Payment form

If we’ve recently sent you a communication about a refund you are entitled to, please fill out the form below for us to provide your refund as quickly as possible.

You will need to provide the reference number and the policy number included on the top right-hand side of the letter or email we sent you, so make sure it’s handy. If you do not complete this form, we may not to be able to provide you with your refund.

Your privacy and safety are important to us. To learn more about how we manage your personal information and how you can protect your details, you can read our Privacy Policy.

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Please answer every question in this form.

Correspondence details

Personal details

We need to collect the following information so that we can process your refund.

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Please ensure you have double-checked your bank account details as this will not be verified against any internal or bank records.

The information provided will be used for refund purposes only and we will not update any current policy information.