Scribd Logo
Upload

Welcome to Scribd!

  • 308 views

    IELTS Test Date Transfer Form

    Uploaded by

    arafathosain
    This document is a request form for candidates seeking a refund or transfer of their test date for an IELTS exam. It requests personal details of the candidate and details of their original test date and center. The candidate must select whether they are requesting a refund or date transfer and provide their preferred new date. They must also provide a statement with the grounds for their application and attach supporting documentation such as a medical certificate or other evidence. The form is reviewed by the test center administrator who will approve or not approve the request, and supporting documentation is reviewed to assist in assessing the application.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    IELTS Test Date Transfer Form

    Uploaded by

    arafathosain
    308 views2 pages
    This document is a request form for candidates seeking a refund or transfer of their test date for an IELTS exam. It requests personal details of the candidate and details of their original test date and center. The candidate must select whether they are requesting a refund or date transfer and provide their preferred new date. They must also provide a statement with the grounds for their application and attach supporting documentation such as a medical certificate or other evidence. The form is reviewed by the test center administrator who will approve or not approve the request, and supporting documentation is reviewed to assist in assessing the application.

    Original Description:

    Transfer date

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document is a request form for candidates seeking a refund or transfer of their test date for an IELTS exam. It requests personal details of the candidate and details of their original test date and center. The candidate must select whether they are requesting a refund or date transfer and provide their preferred new date. They must also provide a statement with the grounds for their application and attach supporting documentation such as a medical certificate or other evidence. The form is reviewed by the test center administrator who will approve or not approve the request, and supporting documentation is reviewed to assist in assessing the application.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    308 views2 pages

    IELTS Test Date Transfer Form

    Uploaded by

    arafathosain
    This document is a request form for candidates seeking a refund or transfer of their test date for an IELTS exam. It requests personal details of the candidate and details of their original test date and center. The candidate must select whether they are requesting a refund or date transfer and provide their preferred new date. They must also provide a statement with the grounds for their application and attach supporting documentation such as a medical certificate or other evidence. The form is reviewed by the test center administrator who will approve or not approve the request, and supporting documentation is reviewed to assist in assessing the application.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 2

    CONFIDENTIAL

    Request for Refund or Test Date Transfer Form

    Personal details
    Title: 1 _

    Given names: 1 ---

    Surname:
    1 ---

    Address:

    1__ -

    Telephone:

    Email:

    Test date registered for:

    Request is for (tick one box): D Refund D Date Transfer


    Centre name/number: 1-------------------,
    Preferred new test date:

    Candidate statement (to be completed by the candidate)

    Please detail your grounds for applying for a refund or a test date transfer
    (attach extra sheet if there is insufficient space).

    Candidate signature: Date:

    Received by: Date:

    Test centre use only: Previous Request for Refunds/Transfer

    Registered test date Date of prior Grounds for application


    application

    Medical Personal Other

    Request (please select): APPROVED D NOT APPROVED D


    Authorised by:
    (IEL TS Administrator) Date:
    CONFIDENTIAL

    Request for Refund or Test Date Transfer Form


    Supporting documentation / evidence: Medical
    (This form must be accompanied by an original medical certificate.)
    Professional Practitioner Certificate (to be completed by medical practitioner)
    Date/s of consultation:

    Candidate affected on the test day (please circle appropriate letter):

    A totally unable to sit exam specify period

    B very severely affected but able to sit exam specify period

    C severely affected but able to sit exam specify period


    D moderately affected but able to sit exam specify period

    E slightly affected but able to sit exam specify period

    F unable to assess ability to sit exam specify period

    Candidate affected at some time prior to the test day (please circle appropriate letter):
    A totally unable to sit exam specify period

    B very severely affected but able to sit exam specify period

    C severely affected but able to sit exam specify period

    D moderately affected but able to sit exam specify period


    E slightly affected but able to sit exam specify period

    F unable to assess ability to sit exam specify period

    Remarks: nature of illness and other relevant information (with reference to the candidate's capacity to sit an exam)
    which will assist in any assessment of this application for special consideration.

    Practitioner's name:

    Address:

    Phone number:

    Provider number: (if applicable): Stamp:

    Signature:

    Supporting documentation / evidence: Other (police report, military service notice, death notice).
    Please specify and attach relevant documentation/evidence

    The information on this form is collected for the primary purpose of assessing your request for a refund/test
    date transfer. If you choose not to complete all the questions on this form, it may not be possible for the test
    centre to process your request.

    You might also like