Refund of Fees Application

PLEASE REFER TO THE BACK OF THIS FORM FOR INSTRUCTIONS AND INFORMATION

Student ID Number Date of Birth

Family Name: Given/Other Names:

Address:

Telephone Number: Mobile:

Email:

Course Name: _________________________________________________

REASON FOR REFUND REQUEST (tick the appropriate box)

Change of HECS-HELP Submitted Thesis Granted Leave of Absence/Deferred Course

US Loan Discontinued Course Withdrawn Subject(s)

Other (please Specify Desired Method of Cheque payment (payable to you or, the person/sponsoring organization that you nominate) Payment Electronic Funds Transfer (EFT), (please provide the bank account details below) NOTE: EFT payments cannot be made payable to a Credit Card

STUDENT DECLARATION/SIGNATURE

I hereby affirm the information provided within this form to be true and accurate. I understand that all payments from this time on will be paid according to this information. If any changes need to be made, I will inform the University of Melbourne of these changes in writing. I request that, in accordance with the University Refund policy, any outstanding fees and charges owing to the University be deducted from the credit amount before any refund is paid. I understand I will receive a refund only if an amount remains in credit after all outstanding fees and charges have been paid in full. Note: Library debts must be paid directly to the Library before any refund can be processed.

Signature Date

ELECTRONIC FUNDS TRANSFER (EFT) – DETAILS OF YOUR BANK OR FINANCIAL INSTITUTION FOR YOUR REFUND

Name and Full Address of Bank or Financial Institution

Telephone Number of Bank or Financial Institution

AUSTRALIAN Transfers Only INTERNATIONAL Transfers Only

BSB: Swift Code/Sort Code/Routing ABA:

IBAN No: Europe, UK, UAE, Israel, Lebanon Only

All Students Name of Bank Account Holder

Bank Account Number Optional EFT Remittance advice by Email

Email / Address:

The University of Melbourne collects personal information in accordance with the University Privacy Policy which can be viewed in full at http://policy.unimelb.edu.au/MPF1104 Information is collected, used and stored for the purpose of administering enrolment and related activities. Commonwealth and State agencies require certain information to be reported or disclosed by the University. You may request access to your information at any time by contacting the privacy officer at privacy-officer@unimelb.edu.au.

Student Centre Use Student Centre Name: Date: Operator Initials: SA-Fees Use Only 1st Semester O/S Student? Y / N Date Received / / 20 Processed By: Refund Calc Statement? Y / N Date Processed / / 20 Amount: $

SA Use only

LOC INT

Direct all correspondence to: Fees – Student Administration The University of Melbourne VIC 3010 Tel: +613 8344 4772, Fax: +613 9347 2520

INSTRUCTIONS TO ALL STUDENTS

If you have changed your enrolment load, discontinued your course, taken leave of absence, or submitted a thesis, you may be eligible to apply for a refund of fees. Reducing your enrolment load will automatically credit any reimbursement to your enrolment, and may be used to pay for any future fees owing.

The preferred method for payment of refunds is by electronic transfer (EFT) to your nominated financial institution, however cheque payment is available. Cheques and EFT payments will only be made payable to you the student, the person you nominate on the front of this form, or to the sponsoring agency paying fees on your behalf. Cheques are posted to the address nominated on this form.

The refund can only be paid where:

1. The University has received the money that is to be refunded, i.e. cheques must have cleared, telegraphic transfers received etc. 2. You have already actioned your enrolment change (for example discontinued your course or submitted your thesis). Submission

of this form does not affect your enrolment in any way – please contact your faculty if you need to make enrolment changes prior to requesting a refund.

3. The subject census date has not yet passed (see note below). 4. No other fees or fines are owing to the University, e.g. library fines. By signing the front of this form you are:

o Requesting that any outstanding fees or fines are deducted from the credit amount before any refund is paid. o Confirming that you understand you will receive a refund only if an amount remains in credit after all outstanding fees and

charges have been paid in full. Note: if you are applying for refund on the basis of special circumstances, such as illness, please complete a Request for Remission or Refund in Special Circumstances form.

INTERNATIONAL PAYMENTS

Refunds sent to an international address or bank accounts are processed in Australian dollars except where international bank procedure states otherwise.

TO APPLY FOR A REFUND

Complete this form, making sure you provide full details of bank accounts and other information required where indicated.

1. Sign the form where indicated. 2. Please lodge the completed form at your Student Centre, or via mail/fax to Student Administration-Fees as per the details above. 3. If you are enrolled as an international student, and wish for your refund to be paid to you in Australia, supporting evidence of your

student or visa status must be provided when you submit this form. Failure to do so will cause processing of your refund to be suspended until appropriate evidence has been provided.

4. Please allow up to two weeks for processing.

NOTE: All refunds must be made payable to the student or (if applicable) the fee payer. If your fees have been paid by a third party; appropriate advice must be given when applying for a refund. In certain circumstances proof of payment may be required.

INSTRUCTIONS FOR STUDENT CENTRES or INTERNATIONAL OFFICE

1. Identify the student (student card, driver’s licence, passport)

2. Check the student has signed the form and all required fields are completed

3. Note date of Lodgment on form

4. Forward the form to Student Administration-Fees, 1st floor Raymond Priestley Building for processing If the student’s application is on the basis of special circumstances, such as illness, ask the student to complete a Request for Remission or Refund in Special Circumstances form.

MORE INFORMATION

Contact details and self-help information is available on the web at portal.unimelb.edu.au

Log in to the portal at any time to check your fees.

Information about the fee (and refund) policy is available at http://www.futurestudents.unimelb.edu.au/courses/fees.html