Refund Request Form

Complete your details as currently on record at Leaders Institute

Personal Details

Course Name

Course Code

COE No

New Title (Mr., Mrs., Ms, etc)

Student Number

Family Name

Given Name

Date of Birth

Student Type: Domestic International

Current mailing address

Town/Suburb

Post Code

Contact Number

Refund Request

The reason for refund is:

Refund Amount:

Declaration

I declare that to the best of my knowledge the information supplied by me is true, correct and complete in every respect. I acknowledge that it is my responsibility to provide all necessary documentary evidence for refund. I acknowledge that I am subject to and must comply with any policies and procedures of Leaders Institute governing my conduct as a student and academic matters affecting my studies.

Signature : your image

Date :

Office use only

Recipient Name

Refund Amount Requested (AUD):

Reason for refund:

Date:

Refund Status

Approved Not Approved

Amount

Approver Comment

Approver Name:

Approver Signature:

Date

Guidelines

Domestic Student Refund Policy

A student who cancels their enrolment on or before the census date in a teaching period is entitled to apply for a refund of fees paid for that teaching period.

Refunds are issued by Electronic Fund Transfer (EFT) or cheque. Refunds will be issued within 14 working days.

International Student Refund Policy

Refunds are only paid in Australian dollars
Payments are refunded:
- Onshore by Electronic Funds Transfer (EFT) or cheque
- Offshore by telegraphic transfer
Requests for refunds of Overseas Student Health Cover (OSHC) must be made to your OSHC provider
Refund payments with generally be made within 14 days of submitting the refund request form and all required supporting documentation

Refund Method

Electronic Fund Transfer (EFT)

Account Holder Name

Bank

Branch Address

Swift Code

BSB Code

Account Number

Cheque

Australian Mailing Address

State

Post Code

Overseas Bank Account Details

Please print all details in BLOCK LETTERS with correct spacing of account number

Bank Sort Code/ ABA RT# or SWIFT Reference

IBAN

Name of Bank

Address of Bank with country

Account Holder Name

Name of Account Holder

Address of Account Holder

Street Address

Suburb

Town/City

State

Post Code

Country