Refund work scheme

Refund of premium

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

Authorisation

Please name your organisation and confirm you have authority to complete this form on its behalf.

Name of the organisation *

Are you authorised to complete this form on behalf of the organisation?

Yes

No

You must have authority to complete this form. If you are not authorised please ask the person with authority to complete the form.

Bank details

Please advise the organisation’s bank account details for this refund.

Account name *

Account number *

Master Group ID number *

Proof of the organisation’s bank account

Please attach a document displaying the company name and bank account, such as a bank deposit form.

Accepted file types: DOC, DOCX, PDF, JPEG, JPG or PNG (Max file size 2MB).

Add another attachment

Organisation address

Please confirm the organisation address.

Street number and name *

Suburb

Town / City *

Postcode

Country *

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 *

Declaration

I confirm that all information supplied in this form is true and correct. *

Refund of premium

Authorisation

Bank details

Proof of the organisation’s bank account

Organisation address

Enter your personal details

Declaration

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