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Student number:
First name:
*
Last name:
*
Email address (must be accessible long-term):
*
I hereby confirm I paid UCU Campus Fees for the spring, summer, and/or fall of 2023.
*
Do you have a Dutch or a foreign bank account?
Dutch
Foreign
IBAN:
*
Account holder
Name:
*
Street & number:
*
Zipcode:
*
City:
*
Country:
Bank name:
*
Bank address:
*
Zipcode:
*
City:
*
Country:
*
Routing number or IBAN:
*
SWIFT or BIC:
*
Account number:
*
Name account holder:
*
Street and number:
*
Zipcode:
City:
*
Country:
*
*
=
Input is required
This statement applies so long as campus fees were paid to UCU for your stay - by you yourself and/or your parents, for example.