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Request For Refund Transfer Form

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tranlyn1403
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14 views1 page

Request For Refund Transfer Form

Uploaded by

tranlyn1403
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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Request for Refund or Test Date Transfer Form

Personal details
Title:
Given names: Surname:
Address:

Telephone: Email:
Test date registered for: / /
Request is for (tick one box): Refund Test Date Transfer We can process a refund payment via bank transfer only.
Please provide your bank details for refund request:
Centre name/number:
Bank name:___________________________
Preferred new test date: / /
Bank branch: _________________________
Please select the test that you registered for:
086100118888
Bank account number: __________________
☐ IELTS(Paper Based) ☐ Computer-delivered IELTS
Beneficiary’s name: ______________________
☐ IELTS for UKVI (Paper Based)

☐ IELTS for UKVI (Computer-delivered) ☐ Life Skills A1

☐ Life Skills A2 ☐ Life Skills B1

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) ☐ Life Skills A1 ☐ Life Skills A2 ☐ Life Skills B1

Candidate statement (to be completed by the candidate)


Please detail your grounds 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 issued by a
Professional Medical Practitioner. The medical certificate must include 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 appl ication for
special consideration.
For other reasons, p lease attach relevant documentation/evidence (police report, military service notice, death notice).
(attach extra sheet if there is insufficient space).

Lý do : Đăng ký thi UKVI IELTS thì chứng chỉ nộp hồ sơ học dự bị đại học mới hợp
lệ mà con lại đăng ký nhầm sang thi IELTS thông thường.
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.
Candidate signature: Date:
Received by: Date:

Test centre use only:


Request (please select): APPROVED NOT APPROVED

Authorised by:
(IELTS Administrator) Date:

March 2020

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