Name: Anita
Family name(s): Smith
Identity document
Type:  Passport
Number:  Y2369480K
Issuing country:  United Kingdom
Postal address:  Carrer de Joan Fuster i Ortells, 8, 43007 Tarragona
Further information:   +34 693 455 293

I DECLARE:

  1. I am a student from the University of Sheffield, United Kingdom, currently on an Erasmus programme at the Universitat Rovira i Virgili.
  2. On 25 September I registered on a Catalan for Beginners course at the Language Service and on the same day paid the full course fee (€225).
  3. I was subsequently informed that as a mobility student I am entitled to free basic language tuition.

I REQUEST:

A refund of €225.

SUPPORTING DOCUMENTS

  1. Photocopy of passport
  2. Photocopy of Erasmus learning agreement
  3. Photocopy of Language Service registration form
  4. Photocopy of proof of payment from the bank

[Signature]

Tarragona, 15 October 2014

Language Service
Universitat Rovira i Virgili

 

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