Reference Code:
For technical assistance with this form please submit a call back request via the ACT Government Feedback System or phone the Canberra Connect Contact Centre on 13 22 81.
For enquiries relating to your Refund Application please contact Access Canberra on 13 22 81.
Please resolve the following issues before proceeding
Click on an issue to go directly to the related section of the form.
errors found:
warnings found:

Request Received

Refund Application
Thank you, your submission has been received.

Next steps

You are required to complete these additional forms to finalize your request.
Your Reference Code is:
Please quote your reference code when enquiring about your submission.

For your records

Would you like a copy of this submission for your personal records?

Check your email

We've sent a copy of your submission to your email address ().If you didn't receive it or would like another copy, just select one of the options below.
Refund Application - Submission confirmation
Your submission has been successful. Please keep a copy of this receipt for your records.
Access Canberra
ABN 16 479 763 216
GPO Box 158
Canberra City 2601
Telephone: 02 6207 1923

Request type

Refund Application
Fields marked with * are required

Staff member completing form

Individual or company requesting refund

Refund Application
Fields marked with * are required
Is the payer: *
Contact person

Postal address

Site details

Refund Application
Fields marked with * are required
If you require help with suburb/district, section or block details, visit ACTMAPi.

Payment options

Refund Application
Fields marked with * are required
Would you like the refund to be paid by *

Postal address

Please note: An administration fee may be deducted from the refund. For administration fees, please refer to the current Fees and charges.
Administration fee applicable?
Has customer been notified?
Please contact client to advise prior to completing this form
Is the application for refund approved? *

Delegate decision

Refund approved? *
© Copyright Avoka Technologies 2019