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
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