Refund Form

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					Please complete form, attach your membership card and evidence required.

Refund Form

Personal and policy details
Given Name:                                                           Family Name:                                                Date Of Birth:    /      /

OSHC Policy Number:                                                   Policy Expiry Date:

Contact Phone Number/s:                                               Email Address/es:

Refund reasons and evidence required

        REASON FOR REFUND                                                            EviDENcE REqUiRED

           you had paid your premium and did not come to                             » Letter from Department of Immigration indicating decline of student
           Australia                                                                   visa; or
                                                                                     » Letter from Institution confirming you will no longer be coming to
                                                                                       Australia to study;

           your Student Visa was not extended, was cancelled or                      » Letter from Department of Immigration indicating non renewal,
           renewal/extension was refused                                               extension or cancellation; and
                                                                                     » Copy of student visa;

           you are obliged to cease studies and leave Australia                      » Certificate of completion from Institution; and
           before the end of a period of approved stay for reasons                   » Flight departure details (ticket, boarding pass or exit stamp and
           beyond your control                                                         identification page from passport);

           you have been granted permanent residence in Australia                    » Copy of permanent residency visa label from your passport;

           you did not reside in Australia for a continuous period of                » The Deed states you must maintain continuous cover whilst you are
           3 months or more but you still held a valid Student Visa                    holding a valid Student Visa, to ensure you meet this requirement
           for this period                                                             please visit and download our Holiday
                                                                                       Credit fact sheet:
                                                                                     » You will be required to apply for a Holiday Credit;

           you can provide proof of OSHC with another organisation                   » Certificate of Insurance from another OSHC provider (showing:
                                                                                       commencement & expiry dates, listed beneficiaries and type of policy)

           you have simultaneous policies with OSHc Worldcare                        » Provide all of your current policy numbers; and
                                                                                     » Copy of entry stamp into Australia; and
                                                                                     » Copy of Student Visa;


  Please indicate the date:
  » you will be departing Australia;                                                                D   D    /   M   M    /   Y   Y      Y   Y
  » you were granted your new visa;
  » you commenced cover with another OSHC provider;

  DON'T FORGET TO ATTAcH YOUR MEMBERSHiP cARD/S                                           NB: You must return all membership cards to complete your refund

  If you cannot return your membership card, please indicate the reason and sign below:

       Membership card has been lost                       Membership card has never been received

  Other – please state: __________________________________________________________________________________________________________

  Signature: ________________________________________________________________

  Date: ____________________________________________________________________
Payment options

   cREDiT cARD

  If you purchased your policy by credit card directly from OSHC Worldcare in the last 12 months, your refund will return to the credit card used
  to make the purchase. Please note if the credit card isn’t in your name, then you will need to contact the owner to organise reimbursement.


  Bank / Fund Name: ____________________________________________________________________________________________________________

  Account Holder’s Name: ________________________________________________________________________________________________________

  Account Number: (maximum of 9 digits) ________________________________________ BSB: (6 digits) ______________________________________

       NB: In the case of incorrect/incomplete information being provided, bank charges will be deducted from your refund amount.

  Bank / Fund Name: ____________________________________________________________________________________________________________

  Account Holder’s Name: ________________________________________________________________________________________________________

  Account Number: ______________________________________________ Swift Code: _____________________________________________________

  IBAN (where applicable): __________________________________________ Routing Number (where applicable): _________________________________

  Bank Address (full street address): _________________________________________________________________________________________________

  Currency which your account is held in: __________________________________________________________________________________________

General Processing of Refunds:
» We will endeavour to process all refunds within 10 working days of receiving a completed refund request form (necessary supporting evidence).
» We may contact you to clarify any details or request further information in order to process your refund.
» Refunds are calculated on a monthly pro-rata basis, with a minimum refund of one month.
» A minimum cover period of 3 months is payable if cover is cancelled after arriving into Australia.
» There is no minimum cover period payable if cover is cancelled prior to arrival in Australia.
» For transfer to someone else’s account, please provide a signed and dated letter of authority.

Please send completed                                          ETI Australia Pty Ltd trading as OSHC Worldcare
                                                               ABN 52 097 227 177
Refund Forms to:
                                                               Privacy: The information that you provide is collected for the purpose of arranging a refund of
OSHc Worldcare                                                 your OSHC Worldcare premium. The information will be disclosed to educational providers the
Locked Bag 3001                                                underwriter, government departments responsible for OSHC, medical practitioners, hospitals
                                                               and other medical and assistance providers. If you would like to gain access to your personal
Toowong QLD 4066                                               information please contact OSHC Worldcare.

Phone: 13 OSHC (13 6742)
                                                                                                                        In association with
Fax:   +61 7 3305 7009