myki Refund &

Reimbursement
form
Use this form if you would like to:
> refund the full balance of your myki; OR
> claim a reimbursement; OR
> convert your myki pass to mykimoney.
PTVH0370 / 0414. Authorised by Public Transport Victoria, 750 Collins Street, Docklands
For more information visit ptv.vic.gov.au
or call 1800 800 007 (6am midnight daily)
If you are deaf, or have a hearing or speech
impairment, contact us through the National
Relay Service:
> TTY users phone 133 677, then ask for
1800 800 007 (6am midnight daily).
> Speak and listen users (speech-to-speech
relay) phone 1300 555 727, then ask for
1800 800 007 (6am midnight daily).
If you need an interpreter:
> Call the Translating and Interpreting Service
(TIS National) on 131 450 and ask for
1800 800 007 (6am midnight daily).
Post this form with your myki (unless lost or stolen) to:
> myki Mailbox
Reply Paid 4318
MELBOURNE VIC 8060
(No stamp required)
If you are requesting a full refund or converting
your myki pass to myki money, dont forget
to include your myki when you post this form.
Note for students
Are you a student pass holder? You MUST return this form
to the station that issued your student pass and get your
VPT concession card updated.
Note to Commuter Club members
You can use this form to claim a refund see Section C.
For more information about myki Refund
& Reimbursement visit ptv.vic.gov.au or call
1800 800 007 (6am midnight daily).
myki Mailbox
Reply Paid 4318
MELBOURNE VIC 8060
(No stamp required)
Please submit your myki with this form
>
if you are requesting a full refund, or
>
if you wish to convert your myki pass to myki money.
Post this form to
Use this form to do one of three things:
Refund the balance of your myki
Claim a refund when you want your full balance refunded
and your myki card cancelled. There are no partial
refunds. You can choose to get your refund by cheque,
or credit the funds to another myki.
If your balance includes a partly used myki pass, you
should submit this form as soon as possible. Used myki
passes that have expired are not eligible for a refund.
Claim a reimbursement
A reimbursement is a pay back or compensation. You
can either get your reimbursement (i.e. myki money spent
and / or myki pass days elapsed) by cheque or you can
credit the funds to a myki of your choice. Reasons for
reimbursement include medical conditions, system faults
and special consideration / other reasons.
Convert your myki pass to myki money
Convert your myki pass to myki money when you no
longer wish to travel on your myki pass, but want to
continue using your myki. You can then use the new myki
money credit to travel, or you can use it to buy another
myki pass for a different zone or time period. You can
convert an unused myki pass OR a partially used myki
pass to myki money.
Do I need to send in my myki card?
Refund of balance Yes
*
Claim for reimbursement No
Convert your myki pass to myki money Yes
*
* If your registered myki has been lost or stolen, you may still submit
this form.
General Information
For more information visit ptv.vic.gov.au
or call 1800 800 007 (6am midnight daily)
Please provide details of the cardholder (if your myki is not registered) or the account holder (if your myki is registered).
The cardholder is the person who uses the myki to travel, and the account holder is the person to whom the myki is registered.
The cardholder and account holder can be the same person.
Postal Details
Postal details are required for delivery of the cheque or any required correspondence.
* Title (Mr, Mrs, Miss, Ms, other) * Given name
* Family name
Contact Details (Please provide at least one telephone number)
Daytime phone number (with area code) Mobile number
* Preferred Method of Contact (Please choose at least one)
Email Telephone
Street name
* Suburb / town
Page 1 of 4
Email address (Please complete using CAPITAL LETTERS.)
Street number Unit number PO Box number
* State * Postcode
Application for myki Refund
&Reimbursement form
How to complete this form
>
Place a cross

X

within the appropriate box when selecting an option.
>
Please use BLACK INK and print within the boxes using CAPITAL LETTERS.
Please complete the mandatory elds marked with an * below.
Section A: Customer Details
FRF-M-003-W
FRF-M-003-W
Page 2 of 4
To claim a reimbursement, please provide details below in support of your reimbursement request. Also provide preferred
method of reimbursement cheque or myki money credit to a nominated myki card. The maximum myki money credit
amount is $250. If your reimbursement is greater than $250 you will be issued a cheque instead.
You dont need to send in your myki with this form.
A reimbursement of credit > GO TO SECTION D
myki card number
The 15-digit card number can be found
on your myki.
I wish to apply for:
Remember to send in your myki with this form.
My myki pass to be converted to myki money > GO TO SECTION E
IMPORTANT: a myki pass with a remaining value greater than $250 cannot be converted to myki money. If your remaining pass value
exceeds $250, you will be issued a cheque refund. You may wish to continue use of your pass until its value drops below $250.
Remember to send in your myki with this form.
A full refund of my myki balance > GO TO SECTION C
Is refund due to a change of concession type?
For a registered myki, cheques will be sent to the account holder.
Cheque to me
Please credit my refund as:
Name of Commuter Club (employer/organisation)
Cheque to my Commuter Club Account Coordinator
myki card number
The 15-digit card number can be
found on your myki.
Credit myki money to the myki card below
The maximum myki credit amount is $250. If your refund is greater than $250 you will be issued a cheque instead.
Claims due to medical condition should be forwarded AFTER your myki pass expires. Attach a medical certicate that covers
each day you are claiming. Conditions apply.
Medical condition
I am claiming a reimbursement due to:
Section B: myki Card Details
Section C: Claiming a Refund (myki money credit or cheque)
Section D: Claiming a Reimbursement
Please read and sign the Privacy Notice and Declaration in Section E.
Please read and sign the Privacy Notice and Declaration in Section E.
FRF-M-003-W
FRF-M-003-W
Special consideration/other reason (Please detail below)
Ticket sale, ticketing equipment or system fault
Equipment serial number (if applicable and known)
Date of incident (dd / mm / yyyy)
Time of incident
: AM PM
Location of incident (if applicable)
Please credit my reimbursement as:
Details of claim If insufcient space, give details on an attachment.
For a registered myki, cheques will be sent to the account holder.
A cheque
The 15-digit card number can be found
on your myki.
myki card number
Credit myki money to another myki card (listed below)
Credit myki money to my myki card
myki money will be credited to the myki listed in Section B.
Page 3 of 4
Section D: Claiming a Reimbursement (cont.)
Please read and sign the Privacy Notice and Declaration in Section E.
FRF-M-003-W
FRF-M-003-W
Public Transport Victoria (PTV) understands and respects your right to privacy and are committed to privacy protection. The Information
Privacy Act 2000 (Vic) and PTVs Privacy Policy regulate how we collect and handle your personal information.
The account holder or cardholder (you) will generally be able to access personal information. If personal information sought by the Public
Transport Victoria (PTV) (we or us) is not provided, we may not be able to full your request. For further information about privacy and on
rights of access to personal information, visit ptv.vic.gov.au or call 1800 800 007 (6am midnight daily).
Unregistered cards: Personal information you provide is collected by or on behalf of the Transport Authorities
#
for the purpose of fullling
your request, and will be used and disclosed only for this purpose.
Registered cards: Personal information provided by or about you or generated by using the Card is collected by the Public Transport
Authorities
#
to issue and administer the Card and relevant entitlements.
Personal information held by the Public Transport Authorities
#
may be used or disclosed (including to each other) for the operation of the
myki ticketing system; to verify entitlement to concession travel; for ticketing enforcement; complaint resolution; in emergencies; otherwise
as required or authorised by or under law; or with your consent. A cardholders personal information may be disclosed to an account holder.
# Public Transport Authorities means PTV, The Department of Transport Planning and Local Infrastructure and any agent, contractor or delegate of PTV
or The Department of Transport Planning and Local Infrastructure including public transport operators.
* Signature of applicant or legal guardian / agent for applicants unable to sign
* Date (dd / mm / yyyyy)
please sign
I am applying for a refund or reimbursement as stated above.
I have read the Privacy Notice.
Date (dd / mm / yyyyy) Location of lodgement
Name of staff member
Has VPT student concession card been replaced (if applicable)?
Yes No
Administration Fee (not applicable)
PTV / KAMCO use only
Date (dd / mm / yyyyy)
myki card number
Customer, please separate and retain. Enquiries: please call 1800 800 007 (6am midnight daily).
The 15-digit card number can be found
on your myki.
Page 4 of 4
Section E: Privacy Notice and Declaration
Section F: myki Office Use only
Section G: Refund & Reimbursement Customer Receipt
Please read and sign the Privacy Notice and Declaration in Section E.
FRF-M-003-W
FRF-M-003-W