Premium refund | Southern Cross Health Insurance

Refund of premium

If we've contacted you to request your bank account details so we can refund premium, please complete the form below.

Are you the policyholder or have you got authority to make changes for yourself and any other members on your policy?

Yes

No

You must be the policyholder or have authority to make changes to this policy. Please ask the policyholder to get in touch or they can complete a policy authorisation form.

Please provide your bank account details for this payment

Note: The bank account details provided here will only be used for remediation payment.

Bank account name *

Bank account number *

Enter your personal details

These details help us verify who you are so we can deal with your enquiry as quickly as possible.

Title

Optional Optional Mr Mrs Miss Ms Mx None

First name *

Last name *

Date of birth *

Email *

Contact number *

Street name and number *

Suburb

Town / City *

Postcode

Country *

Policy number *

By submitting this form, you acknowledge and agree that personal and health information provided to us (including any supporting documents) will be collected, stored, used and disclosed in accordance with the terms of our Privacy Statement.