REQUEST FOR REFUND

Name of Student: Student ID: Unit:

Payment through Bank Deposit

Prefarably Unionbank, Security Bank, BPI, BDO, RCBC, PNB, PSBank, Chinabank,
Metrobank, HSBC Savings Bank and Robinsons Bank

Please indicate the payee’s bank details:

Bank Account Name

Bank Account No.

Bank Name and Branch

Other Payee Details:

Relationship of the payee to student

Contact/Mobile No.

Email Address:

Address (residence)

Birth Date

I hereby certify that the above information given are correct and complete as to the best of my knowledge.

_
Requestor’s Name
(Signature/E-signature over Printed Name)

Guidelines

1. Please submit your refund form to blueandgoldventures@gmail.com for faster processing of the refund.
2. The Accounting Office will process the refund upon the receipt of the completely filled-out refund form and
required attachment/s.
3. Once payment is processed, an email notification will be sent to the student’s and payee’s email addresses.
4. 100php fine/day will be charged for late return.