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 ACT & SE NSW 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*
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 ACT & SE NSW 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

NOTE: This form is only to be used when the finance team at ACT & SE NSW 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.

Bank Details for Reimbursement