Request for Refund or Test Date Transfer Form

PERSONAL DETAILS
Title Mr
Given Names Kenneth Surname Sigua
#0067 San Nicolas Santa Ana, Pampanga
Address Santa Ana, 2022
Philippines
Contact Number 639288031268 Email siguakenneth10@gmail.com

REQUEST (tick one box) Transfer Refund

Centre Name and Number British Council - PH 001
Test Date Registered for April 4, 2021 Location Pampanga

Paper-based IELTS Computer-delivered IELTS IELTS Life Skills

Test Type Registered for
Paper-based IELTS for UKVI Computer-delivered IELTS for UKVI

Module Registered for Academic General Training A1 B1

Preferred New Test Date May 1, 2021 Location Pampanga

Paper-based IELTS Computer-delivered IELTS IELTS Life Skills

Preferred Test Type
Paper-based IELTS for UKVI Computer-delivered IELTS for UKVI

Preferred New Module Academic General Training A1 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 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 extra sheet if there is insufficient space)
My IELTS examination that was already booked on April 4, 2021 was cancelled due to ECQ. I
understand the situation but I am having a problem booking another test date because the payment
reference that I have is the one that I've used before which is different from the one provided to me
when I booked again.

I hope you can help me with this matter. Thank you

The information on this form is collected for the primary purpose of assessing your request for a refund/test date transfer. If

March 2020
 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       Date March 3, 2021

TEST CENTRE USE ONLY

Received by       Date      

Request (please select) Approved Not Approved

Authorised by       Date      
(IELTS Administrator)

March 2020