• Complete this form using BLACK INK and print well within the boxes in CAPITAL LETTERS.
• To provide us with your refund payment instruction, please sign this form and send it back to us within 30 days. If we do not receive a response from
you within 30 days, the payment, will be processed as per the instruction on your cover letter.
• It may take up to two weeks to process your payment.
macquarie.com
Account number:
Account name:
This should be the account number referenced on your refund letter. If you’re unsure of this, please contact your relationship manager or call
us on 1800 672 162.
Former account details
1
I would like the payment to be made to children’s charity, Bear Cottage, on my behalf.
I would like the payment to be made to the bank account below.
BSB:
–
Bank account number:
Bank account name:
Please note, if section 2 is left blank, the payment will be made to charity.
Please check to ensure the BSB and account number are correct, as the account name is not used for processing payments. Entering incorrect
details may mean the wrong account is credited and it may not be possible to recover the funds.
2
How would you like this refund to be treated?
By completing and signing this form, you acknowledge that you were the account holder(s) for the account in section 1 above and that you would like
the payment owed to that account to be made according to the instruction provided in section 2 above.
Signature 1
Date:
/ /
Name:
Phone:
Signature 2
Date:
/ /
Name:
Phone:
3
Signatures
10/21 - OTC
Macquarie Business Banking
Refund instruction form
This information is provided by Macquarie Business Banking, a division of Macquarie Bank Limited ABN 46 008 583 542,
AFSL and Australian Credit licence 237502.
We will handle your personal information in accordance with our Privacy Policy available on our website.
Please scan and email the completed form to business@macquarie.com.
