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Refund Form

This document is an application for a refund from Midlands State University's Bursar's Department. It requests a refund of $XX and includes the student's registration number, name, program, and contact details. It also lists the required attachments - copies of receipts, national ID, student ID, and a statement. The student must sign to apply for a refund for reasons like termination of studies, deferment of studies, or completed studies. The registrar and bursar must also sign to approve the refund.

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Gregory Gidza B Mugobera
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111 views1 page

Refund Form

This document is an application for a refund from Midlands State University's Bursar's Department. It requests a refund of $XX and includes the student's registration number, name, program, and contact details. It also lists the required attachments - copies of receipts, national ID, student ID, and a statement. The student must sign to apply for a refund for reasons like termination of studies, deferment of studies, or completed studies. The registrar and bursar must also sign to approve the refund.

Uploaded by

Gregory Gidza B Mugobera
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

MIDLANDS STATE UNIVERSITY

BURSAR’S DEPARTMENT

APPLICATION FOR REFUND

1. FACULTY…………………………………………….

2. DEPARTMENT……………………………………..

3. DATE……………/……………/………..2017 BANKING DETAILS

THE BURSAR ACCOUNT NAME……………………………………

MIDLANDS STATE UNIVERSITY BANK……………………………………………………..

P. BAG 9055 BRANCH…………………………………………………..

GWERU ACCOUNT NUMBER…………………………………

DEAR SIR

APPLICATION FOR REFUND : $ STUDENT REGISTRATION NO. ___________.

I hereby attach copies of all payments made into my account as proof of the excess amount being
claimed for refund.

Also find attached a copy of the statement and personal identification documents.

Thank you

STUDENT NAME…………………………………….. REASONS FOR A REFUND:

Cell phone No………………………………… TERMINATION OF STUDIES

PROGRAMME ………………………………………… DEFERMENT OF STUDIES

SECURITY CHECK UPS & ATTACHMENTS: COMPLETED STUDIES

1. COPY OF RECEIPTS PAID EXCESS FEES


2. COPIES OF a) NATIONAL ID & b) STUDENT ID

STUDENT’S SIGNATURE……………………………..

REGISTRAR’S SIGNATURE…………………………………………………….

BURSAR’S SIGNATURE…………………………………………………………

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