UNIVERSITY OF SANTO TOMAS. Office of the Vice Rector for Finance APPLICATION FOR REFUND OF FEES (Under the Pandemic] 1 a student of the college/faculty/school of hereby apply for a refund of part of my fees and/or fee adjustments for the reason that (check appropriate blank below): | graduated/met all the academic requirements for graduation at the end of the Term of AY 2019-2020 and had paid fully my accounts for that term am currently enrolled as a_____year student and have fully settled my accounts for the 2nd Term of AY 2019-2020, Special Term of AY 2019-2020, {if applicable), and the 1" Term AY 2020-2021 Lam not currently enrolled but have fully settled my accounts as a year student in the 24 Term AY 2019-2020 and/or Special Term AY 2019-2020 (if applicable) Refundable amounts exceed all my remaining balances in the previous term(s) | wish to claim my refunded amount through (check appropriate blank): Bank Name/Branch: Bank Account Name: Transfer account Number: Tobe claimed from the UST Cashier's Office 2s¢ floor, Main Building, UST Campus (if allowed by quarantine level conditions) Check Signature of Parent/Guardian over Signature of Student Date Printed Name Student Number: CERTIFICATION This is to certify that based on records and per computation, the total amount to be refunded to the aforementioned student is Prepared by: Checked and Verified by: Approved by: Staffin Charge Supervisor, Student Accounts Section Viee-Rector for Finance usT:s004-04-F0O7