Student Request Form

Student Request Form

Ref No. : F-725

Rev No. : Rev 02

Issue Date : 1 January 2015

Effective Date : 22 June 2015

General Particulars

Name: Gender: ☐ Female ☐ Male

Nationality: Date of Birth:

NRIC/Passport: Fin No.:

Contact: Fin Expiry Date:

Email Address: Singapore PR: ☐ Yes ☐ No

Current course:

Type of Request

☐ Withdraw from course1* (please indicate reason for withdrawal below)

☐ Quality of Program / Teaching ☐ Personal/family issue

☐ Financial issue ☐ Work commitment

☐ Transferring to other Course / School (to indicate school name): ______

☐ Others, please specify: ______

☐ Deferment of Study2

☐ Assessment ☐ Module

From: (dd/mm/yyyy) to: (dd/mm/yyyy)

Course/Module Name: ______

Reason: ______

☐ Re-Assessment

Course/Module Name: ______

☐ Change of Registration

☐ Intake ☐ Course

From: (dd/mm/yyyy) to: (dd/mm/yyyy)

Name of new course (if applicable): ______

☐ Transfer of Course3*

Name of new course

☐ Refund4 (where applicable) #

Reason for refund:

☐ Withdrawal from course

☐ Transfer of course

☐ Others, please specify details and submit original supporting documents

______

#Refund Details (where applicable)

Please select payment option below and to furnish the necessary details to facilitate payment

Default mode of payment

☐ Cheque, payable to _ (Strictly name of student account)

Mailing Address

☐ Remittance (Refund to overseas bank account)

* Only applicable to students who are not in Singapore at point of refund or who do not have a bank account in Singapore.

Name of Account (Strictly name of student account)

Account number

Name of bank/branch/city/country

Swift Code

(Please read below notes before signing)

Notes for student who signed standard PEI – Student contract:
1. Please be informed that, international student holding on to a valid student’s pass is to deliver to TaF.tc, within 3 working days from date of this form, the passport and student’s pass for cancellation with Immigration and Checkpoints Authority (ICA).
2. Student is subject to the prevailing fee for the deferred module(s).
3. A student who transfers from one course to another course shall be deemed to have withdrawn from the original course and the standard refund policy shall apply in this instance.
4. Refund, where applicable, will be processed within 7 working days upon the receipt of this original fully completed form with relevant supporting documents (for deferment, change of course cases and any other refund request where approval is required from TaF.tc, the 7 working days will start from the date of request approval). Forms received after 12.00noon would be considered as submission on the next working day. To find out if you are eligible for a refund, please refer to the refund policy under clause 2 in the standard PEI-Student Contract or details can be found on our website.
Notes for student under short-courses (which doesn’t require signing of Standard PEI-student Contract):
1. For refunds, follow the refund table stated in the LOF.
2. Refunds, where applicable, please refer to point 4 shown above.
*A student requesting for withdrawal from course or change of course must provide letter of consent from his/her parents/guardian if he/she is below 18 years old, before the request can be considered.

FOR STUDENT USE ONLY

Name Signature & Date

FOR OFFICIAL USE ONLY

Received by Date received (dd/mm/yyyy)

Signature Time received (hh/mm)

(Where approval from TaF.tc is required)

Approved by __ Date of approval (dd/mm/yyyy)

Signature Approved refund amount S$

Remarks (if any):