BSBI – Berlin School of Business and Innovation GmbH

Alte Post, Karl-Marx-Straße 97-99

12043 Berlin, Germany

+49 (0) 3058 584 0959 | info@Berlinsbi.com I berlinsbi.com

Withdrawal and Refund Application

Please DO NOT PRINT this form. This is an editable PDF form, which MUST be filled in digitally.

The Deadline for submission of Refund Request, as per Study Agreement and Refund Policy, is 14 days prior to start date of the relevant Intake.
Students, whose visa was refused, are exempt from the Deadline condition. Once the visa refusal received, the student has up to 45 days to apply
for the refund from the date on the visa refusal letter.
Please fill in all fields of this form and send it back to us as a PDF document at refunds@berlinsbi.com. The processing of your refund request will take
30 days, after submission of this form to BSBI.

SECTION 1: STUDENT DETAILS

Full Name:
Prakash Bishwakarma

Student Number: Passport Number:

Q1077188 BA0299709

Address: (including country):

Giritole, Kshireshwornath 5, Dhanusha,
Kshireshwornath 45608 Nepal
Telephone Number (incl. Country Code):
+977 9819882985

SECTION 2: WITHDRAWAL OR REFUND REASON

Withdrawal from the course of study (with possible refund) due to:

Visa Rejection

Conditions of offer letter not met (including failure of the English test)

Health Conditions

Other Reasons

Refund due to:

Overpayment

Refer a Friend Scheme

Scholarship

Other Reasons Financial issues

A refund will be subject to deductions based on the Study Agreement.

An Administration Fee of €150 is charged as per the Section V of the Study Agreement.

Geschäftsführung/CEO: Sagi Hartov und Ernst Suganandarajah

HRB: 190515 B, Amtsgericht Berlin, Berlin School of Business and Innovation Gmbh
BIC: BEVODEBBXXX. IBAN: DE54 1009 0000 2959 2060 00. VAT No.: DE323208809 V6 Nov 22
SECTION 3: BANK ACCOUNT DETAILS
Please ensure that correct details are quoted. Failure to do so may result in delay and additional charges.

Bank Name:
Prabhu Bank Limited

Bank Address (including country):

kaushaltar, Bhaktapur, Nepal

Account Holder Name:

Prakash Bishwakarma

Account Number/IBAN:
2647039817800018

Swift Code/BIC Code:

PRVUNPKA

IFSC Code (for India only):

Currency of the Bank Account:

NPR

SECTION 4: THIRD-PARTY BANK ACCOUNT DETAILS

If you need the funds to be transferred to another person or company, please tick YES or NO. If yes, please enter the full name of company or person,
including the Passport Number.

Yes No

Full name of Company or Person (with Passport number):

Bank details of third-party, please put in section 3.

SECTION 5: SPECIAL TRANSFER

In case you wish your deposit/tuition fees to be allocated for another applicant/student, please indicate the student number, name and passport number

Student Number:

Full Name:

Passport Number:

Digital Signature:

Date:

For BSBI Staff to fill out:

As per our account you paid an amount of € We will therefore refund € into your quoted bankaccount above.

Geschäftsführung/CEO: Sagi Hartov und Ernst Suganandarajah

HRB: 190515 B, Amtsgericht Berlin, Berlin School of Business and Innovation Gmbh
BIC: BEVODEBBXXX. IBAN: DE54 1009 0000 2959 2060 00. VAT No.: DE323208809 V6 Nov 22