Waiver of the deductible for psychological concerns

Personal Details

Application for *

First- & Lastname *

Matriculation number (without m): *

Mobilenummer *

+43

UNI-E-Mail *

Address, Postal code, City *

Account details for refund

Name of bank account owner *

IBAN *

BIC *

Explanatory statement (Reasoning regarding financial and social situation):

Explanatory statement (Reasoning regarding financial and social situation): *

Invoices *

Drag and drop files here or Browse Max file size: 3MB

- Max. 3MB, nur .pdf

Confirmation of studies *

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(from the semesters in which the counseling session has been booked)

Confirmation of eligibility for social sponsorship

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(e.g.: confirmation of receipt of study allowances, proof of income etc.)

Complete bank statemens of the last three months, including the current balance *

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Declaration of consent

I accept that my personal data will be processed and stored throughout the application and for the purpose of authorized sponsorships. *

I hereby validate with my signature the correctness and completeness of the statements above. Furthermore, I confirm that I have no other current accounts, savings accounts, etc., except those whose statements are enclosed with the application. *

Are you a robot? *

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