Financial Services
A hard co
py of this document is uncontrolled and may not be the current version. The latest controlled
version can be found on the Financial Services Forms page.
Version
3.0 June 2020
Page 1 of 1
Approved WWP
CREDIT CARD: Please select from the following options.
I paid my fees online through my Student Centre.
I paid my fees in-person or over the phone
PRIVACY COLLECTION STATEMENT:
Domestic Student Refund Request
Excess Funds
Course/s Dropped
Student Number
Email Address
Last Name
Please ensure that your student account is in credit and that you are eligible for a refund when submitting a form.
Please complete ONE refund sec
tion below (e.g. EFT, Credit Card).
If fees were paid by credit card, refunds MUST be processed directly to that credit card.
For more information please refer to the USQ website for the Refund of Student Fees Policy and Procedure.
Please return this form to: debtors@usq.edu.au
Date of Birth
USQ collects personal information to assist the University in providing tertiary education and related ancillary services and to be able to contact
you regarding enrolment, assessment and associated USQ services. The information may be made available to Commonwealth and State
agencies and the Tuition Protection Service Director and Secretary pursuant to obligations under the Education Services for Overseas Student
Act 2000 and National Code or other legislative requirements. Personal information will not be disclosed to third parties other than a USQ
approved agent, partner or any organisation who provides sponsorship to you for your studies, without your consent unless required by law.
The refund will be credited back against the originating credit card - USQ Financial Services staff will contact you to obtain full credit card details.
The refund will be credited back against the originating credit card - you are not required to provide any further details.
EFT (AUSTRALIAN BANK ACCOUNT): Only use if fees were paid by cash, cheque, direct transfer, BPAY or Australia Post.
Other
Account Holder Name
BSB Account Number
Bank Name
REASON FOR REFUND: Please select one of the below options.
Signature Date
Note: Signature not required if emailing
from registered email account.
First Name
Refund Amount
Phone Number
Accounts Receivable to Process:
AUD
AUD
Original Payment
Date
Refund
Amount
Original Payment
Date
Refund
Amount
Request ID
QI / Receipt
Number
QI / Receipt
Number
FINANCE USE ONLY:
SR#
Accounts Receivable Initial & Date
SF Approved
SF Processed
Financial Delegate Initial & Date
Accounts Payable to Process: Electronic Funds Transfer Telegraphic Transfer
Refund
Amount
Accounts Payable Initial & Date
Voucher Number
PS Processed
click to sign
signature
click to edit
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