Refund Change Form

Please complete this form to request a refund. All refunds will be processed via BACS (Bankers Automated Clearing ��).

Customer Information

Title

First Name(s)

Surname

Address

Address 2

Town

Postal Code

Phone Number

Email Address

Refund Details

Council Service the refund relates to:

Council Tax

Non-Domestic Rates

Sundry Debtor Invoices

Blue Badge

Registration

Other Council Service

Please advise which service

Reference Number (if applicable):

Reason for refund:

Amount to be refunded (if known):

Bank Details for BACS Payment

Please ensure the bank details provided are accurate. The Council is not responsible for payments made to incorrect account details provided on this form.

Account Holder’s Name:

Bank Name:

Sort Code:

Account Number:

Declaration

I confirm that the information provided above is accurate and that I am the rightful recipient of the refund. I understand that my bank details will only be used for this refund and not for any other purpose.

Your Name:

Privacy Notice: The information you provide on this form will be used solely for the purpose of processing your refund. Your data will be handled in accordance with our privacy policy.

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