||
| Remarks | |||
| REFUND DECISION | |||
Request approved/unapproved by the Academic Director: | |||
Justification | |||
Learner notified: Learner notified by Date: | |||
Policy Compliance Case closed within 5 working days: | |||
Justification | |||