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WAAARNEM2020 REFUND REQUEST FORM

Please complete this form, we will process your request as soon as possible.

DELEGATE INFORMATION

DELEGATE NAME:

PAYMENT DATE:

AMOUNT MADE:

MODE OF PAYMENT:

RECEIPT ATTACHED: YES NO

REFUND HANDLING - CONTACT INFORMATION

FULL NAME:

MOBILE NUMBER:

EMAIL:

BANK NAME:

ACCOUNT NUMBER:

Delegate's Signature
For Office Use Only

.............................. Amount Refunded:


Date
Date Processed:

Signature:

Note
All refund will be direct deposited into specified bank account within 2-4 weeks.

http://www.saaarmm.org

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