Ccim Fee Refund Form

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FEE REFUND CLAIM FORM

Personal Details

Name: ________________________________________________ Student ID No: ______________________________

Current Contact Address: ______________________________________________________________________________


Telephone No: ______________________________ Email: _________________________________________

Session: ___________________________________ Course: ________________________________________

Details of your request


Reason for request for refund (Evidence required e.g. visa refusal etc.)
Brief details: ________________________________________________________________________________

________________________________________________________________________________
________________________________________________________________________________
REQUESTS FOR TUITION FEE REFUNDS WILL NOT BE CONSIDERED UNLESS SUPPORTING EVIDENCE IS ATTACHED WITH THIS FORM.

Method of Payment
Please select one mode of Refund
Bank Transfer Cheque (only for UK-based students) Other (Please Specify) _________________________________

Please provide details of Bank Transfer

Bank Name & Address: ________________________________________________________________________


Account Name: _________________________________ Account Number: _____________________________
Bank Sort Code: ________________________________ IBAN Number: _______________________________
(Please note: Cheque will be issued on the student‘s name as it appears on the passport)

Declaration

DECLARATION: I confirm that the information I have given on this form is true and complete. I understand that if I provide false
information, my request will not be considered and my right to appeal waived.
I confirm that I have read and understood the Fees and Refunds Policy of Cromwell College of IT & Mgt. (CCIM), and am aware that any tuition
fee refund is entirely at the discretion of the CCIM Management.
I understand that failure to complete the form in full may result in rejection of my request.

Signature: ____________________________________ Date: _______________________________________

For office use only:

Received by: ________________________________ Date: _________________________________

Signature: ________________________________ Remarks: ______________________________

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