Damage / Deposit Bond application form

DAMAGE DEPOSIT / BOND APPLICATION FORM

Use this form when making payment for a damage deposit or bond

For further information or questions regarding this form, please contact Council via 9911 6555

Property Details

Property Address: *

Lot:

DP:

SP:

Applicant details (to whom the future refund will be released)

Company Name

Surname: *

First name: *

Email: *

Contact phone number: *

Application number: *

Postal address: *

Refund method

I wish to nominate the following method of refund: *

ChequeEFTCredit Card* (Not available for all refunds)

* Refund to the same credit card is the default method available only for damage deposit/bonds paid via Council’s eServices online portal. The card must be valid and current at the time of refund.

EFT account details

EFT account name

BSB number

Account number

Applicant declaration

1. I hereby state that the above information is true and correct;

2. I am the person responsible for making this damage deposit/bond payment and am the authorised person to receive the refund;

3. I will advise the City of Canada Bay Council of any changes to my address; bank account; or credit card, and understand that failure to update these details may delay payment of the refund at a later date.

Signature *

Draw signature|Type signatureClear

Date *

Bags

(For Internal Use Only)

BagDamDep, DwayDuplex, DwayIndCom, DwayRes, SkipBin, BusUsePath, RdDamage2, AccOvCou, AccRoadRes, CommPtyBon, RdWrksApp