Application to waive late payment of fees

When should you use this form?

This form is to be completed by students who have incurred a late fee as a result of failing to pay their fee for a teaching period by the specified due date or extended due dates for payments. This form must be submitted within 30 days of the late fee being applied.

For your appeal to be considered, ensure all relevant questions are answered.

Your application will not be considered if you have:

Submitted the form AFTER the teaching period
An existing unpaid liability from Swinburne; or
Previously defaulted on financial agreements; or
Not supplied sufficient proof of financial hardship; or
Not completed the form correctly; or
If relevant supporting documentation is not attached.

Fields marked with are mandatory

Personal Details

Student ID:

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Sector:

International Domestic
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Surname/Family Name:

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Given Names:
(leave space between names)

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Daytime Contact Number:

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Course Code:

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Course Title:

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Request to Waive Late Fees

For which semester and year are you requesting the waiver?

Semester:

Semester 1 Semester 2
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Year:

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Please give reasons for requesting a Waiver and include the documentation below when submitting this application (if insufficient space, attach additional documentation). Mandatory This field is required.

I could not pay my fees by the due date because of:

Delays beyond my control – the payment made by Telegraphic transfers was not processed on time though I paid it before the due date or could not be posted due to insufficient information

Medical reasons – Injury/Illness (attach medical certificates)

Family/Personal/Special Circumstances (provide supporting documentation)

Compassionate grounds (provide supporting documentation)

Other (please specify below, providing relevant details and/or documentation)

200 characters left

Have you incurred a late payment in previous years?

Yes No

Attach Supporting Documentation

You can attach up to 3 documents to support your application. Accepted document formats are: GIF, JPG, DOC, DOCX, PDF. Maximum document size is 2MB. Attach supporting documents:

Attach supporting documents:

Privacy Statement & Disclaimer

Swinburne University of Technology collects, uses and destroys personal information in order to locate student invoices and verify the student's postal address and will use the information only for locating student invoices and verifying the student's postal address in accordance with our Privacy Policy.

I understand that if the request that I submit is incorrect or incomplete that my request will not be processed.

I agree to the terms stated above

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