TT (INTERNATIONAL BANK TRANSFER): Only use if funds were paid by international wire/international bank draft.
Bank Street
Address
Account Holder
Name
Account
Holder's
Overseas
Street Address
CNAPS Code
SORT Code
SWIFT / BIC
Code
Account
Number
Bank Name
Branch Name
Malaysian National ID /
Passport Number
Country
City
State
Preferred
Currency
IFSC Code
IBAN Number
International Student Refund Request
Other: SWIFT
Form B
Routing /
Transit Code
AUD
Last
Name
Application Withdrawal
MICR Code
Application
Number
Refund
Amount
Visa Application Refused
Other
(Please specify)
Street
Please supply applicable details for home country (Refer to Requirements by Country guide below)
Please complete ONE refund method below (e.g. TT, EFT, Credit Card)
* If fees were paid by credit card, refunds MUST be returned to the originating credit card.
*Fees paid by international bank transfer refunds will be returned to the student's home country as per USQ's Refund Policy.
For more information please refer to the USQ website for the refund of Student Fees Policy and Procedure.
UK: SWIFT, IBAN & SORT
Malaysia: SWIFT & National ID
China: SWIFT & CNAPS
Nepal: SWIFT
India: IFSC, SWIFT & MICR
USA: SWIFT & Routing
Requirements by
Country:
Country
City
State
Prior to/or commencing study
First Name
Date of Birth
REASON FOR REFUND: Please provide detailed reasoning and documentation to support your request.
Email Address
Please ensure that your student account is in credit and that you are eligble for a refund when submitting this form.
Continuing students with a credit balance are encouraged to offset this amount against their fees in the next semester.
Please return both pages of your form to:
ioadmissions@usq.edu.au
Student
Number
Date
Excess Funds
Signature
Financial Services
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The latest controlled version can be found on the Financial Services Forms page.
Version 4.0 June 2020
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CREDIT CARD: Please select from the following options.
I paid my fees online through my Student Centre.
The refund will be credited back against the originating credit card - you are not required to provide any further details.
I paid my fees in-person or over the phone
The refund will be credited back against the originating credit card - USQ Financial Services staff will contact you to obtain
full credit card details.
PRIVACY COLLECTION STATEMENT:
Approved
Accounts Receivable to Process:
AUD
AUD
AUD
Accounts Payable to Process: Electronic Funds Transfer Telegraphic Transfer
International Student Refund Request
Form B
Continued
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.
EFT (AUSTRALIAN BANK ACCOUNT): Only use if fees were paid by cash, cheque, direct transfer, BPAY or Australia Post.
Account Holder
Name
Original Payment
Date
Basis of Refund Approval / Additional Comments Confirmed and Supported By
Date
Signature - Director, USQ International
Name (Print or Stamp)
Date
Bank Name
Refund request approved in accordance with the Refund of Student Fees Policy and Procedure
Refund
Amount
Original Payment
Date
Refund
Amount
Original Payment
Date
Refund
Amount
Account Number
Refund
Amount
Request ID
QI / Receipt
Number
QI / Receipt
Number
QI / Receipt
Number
INTERNATIONAL OFFICE USE ONLY:
FINANCE USE ONLY:
BSB
Financial Services
A hard copy 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 4.0 June 2020
Page 2 of 2
SR#
Accounts Payable Initial & Date
Voucher Number
PS Processed
Accounts Receivable Initial & Date
SF Approved
SF Processed
Financial Delegate Initial & Date
click to sign
signature
click to edit