Withdrawal and Refund Application Form

Version: 1.1 | Responsibility: Financial Controller | Last Reviewed: February 2024

Student ID number: *

Given/First Name *

Family/Last name: *

Email *

Phone *

Date of birth *

Address

Address *

City *

State *

Country

Postal code *

Enrolled Course: *

Withdrawal Section

The Reason for Withdrawal: *

Please tick and submit the supplementary evidence documentation to justify your reasoning. Further evidence may be required. If unsure of the requirements, please speak to Student Services.

Other, please specify:

Supplementary Evidence: *

Do You Require a Release? *

Yes

N/A

Refund Section

Please fill this section if you are applying for a refund.

Reason(s) Other Than Withdrawal

Overpaid

Did not use the additional service (i.e. airport pick-up, accommodation fees)

Other

If other, please specify:

Send refund to the following:

Electronic funds transfer (EFT) or T/T (Telegraphic Transfer)

Phone Pay

Name of bank:

Account name:

Branch

Province:

BSB/SWIFT:

A/C:

Name of Intermediary Bank:

SWIFT code (Intermediary Bank):

IFSC code (for India):

IBAN Number:

CNAPS Number (for China):

Mobile:

Name of Recipient:

Phone Pay Method:

Student Declaration

I declare that:

All the information provided in this application is complete and correct.
I confirm that I have read and understood UIA's requirements, as per their withdrawal and refund policies including refund amount.
I understand that failure to provide correct information in relation to this application may result in the rejection of my application.
I have informed my Agent of undertaking this step to withdraw my application with UIA and that I am seeking a refund.
I understand that if the supplementary documentation evidence I have provided is deemed to be questionable, necessary precautions, such as contacting the respective source, to validate the document, may be conducted.
I acknowledge and accept that a decision arising out of this application including the refund amount is final and that I am bound by the outcome of this application. If payment is not made in advance, instead of refund, payment must be made to clear tuition, and any other relevant fee.
I understand and accept that refunds can be made instalments.
I also acknowledge that if my request for withdrawal is approved, it may affect my student visa and I understand that if I need to seek further information from the Department of Home Affairs, I will either check their website, contact their helpline (131 881) or attend their office regarding advice about my visa.

DISCLAIMER: This withdrawal request is subject to the confirmation of acceptance, which will be decided by UIA after reviewing your application. Only full applications with all the required supporting documentation included with the application will be considered. The withdrawal will only take effect once the decision of acceptance has been made –“last day of study”. Please refer to UIA's withdrawal policy for more details.

The refund process will only be activated once the withdrawal takes effect. Please allow up to 15 working days after the withdrawal takes effect for your refund application to be processed (20 working days total).
Please refer to UIAI's refund policy for more details.

Student Signature: *

Clear

Sign Date: *