Request for Refund or Test Date Transfer Form
Information for Candidates

Application Process for Refunds

Candidates who seek to cancel their registration or transfer
test dates within the five-day period prior to the test date
will only receive a refund if they can satisfy to theAdministrator that their ability to sit the test has been
affected by illness or serious cause. Serious causes include:

In case candidates seek cancellation or test date transfer
after the test date, candidates must lodge an application forrefund no later than two days after the test date.
Candidates must complete a Request for Refund Form andattach the appropriate documentation and/or evidence.
Acceptable documents may include a medical certificate
from a qualified medical practitioner, a death certificate, or apolice report. Statutory declarations and certificates signed
by family members are not acceptable.

• illness – e.g. hospital admission, serious injury or illness(does not include minor illness such as a mild cold)• loss or bereavement – death of a close family member• hardship/trauma – victim of crime, victim of a traffic
accident• military service.

The Administrator will advise the candidate within one weekof lodging the application whether or not their request has
been approved.
Refunds – If the candidate’s application is approved, thecentre will refund the test fee to the candidate. However thecentre may deduct an administrative fee (no more than 25%of the test fee).
Transfers – If the candidate’s application is approved,
candidates must select a test date within the next threemonth period and this will be approved by the Administrator
depending on availability for the selected test date. Theremay be limited availability for test dates in the first five-weekperiod. Candidates who wish to transfer to a test date morethan three months away should apply for a refund and thenre-apply for the test.

October 2023

Request for Refund or Test Date Transfer Form
Personal details
Title (Mr. Ms etc.) :Given names:

Surname:Address:

Telephone:

Email:

Test date registered for://

Test venue registered for (tick one box): □ Tokyo □ Nagoya
Request is for (tick one box): □Refund□Test Date Transfer

For Test Date Transfer, please specify the following details:
Preferred new test date://Venue (tick one box): □ Tokyo □ Nagoya
Module (tick one box): □ Academic □ General Training
Please choose a session at our Centre still open for booking referring to:https://ieltsregistration.britishcouncil.org/?organisation=UK-PLUS-Nagoya
For weekend (Saturday or Sunday), please specify the preferred sitting.
Sitting (tick one box)

: □AM LRW (PM Speaking) □PM LRW (AM Speaking)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 aProfessional Medical Practitioner. The medical certificate must include nature of illness and other relevant information(with reference to the candidate’s 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).

The information on this form is collected for the primary purpose of assessing your request for a refund/test
date transfer. If you choose not to complete all the questions on this form, it may not be possible for the test
centre to process your request. *Signature must be hand-written.
Candidate signature:

Date:-------------------------------------------------------------------------------------------------------------------------------------------------------------Test centre use only:
Received by:

Request (please select):

Date:

APPROVEDNOT APPROVED

Authorised by:(IELTS Administrator)

October 2023

Date: