Refund Policy Request (Page 3 of 3) in pdf

Refund Policy Request Page 3

Appendix A

REQUEST FOR REFUND

I, _ _ _ _ _ _ _ _ _ parent/carer of _ _ _ _ _ _ _ _

In Year ____________ request a refund of $ ____________

(Please attach a Medical Certificate if applicable

Reason for refund :



Parent Payments



Uniform Shop Refund



Other

Please specify reason for refund :

I understand and agree that:

A refund may not be made to me or be made in full or in part, having regard to the

associated expenses already incurred by the school, and the school's refund

guidelines provided to me.

The school receipt for the original payment is attached I not attached. (Please circle)

My details will be kept confidential and will not be used for any other purpose.

My refund may be made by direct deposit into my bank account.

BSB: ______________________________________

Account name: ______________________________

Account Number: _____________________________

Signature of Parent/Carer

Date

(School Use Only)

Authorised by: Name:

Signature:

Date:_______

APPROVED Refund Amount: $

_____

Original Receipt Number:

Signature of Principal

Date

Refund Policy Request Page 3