Request For Refund or Test Date Transfer Form - Wef1june2020

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Request for Refund or Test Date Transfer Form

Personal details
Title: Ms.

Given names: Khanh Linh Surname: Lai


Address:
Apartment 411, Block A2, No.250 Minh Khai Street, Hai Ba Trung District, Hanoi City

Telephone: 0912836999 Email: [email protected]


Test date registered for: 21 / 08 / 2021
We can process a refund payment via bank transfer only.
Request is for (tick one box): X Refund Test Date Transfer
Please provide your bank details for refund request:
Centre name/number: British Council Hanoi
Ngân hàng Quốc tế VIB
Bank name:___________________________
Preferred new test date: / /
Hai Bà Trưng, Hà Nội
Bank branch: _________________________
Please select the test that you registered for:
025704060249481
Bank account number: __________________
☐ IELTS(Paper Based) X Computer-delivered IELTS
☐ ĐẶNG THỊ NGỌC CHI
Beneficiary’s name: ______________________
☐ IELTS for UKVI (Paper Based)

☐ IELTS for UKVI (Computer-delivered) ☐ Life Skills A1

☐ Life Skills A2 ☐ Life Skills B1

Please select the test that you wish to transfer to :

☐ IELTS(Paper Based) ☐ Computer-delivered IELTS ☐ IELTS for UKVI(Paper Based)

☐ IELTS for UKVI (Computer-delivered) ☐ Life Skills A1 ☐ Life Skills A2 ☐ Life Skills B1

Candidate statement (to be completed by the candidate)


Please detail your grounds for applying for a refund or a test date transfer .
In case of medical reasons, this form must be accompanied by an original medical certificate issued by a
Professional Medical Practitioner. The medical certificate must include nature of illness and other relevant information
(with reference to the candidate’s capacity to sit an exam) which will assist in any assessment of this application for
special consideration.
For other reasons, please attach relevant documentation/evidence (police report, military service notice, death notice).
(attach extra sheet if there is insufficient space).

Em đi du học vào tháng 9, nên không thể đổi lịch sau giãn cách Covid-19, vì thế em xin phép hủy đăng kí thi.

The information on this form is collected for the primary purpose of assessing your request for a refund/test
date transfer. If you choose not to complete all the questions on this form, it may not be possible for the test
centre to process your request.
Candidate signature: Lại Khánh Linh Date: 22/08/2021
Received by: Date:

Test centre use only:


Request (please select): APPROVED NOT APPROVED

Authorised by:
(IELTS Administrator) Date:

March 2020

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