ABILITY English Method of Refund Payment: 1 [authorise ABILITY English to pay the refund | am eligible for to the person and bank account nominated herein: O Myself § A third party Namo: _Catlos Julio Lod Vrsquet Relationship Primo Please ensure all details are fully completed to avoid delay in receiving your efund Carlos Julio Rocky Vosquee ‘Account No: 012217 393361682 Bank _AN@ bank Bank's Address: WarriAgal Mall Branch Bank's BSB No (within Australia only) ‘or SWIFT Code (for overseas Ol2217 transfer): i See ‘Account Holder's Address: 11 bullara crescent Nofrdwertd 2099 O. Please transfer my fees as a credit to my new course at ABILITY English or MEGT Institute (please attach Letter of Offer and payment details for the new course) Student Declaration: have read and understood ABILITY English Terms and Conditions of Enrolment, including its Refund Policy. | declare that the information | have supplied on and with this form is, to the best of my knowledge, true and correct. | understand that personal information collected on or with this form will be used for the purpose of assisting to make an informed decision on my request. Student Signature — Anthony Poj)5 R Date. 20/02/ 20\7 Parent Signature Date (ifthe student is under 18 years of age, signature of parent or legal guardian is also required) Campus Manager Careroveo CIWOTAPPROVED 4... Comments: ‘Signature: Notice of econ sntto student Name ate Paymont processes y bate ‘Actioned by Finance | geo onl C1 Notity Admissions of rund payment detais (for PRISMS reporting) Page 2 of 2