OFFICE USE ONLY
Completed by:
Date Received: Signature:
Refund Authorised: Yes No
Refund approved Signature: Position: Date:
Payment approved Signature: Position: Date:
Assesment No:
Reason for Refund:
Refund Amount: $
Method of Refund: Cheque Bank Transfer (Note: GDC only make payments on the 20th of each month)
Account Name:
Account Details:
Bank Branch Account Number Suffix
Property Owner Details:
Postal Address:
Phone: Mobile: Email:
Signed (on behalf of client) by: Date:
Solicitor Rates Refund Form
29 Bowler Avenue, Gore 9710
PO Box 8, Gore 9740
Phone 03 209 0330
Email info@goredc.govt.nz
www.goredc.govt.nz
Solicitor Rates Refund Form 1
RURAL CITY LIVING
Creditor Refund
Creditor (AP) Number:
Bank Account Number given/ Already has a creditor
account setup
GDC Transfer
select one of the below
AP 587.01
(electronic)
AP 14.01
(cheque)
To account:
Internal transfer only
Non Creditor Refund
* No bank Account Number given (Cheque only)
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