Name

Business Name (if applicable)

Email Address

Address

Postcode

Name of the registered bank account holder (if a business, please include the business name)

Vehicle Registration Number

Bank Account Number (The 8 digit number NOT your long card number).

Sort Code

Amount Agreed (This will be verified by the refunding agent).

First 8 digits of the long card number (Same card used as the original payment)

Last 4 digits of the long card number (Same card used as the original payment)

Has the original card used to make payment now expired or unknown?
If so, please tick this box.
(We can only process refunds to the card that originally made the payment. If this is now expired, we will process a BACS payment after the necessary security checks. Please be aware this may take a little longer).

What is the refund for? (E.g., UTCN refund, Pre-Paid account refund, debt collection agency refund etc.)

Pre-Paid Account Number (if applicable)

UTCN Number (Beginning with "TT") (if applicable)

Which agent authorised your refund (if known)

If your refund was agreed by email or letter, please attach evidence here. This will help the refunding agent verify your refund.

(Please note: 20mb is the combined file size limit for all your uploads, accepted file types are PDF, JPEG, JPG, PNG, DOC & DOCX)