Consent Letter For Transfer of Funds To Different Account

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CONSENT LETTER FOR TRANSFER OF FUNDS TO DIFFERENT ACCOUNT

Date: ENTER DATE

From: ENTER CLIENT NAME WHICH APPEARS ON SIGNED APPLICATION FORM

To: Kells Academy


6865 De Maisonneuve West,
Montreal, Quebec.
H4B 1T1

I, the undersigned, ENTER CLIENT NAME WHICH APPEARS ON SIGNED APPLICATION FORM hereby confirm the
following:

1. I am the RELATIONSHIP (MOTHER OR FATHER) of STUDENT NAME, who was registered in grade ENTER LEVEL
or the 2019-2020 academic and has cancelled due to HIS/HER - ENTER VALID REASON FOR CANCELLATION..

2. I request and authorize Kells Academy to issue a refund for the balance of fees in the amount of $$$ Cdn ($$$
dollars this information will be provided by the Accounting Department) to the name of ENTER NAME OF
PERSON WHOSE ACCOUNT WILL BE USED TO REFUND THE MONEY OWED TO THE APPLICANT

I will personally hold you harmless in the unlikely event that anyone proposing to act as me should ever claim for this
payment.

Signed on this___________ day of ENTER MONTH 2020 in the City of __________________________

__________________________________________
ENTER CLIENT NAME WHICH APPEARS ON SIGNED APPLICATION FORM
Relationship to student

Passport Number for ENTER CLIENT NAME #


WHICH APPEARS ON SIGNED APPLICATION
FORM
SIGNATURE

Passport Number for ENTER NAME OF #


PERSON WHOSE ACCOUNT WILL BE USED TO
REFUND THE MONEY OWED TO THE
SIGNATURE
APPLICANT

Recipient Bank Name: ___________________________________________

Account Name: ___________________________________________

Bank Address: ___________________________________________

Account Address: ___________________________________________

Transit Number: ___________________________________________

Institution Number: ___________________________________________


Bank Account Number: ___________________________________________
Please sign this agreement and provide clear copies of the both passports with photographs and signatures.

_________________________________________
Irene Woods - Director

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