Applicant Details

Owner Name(s) *

Postal Address *

Primary Phone *

Secondary Phone

Email address *

Property Information

Property Address *

Property No.Property No. is located on the top right hand side of the rate notice.

Refund Details

Refund paid by Electronic Deposit only

BSB No. *

Bank Account No. *

Account Name *

Reason for Refund *

OverpaymentSelling PropertyOther

Other Reason *

Amount to be Refunded *

Less Rates Refund Processing Fee

Refund Amount to be Processed

Applicant Declaration

I understand that by completing and signing this application, this request will be processed in the exact manner specified above and that it will be processed on the next available payment run. *

I understand that the Rates Refund Processing Fee will be deducted from the amount to be refunded. *

I declare that the above details I have provided are true and correct. Mareeba Shire Council does not take responsibility for the supply of incorrect information. *

Applicant Name *

Date *

Applicant Signature *

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Privacy Notice: Mareeba Shire Council is collecting your personal information in accordance with the Local Government Act 2009 in order to process this application. If you choose not to provide your personal information, the application may not be approved. Your personal information will only be accessed by authorised Council employees. Your personal information will not be used for any other purpose or disclosed to any other person or entity unless you have given us permission or we are required by law. Please refer to Council’s QPP Privacy Policy for further information on access or correction of personal information held by Council.