Incident Details

What happened?(Required)

Incident date(Required)

Value of excess you are requesting be refunded(Required)

In which country did the incident occur?(Required)

Vehicle make/brand(Required)

Document Uploads

If you have been given a passcode please enter it here

Please upload a copy of your drivers licence(Required)

Max. file size: 2 MB.

Please upload your receipt/booking confirmation(Required)

Drop files here or

Max. file size: 2 MB, Max. files: 5.

Please upload a copy of your vehicle rental agreement with the company you collected your vehicle from(Required)

Drop files here or

Max. file size: 2 MB, Max. files: 5.

Please upload a copy of your bank/creditcard statement showing the charge made(Required)

Max. file size: 2 MB.

Please upload evidence such as an official police report, report from a roadside assistance service, or a repair invoice(Required)

Drop files here or

Max. file size: 2 MB, Max. files: 3.

Please upload photos of the damage if you have any

Drop files here or

Max. file size: 2 MB, Max. files: 5.

Please upload a copy of the pre-rental inspection report (if applicable)

Drop files here or

Max. file size: 2 MB, Max. files: 3.

Please upload any other photos/documents which maybe useful

Drop files here or

Max. file size: 2 MB, Max. files: 5.

Please provide further details(Required)

Please provide any additional information

Vehicle Hire Details

Booking/order/voucher number(Required)

Vehicle Registration Number (check your local hire agreement or damage report)(Required)

Date vehicle hire purchased(Required)

Vehicle hire start date(Required)

Vehicle hire end date(Required)

Your Details

First Name(Required)

Last Name(Required)

Address(Required)

Town/City(Required)

US States(Required)

Postcode/Zip(Required)

Country(Required)

Mobile Phone(Required)

Payment

Please ensure your bank details are correct. We can not refund the card you purchased with as we are a third party refunds service and do not hold your original purchase information. All bank data is encrypted and securely managed.

Payment

Please ensure your Sort Code and Account Number are correct. We can not refund the card you purchased with as we are a third party refund service and do not hold your original purchase information. All bank data is encrypted and securely managed.

Name as it appears on your bank account(Required)

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Account Number 8 Digits(Required)

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Sort Code 6 Digits(Required)

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ABA Routing Transit Number(Required)

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Bank Account Number(Required)

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IBAN(Required)

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BIC

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Declaration

On clicking the 'Submit' button below you will be registering a refund request which we will process on behalf of the vehicle hire company.
If there are other persons on this booking you have the authority to submit a refund application on their behalf.
You shall provide any further information which may reasonably be requested
You understand that the making of a fraudulent or exaggerated refund application is a criminal offence and may leave you liable to prosecution.
You agree that we may contact you via email and SMS for the purposes of this refund application
You agree that your name and email address will be provided to Revolut for the sole reason of processing your refund

Incident Details

Document Uploads

Vehicle Hire Details

Your Details

Payment

Payment

Declaration

This website is operated by Secure Refunds LimitedRegistered office Gibraltar Heights, Bishop Rapallo's Ramp, GX11 1AA, Gibraltar Registered Company Number 106563

This website is operated by Secure Refunds Limited
Registered office Gibraltar Heights, Bishop Rapallo's Ramp, GX11 1AA, Gibraltar Registered Company Number 106563