CANCELLATION AND / OR REFUND REQUEST FORM

APPLICANT INFORMATION

APPLICANT NAME:
CONTACT NUMBER:
PASSPORT NUMBER:

WHO OR WHAT COMPANY SHOULD THE

REFUND CHEQUE BE ISSUED TO:

REQUEST DETAILS.

JOB APPLIED FOR: COUNTRY:

I UNDERSTAND THAT HAVING UNDERGONE THE RECRUITMENT PROCESS, THERE WERE COSTS INCURED UP
TO THE POINT OF MY CANCELLATION. THE COMPANY WILL CALCULATE AND ISSUE THE BALANCE
THEREAFTER.
ACCORDING TO THE COMPANY'S POLICY, THE AMOUNT IS REFUNDED AS THE AGREEMENT IS CANCELLED.
HOWEVER, 20% OF IT IS DEDUCTED AS REFUND CHARGES. THE PROCESS TAKES 30 WORKING DAYS.

PAYMENT DETAILS: NB: AN OFFICIAL RECEIPT MUST BE AVAILABLE FOR A REFUND.

HOW MUCH DID YOU PAY? WHICH MODE DID USE TO INDICATE MPESA CODE:
PAY? DATE AND TIME.

I CERTIFY THE INFORMATION PROVIDED ON THIS APPLICATION IS ACCURATE AND COMPLETE.

SIGNATURE THUMB

OFFICIAL USE ONLY

APPROVED BY: ___________________________________________DATE: _______________________________

AMOUNT PAID AND TIME:

MPESA CODE: