REQUEST FOR REFUND OF REALISATIONS CHARGE

Trustee  name:	     	
Contact person:	     	
Phone:	     	
Email:	     	

RE: Administration Number	Estate Number          Debtors Name		
 	 
Amount of refund claimed		Date/s of original payment
$      				              
$      				     				 
$      				     

Reason for refund (please tick appropriate reason and provide a brief explanation in the box below)

       Error in original calculation of the Realisations Charge	

       Adjustment due to payment of surplus to debtor	

       Other   
 
REFUND INFORMATION:
Please outline the circumstances giving rise to the claim for refund.   

 

PLEASE ATTACH A STATEMENT OF RECEIPTS & PAYMENTS IN THE ESTATE.

ITSA Office Use Only	Date request received:		
	Date of original payment:		
	Original payment batch/ref:		
Refund Recommended:        Y       N	Date refund approved/rejected:		
Reason Refund Declined:

Authorised officer:

		Date: