PO Box 12723, Die Boord, 7613

Tel. 021 883 2454 / 021 110 0200

Fax. 021 883 2378 / 086 11 12 121
www.oxbridgeacademy.edu.za

Refund form
Student no: 21935674 Date: 2021/12/08
Name: Sindiswa Surname:
Siyaya
ID no: 0402030162083 Contact no:
0730849287
Refund amount:
R400
Student bank account details:
Bank name: Capitec Branch code: 470010
Acc. name: Account no:
Capitec Global 1 1829034691
Acc. type: Debit
Reason why I am requesting a refund:

Because I overpaid my account when I had to

pay my sister's account who's also a student
at Oxbridge Academy therefore I am asking for
the refund so I can rectify this mistake.

Student: Date:
2021/12/08
For office use only:
Request: Approved: Denied: Amount:

Manager: Date:

FM: Date:

OXBACA/RRF/16/v3