Lublin. . ./ . .

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Tuition Refund Request Application

(Wniosek o zwrot czesnego)

Bank Transfer Details

(Dane do przelewu bankowego)

Bank Account No.

6 2 2 2 3 5 7 8 8 4 7 3

Swift Code.
F I R N Z A J J

First Names & Surname:

Address:
Country: 81 Wedgewood green,1 Smith road ,Bedfordview ,Jhb ,SA
Phone No: South Africa
Email: ( + ) 27 83 387 6015
info@bizzyfiresa.co.za

Please state reason for fee refund request (MUST BE FILLED IN)
Vincent Pol couldnt give me the course of my choice which is BSC Nursing ,fortunately i
got the offer from another university,l was invoved in a car accident which resulted in the lose
of my personal documents . This incident delayed the visa application process because when l
reached the embassy they were already closed for interviews.

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Students Signature Deputy tbanccIlor for International SNzdies
(Rodpis Studenla) (Zastppca Kanelerza de. Wspdlyraoy Zo graniczneJ)

Office use only (KASA j

Czesne WB nr. Data PodpfS