Scribd Logo
Upload

Welcome to Scribd!

  • WOW Refund Processing Form 1

    Uploaded by

    Jerome
    60 views1 page
    This refund processing form collects customer and account details to process an insurance refund via electronic funds transfer. The customer must be the primary policy holder listed on the policy. By signing, the customer consents to the collection and disclosure of their account information solely for the purpose of facilitating the refund. The form and account details can be emailed to the provided address for processing.

    Original Description:

    Woolworths refund processing form

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    This refund processing form collects customer and account details to process an insurance refund via electronic funds transfer. The customer must be the primary policy holder listed on the policy. By signing, the customer consents to the collection and disclosure of their account information solely for the purpose of facilitating the refund. The form and account details can be emailed to the provided address for processing.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    60 views1 page

    WOW Refund Processing Form 1

    Uploaded by

    Jerome
    This refund processing form collects customer and account details to process an insurance refund via electronic funds transfer. The customer must be the primary policy holder listed on the policy. By signing, the customer consents to the collection and disclosure of their account information solely for the purpose of facilitating the refund. The form and account details can be emailed to the provided address for processing.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    of 1

    Refund Processing Form

    Complete the form using blue or black pen and print in clear CAPITAL LETTERS
    Customer Details
    Given names(s) Surname

    Policy Number Contact Number

    Refund Amount

    Account Details
    BSB Account number
    –
    Account name Account type

    Savings Cheque

    Conditions
    Refund can only be issued to the primary policy holder listed above. Refunds will be processed via Electronic
    Funds Transfer (EFT).

    Authorisation
    I consent to Woolworths Insurance collecting, using and disclosing the above account details for the purpose
    of facilitating this refund to me. You can obtain a copy of our privacy policy by visiting our website
    woolworths.com.au/insurance or by calling us on 1300 575 725.

    Signature

    Date

    Name

    By updating your details you give us the authority to debit this nominated account for future payments, if the policy
    owed a refund is active.

    Please return this to us by:

    Email: scan or take a photo of your completed form and send it to:
    CustomerSolutions@woolworthsinsurance.com.au

    Issued by The Hollard Insurance Company Pty Ltd ABN 78 090 584 473 AFSL 241436

    You might also like