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IELTS_Request-Refund_Test-Date-Transfer_Form_OSR

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5 views

IELTS_Request-Refund_Test-Date-Transfer_Form_OSR

Uploaded by

Kachiusa English
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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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: Test Date Transfer
GIVEN NAMES: Kim Khánh
FAMILY NAME: Trần
ADDRESS: khu tap the truong trung hoc pho thong my loc, huyen my loc, tinh nam dinh
NATIONAL ID/ PASSPORT No 035307010302
TELEPHONE: 0356800162 EMAIL: [email protected]
CHANGE REQUESTED:
Request is for (đánh dấu chọn): □ REFUND □
v TEST DATE TRANSFER
CENTRE NAME / NUMBER: IDP - NEU, so 207, đuong Giai Phong, quan Hai Ba Trung, Ha Noi, Viet Nam
TEST DATE REGISTERED FOR: 28/12/2024
MODULE REGISTERED FOR: □v ACADEMIC □ GENERAL TRAINING

Please select the test that you registered for:

□v 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: 07/12/2024


PREFERRED NEW MODULE: □
v ACADEMIC □ GENERAL TRAINING

Please select the test that you wish to transfer to:

□v 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.

I can't take the IELTS test on December 24th as I have a semester exam at school on the same day. I sincerely
hope for your support.

TEST TAKER SIGNATURE: TRAN KIM KHANH DATE: 18 / 10 / 2024

RECEIVED BY: IDP Ielts HN, [email protected] DATE: 18 / 10 / 2024

TEST CENTRE USE ONLY:

Request (please select): □ APPROVED □ NOT APPROVED


AUTHORISED BY:
(IELTS ADMINISTRATOR) DATE / /

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