Refund Form for Tuition and Accommodation
Refund instructions - All refunds are strictly paid back to the original payee/bank account.
Refunds cannot be paid to an alternative account/person.
Forms cannot be processed without the supporting documents. You must submit:
Evidence of the originating payment i.e. receipt(s), transfers, statements etc.
A copy of the account holder’s bank statement to verify the account to be paid.
A copy of the visa refusal, if this is the refund reason.
Please submit completed forms and attachments to RefundReq.fin@coventry.ac.uk.
Missing or incorrect information will delay your refund and your refund form will be sent back to you for completion.
First name:___________________________ Surname/Family name:_______________________
SID/Application Number:____________________ Tel:__________________________________
Email:________________________________________________________________________
Full Address:___________________________________________________________________
______________________________________________________________________________
Please select location of study (select one option):
Coventry University Campus Coventry University London Campus
Coventry University Scarborough Coventry University Coventry College
Refund Amount:
Please select refund reason (select one or more options):
Discount Withdrawal Other
Overpaid Visa Refused
If other please indicate:___________________________________________________________
Your details
Refund details
£
If paid by card provide details of that card only - must be within 6 months of paying
Last four digits of the card you paid with
Card expiry date
(for security reasons do not quote the whole card number)
For cash, cheque and bank transfers the following bank details are required.
UK refunds require Bank name, account number, sort code, bank address and full account
holder name.
Overseas refunds require all account fields to be completed (marked *)
Bank name:*____________________________________________________________________
Bank street name:*_______________________________________________________________
Bank city:*_____________________________________________________________________
______________________________________________________________________________
Bank country:*_________________________ Postcode/Zipcode:*_________________________
Account number*:________________________________________________________________
Sort code (for UK bank accounts):___________________________________________________
Swift code (non-UK):*____________________________________________________________
IBAN (if applicable):*_____________________________________________________________
IFCS code (India):*_____________________________ Branch Pin (6 digits):*_______________
Account holder exact full name:*____________________________________________________
Account holder street name:*______________________________________________________
Account holder city:*_____________________________________________________________
______________________________________________________________________________
Account holder country:*____________________ Postcode/Zipcode:*______________________
______________________________________________________________________________
Account holder Phone no:*_________________________________________________________
Refund currency required:*________________________________________________________
Signed:* ____________________________________ Date:*___________________________
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