The London Institute of Banking & Finance is a registered charity, incorporated by Royal Charter.
Appeal application and payment form
Please save a copy of this form to your computer and complete it on-screen before emailing it to enquiries@libf.ac.uk.
Alternatively, you can print a copy to complete in BLOCK capitals and scan and email it to enquiries@libf.ac.uk or post to
Student Support Services, The London Institute of Banking & Finance, 4–9 Burgate Lane, Canterbury, Kent CT1 2XJ United Kingdom.
If you have any queries please contact us on +44 (0) 1227 829499
YOUR DETAILS
LIBF number (If known) ____________________________________________________ Title (Mr/Mrs/Ms etc) _____________________________________________
First name(s) / Given name(s) ____________________________________________________________________________________________
Last name / Family name _______________________________________________________________________________________________
Previous name
(Please tell us any previous name you have used that would help us link this registration to any other records we may hold for you)
_____________________________________________________________________________________________________________________
Date of birth (DD/MM/YYYY) _____________________________________________________ Gender Male
n
Female
n
YOUR DETAILS
YOUR DETAILS
Preferred email address _______________________________________________________________________________________________________________________
Please provide a telephone number we can use to contact you if necessary:
Telephone no. _________________________________________________ Mobile no.
(if different from 'Telephone number') ___________________________________
CONTACT DETAILS
YOUR DETAILS
The fee to make an appeal is £117.00. (Refundable if your appeal is upheld.)
I wish to appeal the outcome of:
Result enquiry
n
Special consideration application
n
Reasonable adjustment application
n
Malpractice outcome
n
Statement of Professional Standing application / audit: Stage 1
n
Stage 2
n
Assessment name (if applicable): __________________________________________________________________________________________
Assessment date (if applicable): ___________________________________________________________________________________________
Please provide full details of the circumstances that led to this application. Continue on a separate sheet if necessary
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Please list any documents you are providing as evidence to support your claim:
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
Would you like
The London Institute of Banking & Finance to return the enclosed documents? Yes
n
No
n
APPEAL INFORMATION
MS05/18
YOUR DETAILS
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Appeal fee - £117.00 £ ____________
TOTAL PAYABLE £ ____________
Payment options
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I authorise The London Institute of Banking & Finance to debit
my Visa / MasterCard / debit card for the total payable
Card number
nnnn nnnn nnnn nnnn
Expiry date
nn
/
nn
Valid from
nn
/
nn
Issue number
nnn
(if applicable) Security number*
nnn
Signed ______________________________ Date_________________
*
This is the last 3 digits found on the signature strip on the reverse of your card.
n
I enclose a cheque for the total payable, made payable to
The London Institute of Banking & Finance
n
I will pay by bank transfer (ensuring all bank charges are
covered)
Bank transfer information (please provide your details with the
transfer so we can trace your payment):
Account Name: The London Institute of Banking & Finance
Account Number: 10514632
Sort Code: 20-18-00
International Bank Account Number (IBAN): GB83 BARC 2018
0010 5146 32
SWIFTBIC (Bank Identifier Code): BARCGB22
REGISTRATION AND PAYMENT DETAILS
FEES AND PAYMENT DETAILS
We will use and protect your personal data in accordance with
current data protection legislation to process your appeal. Further
details, including your rights, the disclosure of data to third parties,
storage, retention and how to amend your personal data, can be
found within our Privacy Notice (www.libf.ac.uk/privacy).
USING YOUR PERSONAL INFORMATION
n
I declare that the information contained in this form is true
and accurate, consent to the processing and use of personal
data as outlined in the Privacy Notice and accept our terms
and conditions.
n
I confirm that I have read the Appeal policy / code of
practice and understand it.
Signed* __________________________ Date __________________
*Please note that all unsigned forms will be returned and will cause delay in the
processing of your registration.
DECLARATION
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