Third Party Billing and Payment Agreement
This form must be submitted for each semester of registration at the Canadian University Dubai. The University will accept third party contractual agreements if the following conditions are met:
1.
2.

The terms and conditions of the financial obligation between the student and the third party are clearly identified.
This agreement form is signed by the third party and the student.

DEADLINE for SUBMISSION: This form must be submitted prior to the end of the Add/Drop period of the semester.
Student Name

Student ID

Third Party Name

Mobile Number

Billing Contact Name

Billing Address

Billing Mobile/Phone

Semester/Term

Billing E‐mail Address

Amount Owing

Please identify if the amount owing is
Estimated or Actual.

Estimated Cost OR Actual Cost

Percentage Covered

Does the payment by the Sponsor/Organization cover:
Tuition

Yes/No

Fees (non‐refundable)

Other: (Please specify.)

Specify Maximum N of Credit Hours

Specify Minimum N of Credit Hours

Method ofPayment

Details of Payment

University Sponsorship Office Signature:
Date:

Cashier Stamp:
June 2015 v1

Yes/No

Housing (non‐refundable

Yes/No

Student Agreement
I acknowledge that my signature authorizes release of my financial and academic details to the Third Party person or organization for the purpose of paying tuition and fees and eligibility for funding in future semesters.
I fully understand and agree that if the Third Party Sponsor or Payee named in this agreement does not pay all funds assessed to my account in full, it is my responsibility to pay in full any and all outstanding financial obligations to the Canadian University Dubai.I acknowledge that I will be unable to obtain an Official Transcript, qualifyfor graduation and/or registerin subsequent semesters until all outstanding fees are paid in full.
I fully understand that if I withdraw from a course I am required to inform the sponsor or organization that I have withdrawn and/or changed the terms of this agreement. I acknowledge that I will be eligible for a refund based on the assigned percentage or amount identified above. The refund will be applied to the next semester of registration until I withdraw from studies at the Canadian
University of Dubai or graduate.I understand that there is no refund of scholarship, bursary or discount amounts.
Print
Name:

Signature:

Date:

Thirty Party or Sponsor Agreement
I agree to pay the amount specified above immediately upon receipt of the University’s invoice and that payment is not contingent upon the student’s grade or academic status.
I understand that I or my organization must respect payment deadlines and that I or my organization will pay late payment penalties or be subject to UAE laws regarding delinquent accounts.
I agree to pay the amount by bank transfer or cheque only. The University does not accept Third Party payments by cash or credit card. I fully understand and agree that if I or my organization does not pay the amount identified in this agreement in full, that the student will be responsible for the full amount and will be unable to obtain an Official Transcript, qualify for graduation and/or register in subsequent semesters until all outstanding amounts are paid in full.
I further understand that I will forfeit access to the student’s academic record if I or my organization has not paid the amount identified in the statement above.
I fully understand that if the student withdraws from a course and a refund is available, I or my organization will be eligible for a refund based on the assigned percentage or amount identified above. The refund will be paid in the manner in which it was received six weeks after the end of the semester. I understand that there is no recovery of fees or scholarship amounts should the student be eligible for a scholarship.
I understand that the University reserves the right to cancel this agreement at any time.
Print
Name:

Signature:

Sponsor’s Stamp (if applicable)

June 2015 v1

Date: