If we've contacted you to request your bank account details, so we can refund any overpaid premium, please complete the form below.
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.
Note: The bank account details provided here will only be used for remediation payment.
You can use a screenshot of internet banking, a deposit slip, or a copy of a statement. All transaction details can be blanked out, but please ensure the proof includes the full account number and the name that's listed on the bank account.
Accepted file types: DOC, DOCX, PDF, JPEG, JPG or PNG (Max file size 2MB).
These details help us verify who you are so we can deal with your enquiry as quickly as possible.
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 Member Privacy Statement.