Request refund | intranet.ucll.be

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Staff or student:

Staff

Student

Name:

Family name (familienaam)

Given name:

First name (voornaam)

Date of birth:

UCLL ID (r, s, m number):

UCLL ID (u-number):

Private email address:

NOT your UCLL e-mail address !!

Repeat private email address:

Region of bank account for refund

Choose the region of the country where the bank acocunt is registererd.

Bank account IBAN code EU:

Enter the IBAN code of the bankaccount on which the balance has to be refunded. MAKE SURE THAT YOU ENTER THE CORRECT IBAN CODE !!

Bank account IBAN code :

Enter the IBAN code of the bankaccount on which the balance has to be refunded.

Bank account holder

Enter the name of the bank account holder.

Motivation

Motivate the reason why you are requesting a refund of your UCLL balance.