Repayment Form

EXAMS IN GOETHE-INSTITUT INDONESIEN

Cancellations made during the registration period: 100% refund
Cancellations made within 7 days after the registration period: 75% refund
Cancellations made after after the abovementioned period: no refund

Refunds will be processed within 14–30 working days.
All cancellation requests must be submitted in writing.

Examination

Examination Date

Examination Location

Customer Number

0062xxxxxx

Full Name

Date of Birth

Mobile Number

Email Address

Payment Method

Payment Receipt

NB: The total size of all uploaded files may not exceed 20 MB.

Bank Account Number

Account Holder's Name

Bank Branch

Reason of Refund

Medical Report

NB: The total size of all uploaded files may not exceed 20 MB.

Terms and Conditions of Cancellation

I am aware of the terms and conditions of cancellation.

* required

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