Section 2 Refund details
Reason for refund
Withdrawal Visa refusal * SFE funded * Over payment Did not meet conditions
Other (please specify)
I am requesting a refund of £
For overpaid fees for tuition accommodation other
I want the refund to be made to: myself third party
Student Signature Date
Please note that it is your responsibility to cancel or amend any payment instructions held by the University.
* Please provide supporting documentation.
Student refund application form
Section 1 Student details Please print clearly
Mr / Ms / Mrs (please circle one)
First name ID number
Surname
Address
Email address
Telephone no I am a: Home/EU student International student
University use only
Approved by
Date received
Debt checked
Any queries relating to completion of this form, please email Refunds@herts.ac.uk
Source bank account
Update bank details
Checked by
Section 3 Bank account details. (Please ensure that correct details are CLEARLY quoted - failure to do so may result in delay and if
rejected, charges may also be incurred). Please provide details of the source bank account where the payment was originally made
from. Failure to do so will delay refund payment.
Bank name
Account holder’s name
Bank Branch / Address
Account number Sort code
IBAN code Swift code
(For international students only) For international students only
KM2694/0516
