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

Tarragona, 15 October 2014