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* 1. Student Name:

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* 2. Student ID:

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* 3. Mobile/Home Phone number:

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* 4. Email:

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* 5. Address:

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* 6. Course Name:

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* 7. Course Start Date:

Date / Time

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* 8. Last Date Attending Class:

Date / Time

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* 9. Reason for refund:

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* 10. Please ensure that you attach relevant documents as required in question 9.

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
Choose File
No file chosen

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* 11. I would like to be refunded to:

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* 12. Bank details:

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* 13. I have read and understood the refund policy (available electronically at https://gbca.edu.au/students/) and the student acceptance agreement.

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* 14. Please enter the name of the agent who helped preparing  the application of enrolment to GBCA?

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* 15. Who is completing this form?

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* 16. For office use only
Refund calculation:

T