Tax Refund Application Form (STA17) - Super Tax RefundsSuper Tax Refunds

Title
Name*
First Last
Date of Birth*

Day
Month
Year
Australian Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
International Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Email Confirm Email
Australian Mobile Telephone*
Overseas Telephone Number*
Which Country are you from?*
Passport Number*
Tax File Number*
ABN

Approximate First Date of Arrival in Australia*

Day
Month
Year
Approximate Last Sate of Departure from Australia*

Day
Month
Year
Date when your visa expires*

Day
Month
Year
Would you like us to claim back your superannuation money when you leave Australia?*
- Yes
- No
How many superannuation funds do you think you have?*
Superannuation (1)
Fund Name Member Name (If Known)
Superannuation (2)
Fund Name Member Name (If Known)
Superannuation (3)
Fund Name Member Name (If Known)
Superannuation (4)
Fund Name Member Name (If Known)
Superannuation (5)
Fund Name Member Name (If Known)

VERY IMPORTANT

Please make sure your bank details are correct. We take no responsibility for refunds paid to a wrong bank account as a result of the incorrect bank details you have provided. Retrieval fees apply to trace lost payments.
Please choose where you would like us to pay your refund. If you change your bank details then make sure to email us at info@supertaxrefunds.com.au Please choose from payment options below:
Account Type:*
Account Name*
BSB*
Account Number*
Choose Country*
Account Name*
Bank Name*
Branch Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
SWIFT Code (BIC)*
IBAN*
Sort Code*
Bank Code*
Branch Code*
Transit Code*
FedWire/Routing Number/ABA*
Other Details
Residential Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name	Email	Phone

VERY IMPORTANT