If we've recently sent you a communication regarding a refund we owe you, completing this form will enable us to provide the refund as quickly as possible.
You will need to enter your customer number and reference number, as it appears in the communication we sent you.
The protection of your privacy and details is important to us. To find out more information go to our privacy statement.
Reference number*
Customer number*
First Name*
Last Name*
Date of Birth*
Contact Number*
Email address*
A confirmation will be sent to this email address
Name of Account holder*
Bank Account number*
*Information is required. The information provided will be used for refund purposes only and will not update any current policy information.
Once we have your NZ bank account number, your refund will be processed within timeframes as advised in your letter or email. Please ensure you have double checked your bank account number as this will not be verified against any internal or bank records.
Branch Bank Number
Branch
Bank Account number
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