Rates refund form

If the applicant is in the process of disputing this payment with their Bank, Financial Institution or BPAY DO NOT COMPLETE THIS FORM. Waverley Council cannot take action while the payment is under dispute. The Applicant must refer back to their Bank, Financial Institution or BPAY for action.

PLEASE NOTE: your credit card details are not required, please do not provide this information anywhere on the form.

Property details

Applicant details

Applicant full name *

Applicant phone number *

Are you the

Current owner
Previous owner

Payment Details

Reason for refund (e.g. overpaid in error, waste credit, paid wrong assessment number or other reasons) *

Receipt number (if you have it)

When was the payment made? *
Day Month Year

Amount requested to be refunded? *

Method of payment? *

By Card via Council's Website
By Card via 1300 automated payment line
BPay
In person at Customer Service Centre
In person at Commbank Branch
By Mail to Locked Bag
Direct Debit

Supporting documents Bank Statement and/or Copy of Credit Card Statement including name(s) and address. Please remove credit card number from statement.

Bank Details

Declaration * By accepting this declaration and/or completing the transaction you are verifying that

you are authorised to make this application

the statements and information provided are accurate, true and complete

you have received all relevant third party consents and authorisations

you attest to the validity of all content within this electronic application.

I declare that the information provided in this form is true and correct.

Privacy

Waverley Council (55 Spring Street, Bondi Junction NSW 2022) is collecting and holding your personal information to organise a refund. Finance department will receive and access your refund request. The supply of your information is voluntary. If you do not provide your personal information, we might not be able to access and organise your refund. You have a right to access and correct the personal information you provide. Questions concerning privacy or the use of your personal information should be referred to governance@waverley.nsw.gov.au