Reimbursement

Reimbursement

4U PLAN MANAGERS
What is a Reimbursement?

A reimbursement is when you get paid back for money you've spent.

For example, if you pay for services or supports that are part of your NDIS plan, you can submit those expenses and receive the money

Note: If you are unsure, please reach out to us before making any payments.
1. Reimbursement Submission Details

Note: this form can only be completed by the participant or their nominated representative.
Name

First NameLast Name
NDIS number*
You can find your 9-digit NDIS number on your plan or myplace portal.
Does the support align with your NDIS plan?

The NDIS will only fund reasonable and necessary supports, as outlined in the 'NDIS Funding Criteria'. Please ensure that you have sufficient funds available in your NDIS plan before submitting this request.
Have you checked that this support can be funded?

YesNo
Please provide any extra details we should know about your reimbursement request
2. Invoices / Receipts
Please upload a copy of any relevant invoices or receipts here.

Cancelof
3. Bank Details

Please provide your bank information for your reimbursement request.
Bank Account Name
BSB
Account Number
4. Declaration

By providing your signature below, you agree to the terms and conditions outlined in this document.
Signature

Clear
Should be Empty:

1. Reimbursement Submission Details