Refund Request by nyut545e2


									                                                                                                                  Date Stamp

                                  Refund Request
                                   All fields MUST be completed
                                   To be completed in BLUE or BLACK BIRO
                                   To be completed by ALL students applying for a refund of fees


               Name:                                                      Student Number:

   Mailing Address:

                 City:                                                    State

             Postcode:                                                    Country:

     E-mail address:
                          (Compulsory if requesting EFT payment. If not supplied, a refund will be paid by cheque)
B. REQUEST DETAILS: e.g. Reason for refund request. Please attach supporting documentation* (see over).

- For International Money Transfer or Bank Draft, the Refund Request – International Currency form must be
    completed in addition to this Refund Request.
- Refunds can only be paid into an account in the student’s name unless the Refund Request – Alternative Payee form
    is completed and attached to this Refund Request.

     Account Name:

          Bank Name:


        Account Number:

D. SIGNATURE: Please tick (as applicable) and sign and date this Request
      My fees are not funded by a CQU scholarship or study support scheme
      I authorise CQU to pay into this bank account as per my instructions (EFT only)

Signature:                                                                                   Date:

 Original Form?             YES                  NO        Original forwarded?         YES      Date sent
Receipt #:                               Receipt Date:                                              Inv:
Ref Amt:        $                         Admin Fee: $                                           Raised: YES / NO
Reason for refund:
Date Processed:                                                    Processed by:
Refund Number:                                                     Refund Type:

 Approved?               YES              NO        To be reprocessed              Communication Created

Approved By:                                                                          Date

20017    GO       FINAC      00000 00000 00000    (100% EXCL O) DOF/HOD

                                                                                             Refund Request Form August 2007
Information about credit balances and refunds

Important notes
 The original Refund Request Form/s with an original signature must be submitted. An original signature and a current e-
   mail address must be submitted when an EFT payment is requested – no exceptions.
 Credit balances less than $10.00 AUD will be refunded only by Electronic Funds Transfer (EFT) to an Australian bank
 “Student” includes current and former students and applicants.

Credit Balances
 Students can apply for a refund if their account is in credit. It is the responsibility of the student to be aware of all credit
   amounts (excess payments) on their account and to maintain current address and contact details.
 The University deems that credit balances (excess payments) are unclaimed if the student’s program status is inactive for
   more than one (1) term. Credit amounts on a student’s account will be forfeited to the University if unclaimed.

 Credit balances on student accounts can be refunded subject to the relevant Refund and Excess Payments (Credit
     Balances) Policy at Separate policies apply to:
     - Domestic students and applicants;
     - International students and applicants;
     - Language Centre applicants and students.
Applying for a refund
 All students applying for a refund must complete the Refund Request Form
 If the refund is to be paid to someone other than the student, the Refund Request - Alternative Payee Form must also be
    completed by the student
 If the refund is to be paid by International Money Transfer or by Bank Draft in a currency other than Australian dollars,
    the Refund Request – International Currency Form must also be completed by the student
 Some students will need to complete all three (3) Forms
 Refund Request Forms are located at

Where to submit your application
 Students and former students at an Australian International Campus of Central Queensland University (Brisbane, Gold
   Coast, Melbourne, Sydney) or at an off-shore campus or teaching site (Hong Kong, Singapore) must submit their
   Refund Request Forms to that campus administration in the first instance.

Brisbane Campus                               Gold Coast Campus                             Melbourne Campus

Central Queensland University                 Central Queensland University                 Central Queensland University
108 Margaret Street                           60 Marine Parade                              108 Lonsdale Street
Brisbane QLD 4000                             Southport QLD 4215                            Melbourne VIC 3000
Students and former students at               Sydney Campuses                                All CQ Campus, Noosa Hub and Flex
Fiji, Hong Kong, Malaysia, Shanghai                                                              students and former students
and Singapore                                 Central Queensland University
                                                                                            Student Administration, Building 2,
Treasury and International                    Undergraduate Campus                          Central Queensland University
                                              333 Kent Street                               Rockhampton QLD 4702
Financial Services Division
Building 65, Central Queensland
                                              Postgraduate Campus
University                                    400 Kent St
Rockhampton QLD 4702
                                              Sydney NSW 2000

Deceased students
 The personal legal representative of the Deceased Estate can apply for any excess payments which are to be refunded.
    Refunds will only be processed once all requirements of the University and the country of nationality have been fulfilled.
    See the relevant Refund Policy for full details.

* Supporting documentation is required if:
 You are claiming a refund of fees paid for courses withdrawn after the last day to withdraw without financial penalty due
     to any special circumstances.
NOTE: You may need to consult one of the policies listed below and make application for consideration of the special
circumstances before a refund can be processed. Policies are located at
- Recrediting of Student Learning Entitlement in Special Circumstances; or
- Withdrawal without Financial Penalty in Special Circumstances.

                                                                                                  Refund Request Form August 2007

To top