ICOT DUBLIN - Refund Request Form
Student Name *
Your answer
Student ID *
Your answer
Student Address *
Your answer
Phone *
Your answer
Email *
Your answer
Requests refund for *
Total amount paid for the service requested *
Your answer
What's the name of your agent ? *
Who did you buy your course from ?
Your answer
When did you make your payment to ICOT College? *
MM
/
DD
/
YYYY
Have you got your Insurances already ? *
Governamental Insurance that ICOT provides
What is the reason you are asking for refund ? *
Your answer
Would you like to sell your course to other student and receive your full money back ? *
In that case we will not deduct €300 fee from you total amount
Your answer
Did you pay extra fee for morning or afternoon class ? *
If yes, How much was it paid ? *
Your answer
Have you got your GNIB already ? *
Did you go to immigration and collected your GNIB ?
If you didn't get it - Did you get your GNIB Denied ?
Was your GNIB refused ?
If you get your GNIB refused, could you please send an email with the immigration letter copy and copy of all your passport pages to the address below
Receiver's Name *
Responsible for the acount who is getting the money
Your answer
Receiver's Address *
Personal address of the person who is responsible for the account
Your answer
Receiver's Account Number *
Your answer
Receiver's IBAN number *
Your answer
Receiver's Bank SWIFT Address / BIC *
Your answer
Receiver's Bank Name *
Your answer
Receiver's Bank Address *
City, State, Country
Your answer
Receiver's Bank Code *
Your answer
Other Comments *
Your answer
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