Applicant

Address

Tel. No.

Name

(Name of organization)

(Male/Female)

Date of birth

Name of facility

Period of use

From: (Date/Time)

To: (Date/Time) (____ nights ____ days)

Number of persons eligible for refunding (persons)

Total (male/female)

Adults (male/female)

Teenagers

(male/female)

Children

(male/female)

Reason for refunding

Fees paid

Refundable amount (won)

Account No. for money transfer

Name of financial institution

Account holder

I (we) hereby apply for the refund of fees for the use of a facility as stated above pursuant to Article 4 of the Seoul Metropolitan Government Enforcement Rule of the Ordinance on Establishment and Operation of Nature Experience Facilities for Families.

Date:

Applicant: (signature or seal)

To: Mayor of the Seoul Metropolitan Government