Request for Refund or Test Date Transfer Form



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Request for Refund or Test Date Transfer Form

PERSONAL DETAILS

 

PASSPORT ID:



GIVEN NAMES:

FAMILY NAME:

ADDRESS:

TELEPHONE:

EMAIL:

CHANGE REQUESTED:

Request is for (tick one box):   □  REFUND    □  TEST DATE TRANSFER

CENTRE NAME / NUMBER:

TEST DATE REGISTERED FOR:

           /            /

MODULE REGISTERED FOR:

□  ACADEMIC    □  GENERAL TRAINING

PRO U D C O

- OWNER OF  IELTS

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)                                               



  IELTS Life Skills

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)                                               



  IELTS Life Skills

PREFERRED NEW TEST DATE:

           /            /

PREFERRED NEW MODULE:

□  ACADEMIC    □  GENERAL TRAINING

TEST TAKER STATEMENT

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. For other reasons, please attach relevant 

documentation/evidence (police report, military service notice, death notice). Attach an extra sheet if there is insufficient space.

TEST TAKER SIGNATURE:

DATE:

               /            /

RECEIVED BY:

DATE:

               /            /

TEST CENTRE USE ONLY:

Request (please select):   



  APPROVED    



  NOT APPROVED

AUTHORISED BY: 

(IELTS ADMINISTRATOR)

DATE:

               /            /

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