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IELTS Request-Refund Test-Date-Transfer Form Binh

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phamhaivan29
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19 views

IELTS Request-Refund Test-Date-Transfer Form Binh

Uploaded by

phamhaivan29
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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PR O U D C O - O WNER O F I ELT S

Request for Refund or Test Date Transfer Form


PERSONAL DETAILS
TITLE:
Ms V˙ Thị Thanh Bình
GIVEN NAMES:
THI THANH BINH
FAMILY NAME: VU
ADDRESS: Số 1 ngõ 145 Quan Nhân, Nhân Chính, Thanh Xuân, Hà Nội
NATIONAL ID/ PASSPORT No 030177001032
TELEPHONE: 0976367876 EMAIL: [email protected]
CHANGE REQUESTED:
Request is for (đánh dấu chọn): □ REFUND □ TEST DATE TRANSFER

CENTRE NAME / NUMBER: VINUNIVERSITY


TEST DATE REGISTERED FOR: 23/11
MODULE REGISTERED FOR: □ ACADEMIC □ GENERAL TRAINING

Please select the test that you registered for:

□ IELTS (Paper Based) □ Computer-delivered IELTS □ IELTS for UKVI (Paper Based)
□ IELTS for UKVI (Computer-delivered) □ IELTS Life Skills □ OSR (Computer-delivered)

PREFERRED NEW TEST DATE: 30/11/2024


PREFERRED NEW MODULE: □ ACADEMIC □ GENERAL TRAINING

Please select the test that you wish to transfer to:

□ IELTS (Paper Based) □ Computer-delivered IELTS □ IELTS for UKVI (Paper Based)
□ IELTS for UKVI (Computer-delivered) □ IELTS Life Skills □ OSR (Computer-delivered)

TEST TAKER STATEMENT


Please detail your reasons for applying for a refund or a test date transfer.

In case of medical reasons, this form must be accompanied by an original medical certificate. For other reasons, please attach relevant
documentation/evidence (police report, military service notice, death notice). Attach an extra sheet if there is insufficient space.

Test date transfer

TEST TAKER SIGNATURE: DATE: / /

RECEIVED BY: DATE: / /

TEST CENTRE USE ONLY:

Request (please select): □ APPROVED □ NOT APPROVED


AUTHORISED BY:
(IELTS ADMINISTRATOR) DATE / /

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