Cancellation by Participant Contact details of the participant Family name:* First name:* Date of birth (day/month/year):* ---12345678910111213141516171819202122232425262728293031---JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember---19501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008 City of birth:* Country of birth:* Street and house number:* Postal code:* City:* Country:* Email address:* Repeat email address:* Phone number:* Fax number: Please scan your passport (incl. visa/residence permit, if applicable) and upload the scan. About the booking Course number (please only list the modules that you wish to cancel): Start date of the earliest module you wish to cancel (day/month/year):* ---12345678910111213141516171819202122232425262728293031---JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember---2019202020212022202320242025 Please state the reason why you are unable to join the course.* My visa application has been rejected.Other reason Please upload a scan of the rejection letter. Please specify the reason. * Bank details Please enter the bank details of the account that any refundable fees should be transferred to. Information on the account holder Account holder (first name and family name):* Street and house number:* Postal code:* Stadt:* Country:* Information on the bank IBAN: Account number: * BIC/SWIFT:* Name of the bank:* Street and house number:* Postal code:* City:* Country:* I acknowledge that by submitting this form, I agree to abandon my claim to a place in the course in question. The personal data provided in this form, especially your name, address and date of birth, are being collected solely for the purpose of handling your request. They will be processed by Sprachenakademie Aachen gGmbH in accordance with the data protection regulations. Detailed information on data protection as well as on your right of revocation can be found here. I agree that my personal data may be stored and processed for the purpose of handling my request.