Bank Details for a Refund (GG

Bank Details for a Refund

Girl Guides NSW, ACT & NT | ABN 21 366 241 150
NOTE: This form is only to be used when the finance team at North Pacific Coast Region of Girl Guides has requested you complete this form to provide bank details for a pre-approved refund. You will need your REFUND REFERENCE provided by the Finance Team to complete this form.
District/Facility*
Note: Districts are listing alphabetically, including 'east', 'west', etc...
This refund relates to payments for:

1x Youth GG Member2x Youth GG Members3x Youth GG MembersOther person/s - specify below.
Name of Youth Member*

First Name 1Last Name 1
Name of second Youth Member*

First Name 2Last Name 2
Name of third Youth Member*

First Name 3Last Name 3
Other person/s*
Please confirm the name of the person/s or organisation to be refunded.
Name (person completing)*

First NameLast Name
Contact Email*
Please provide email for any additional queries
Mobile/Contact Ph*
Please provide the best contact number for any queries
Miscellaneous and 'OTHER' notes, please detail here:
If there are other details pertinent to this refund please provide details.
Amount to be Refunded*
Please type amount you understand is due to be refunded. e.g. $70.00
Refund Reference*
Finance has provided a 'REFUND REFERENCE', refunds will not be provided without the correct reference. Your reference will be in the format above, as 3 digits, 3 letters and 2 digits.
Bank Details for Reimbursement

Please ensure the bank details provided are accurate as GGA North Pacific Coast Region will not be responsible for retrieval of funds where incorrect account details are provided.
Account Name*
Bank*
e.g. Bendigo, CBA, NAB, St Georges, Westpac
BSB Number*
Please enter 6 digit BSB Number with no spaces
Account Number*
Please enter Account Number with no spaces
Please Sign*

Clear
Please verify that you are human*
Should be Empty:

Bank Details for a Refund

Bank Details for Reimbursement