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Request For Refund or Test Date Transfer Form: Wang Zhi

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287 views2 pages

Request For Refund or Test Date Transfer Form: Wang Zhi

Thank you for understanding. I'm afraid I don't have enough context to summarize that document. Perhaps we could discuss something else.

Uploaded by

Tom Li
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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PROUD CO- OWNER OF IELTS

Request for Refund or Test Date Transfer Form


PERSONAL DETAILS
TITLE: Mr.
GIVEN NAMES: Zhichao SURNAME: Wang
ADDRESS: 23 Guy st.

TELEPHONE: 709-3309688 EMAIL: [email protected]

Change requested:

Request is for (check one box): ✔ REFUND TEST DATE TRANSFER

CENTRE NAME / NUMBER: CA050 ILAC (IELTS Vancouver)

TEST DATE REGISTERED FOR: 08/21/2021


MODULE REGISTERED FOR: ACADEMIC ✔ GENERAL TRAINING

Please select the test that you registered for:

✔ IELTS (Paper Based) Computer-delivered IELTS

IELTS for UKVI (Paper Based) IELTS for UKVI (Academic) (Computer-delivered)
PREFERRED NEW TEST DATE:

PREFERRED NEW MODULE: ACADEMIC ✔ GENERAL TRAINING

Please select the test that you wish to transfer to:

✔ IELTS (Paper Based) Computer-delivered IELTS

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

Test taker statement (to be completed by the test taker)


Please detail your reasons 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 the nature of the illness and other relevant information (with reference to your 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 an extra sheet if there is insufficient space.)

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.

TEST TAKER SIGNATURE: wang zhi Digitally signed by wang zhi


Date: 2021.06.12 22:57:27 -02'30' DATE: 06/12/2021

CLEAR FORM

TEST CENTRE USE ONLY:


RECEIVED BY: DATE:

Request (please select): APPROVED NOT APPROVED

AUTHORISED BY:
(IELTS ADMINISTRATOR) DATE:
IELTS
The test
Return to: [email protected] you can
trust

Candidate First Name: Zhichao Candidate Last Name: Wang

E-mail: [email protected]

Price Quantity Total


$80 1 $80

Total $80

Card Holder’s First Name: Zhichao Card Holder’s Last Name: Wang

Card Holder’s Address + Postal Code: 23 Guy St., St.John's, NL, Canada, A1B 1P7

Credit Card: MasterCard Visa Credit Card Number: 5191230207136277 Expiry Date: 0224

I authorize ILAC to charge $80.00 to the above credit card. 822

Card Holder’s Signature: Zhichao Wang Date: Jun 12, 2021

For Office Use Only

Receipt No.: Date:

Administrator:

[email protected] www.ieltsvancouver.com

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