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l,8''1.\'OL.Y 00UR&111A1 Tlll tr.\'I\IERSllY IIAS l"Ol'Jt CORRECT ('ORRl!SPOSDD/Cl.
Student Financial Services ADORI.SSAT AU.Tl'll!S.
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REQIIESJ' t:rut HEFUND OF EX(ESS FEES I DEPOSITS

A. FOR COM.Pl.ETION BV STUDENT
I, THE UNDERSIGNED, HEREBY REQUEST A REFUND OF EXCl!SS Pl!l!S OR DEPOSITS PAID WHICH IS TO THE CREDIT OF MY ACCOUNT IN THI!
BOOKS OF THE UNIVERSITY.

S11JDENTNO

SURNAME
Mactl0,I~
FULL NAME (S) niond 1,
AMOUNT OF REFUND ~113D
1)e@s 1b rer 1t@sttemen o.rCJ resicterre
REFUNDI.R.O

HAVE YOU INFORMED THE UNIVERSITY OF YOUR BANKINGDETAILS:j@NQ

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QFNOT. T/IEN R{iQUESTT1/£ BANI{ /)£TAU-~ PQRM PROM me P/!F.SOFFICERI

CONTACT TEL. NO. : (Cl

EMAIL ADDRESS

POSTAL ADDRESS I+ etn \C)t cfcl A~hbwion

STUDENT SIONATURE
8. STUDENT FUNDING - SCHOLARSHIPS

NAME OF THE SPONSOR r.J/A

APPROVED AMOUNT OF REFUND N}A
PREPARED BY (Name and Signature of Advisor) : _ _ _ _ _ _..;.('J_/wA,_,__ _ _ _ _ _ _ _ _ _ __

CHECKED BY (Name and Signature ofSemor Advisor): _ _ _ _ _ _'tJ__./..;.A

_ _ _ _ _ _ _ _ _ _ __
APPROVED BY (Name and Signature ofHcad ofScholo1$hips):,__ _ _.~...:../.;..J1.:..-_ _ _ _ _ _ _ _ _ __

APPROVED BY (N1111lC and Signature ofStudent Funding Manager):

8. STIJDENT FUNDING - BURSARJES

NAME OF THE BURSAR/GRANT : _ _\\)

_~_ r-i_ ~ - - - - - - - - - - - - - - - -
APPROVl!DAMOUNTOF REFUND: ----~.;:1. _1_80;__;;_______________
PREPARJ!D BY (Name and Signature of Advisor): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

CHECKED BY (Name and Signature ofSenior Advi50r): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

APPROVED BY /Name and Signature of Head ofB11t111rica): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

APPROVB> BY /Name and Signature of Student l'widin11 Manager):

STAMP

RETURN COMPLETED FORM TO THE FEES OFFICE ON YOUR CAMPUS OR VIA EMAIL AT:

WESTVILLE STUDENTS: \\'r,Mlldffl{II ukzn,u.u HOWARD COLLEGE STUDENTS: Ho" ardrrr&(a•ukzn.11c.za

PIETERMARITZBURG STUDEN'TS: Pmbrm(il ukzn.ac.za MEDICAL SCHOOL STUDENTS: l\ttduhfm<a ukzuc.za
EDGEWOOD STUDENTS: t:dge"oodftn{il ukzn.ar.:ta
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