For Admin Use Only:

Received By:

Date:

Request for Enrolment Defer/ Suspend/ Cancellation Form

Information provided in this form will be used to amend your CoE via PRISMS system.
Student name: Student ID No.:
Phone number: Email address:
Current residential
address:
Original course Original course
Start Date finish Date:
Proposed course
Course enrolled:
finish date

Reason for enrolment Defer/Suspend/ Cancellation is: Please tick one box only
Visa Refusal (please provide Visa Refusal letter issued by DIBP;
required)
Illness (please provide Medical Certificate; required)
✓
Transfer (please provide offer letter; required)

Other (please provide reason)

I’m requesting to take the following action for my enrolment from the General English
Course:

Defer Suspend Cancel

Student Declaration:
1 I understand a $300 cancelation fee will apply and I must pay within 48hours from the time I sign
this form.
2 I will remain liable for all fees if I do not formally cancel my enrolment prior to the relevant course
start date as stated on COE.
3 The effective date of this request is the date this form is received by Pacific English Study, along
with required supporting documents. If any supporting documentation is missing, request will
become void.
4 I have read and understood the reverse side to this form.
5 I have retained a student receipt as evidence of my submission
6 Cancellation of enrolment may affect my student visa, Pacific English Study will notify DIBP via
PRISMS when my enrolment is deferred, suspended or cancelled.
7 I should contact my local DHA offices, www.homeaffairs.gov.au or by phone 131 881 to
seek advice on how this will affect my visa status.

Student Signature: Date:

1 Pacific English Study (CRICOS No. 03215E)

Request Form for Enrolment Defer- Suspend- Cancellation
Level 2, 17 Orchid Avenue; Surfers Paradise QLD 4217 Australia
Tel: +61-7-5527-5306; Fax: +61-7 -5538-4390; E:info@pacificenglishschool.com
For Admin Use Only:

Received By:

Date:

Effective Dates
The effective date of Defer/Suspend/Cancellation is based upon the date the form was completely
submitted to Pacific English Study. It is student’s responsibility to receive formal acknowledge of
lodgement, by receiving a form receipt.
Financial Liability
If students do not officially deferred/suspended/cancelled their enrolment prior to the relevant
commencement date as stated on the current COE, will remain liable to pay for the course of study
they have enrolled in, even if they have not or are no longer attending classes.
Fee Refunds
Eligible students may obtain an application for Request for Fee Refund Form from Student
Administration.
Please refer to Pacific English Study Student Agreement and Refund Policy.

Student Fees Refund Request

Overseas Bank Details:

Please ensure that your full overseas bank details are provided to avoid delaying the processing of
your refund.
Account Holder’s Name:
Account Holder’s Address:
Bank Name:
Branch Name:
Address of Bank:
Account Number:
Swift/BIC Code: It is essential to provide one
IBAN-UK, Europe Code: of these codes for a refund.
Sort Code:
ABA or Routing Number:

Australian Bank Details:

Please ensure that your full Australian bank details are provided to avoid delaying the processing
of your refund.
Bank Name: CommonWealth Bank
Branch Name: Pacific Fair Broadbeach
Account Holder’s Name: Dingoos Trust
Account Details: BSB: 064483 Account No.: 10747359

Student Signature: Date:

2 Pacific English Study (CRICOS No. 03215E)

Request Form for Enrolment Defer- Suspend- Cancellation
Level 2, 17 Orchid Avenue; Surfers Paradise QLD 4217 Australia
Tel: +61-7-5527-5306; Fax: +61-7 -5538-4390; E:info@pacificenglishschool.com