Charging cost or fuel expense refund form

If, for some reason, you have to pay for fuel or charging out of your own pocket (like when your card is not working), you may be eligible for a refund from KBC Autolease, provided you:

Have a contract lease vehicle with fuel or charging cost included in the charge you pay
Bought the fuel or charging cost less than six months ago
Submit no more than three fuel or charging expense claims per form

1Particulars

Vehicle registration plate

Company

2Driver details

Driver's first name

Driver's surname

Street

Number

Postal code

Town/City

E-mail address

3Account for making the refund

Name of account holder

IBAN

BIC

4Charging or refuelling details

Charging or refuelling session 1

Date of charging or refuelling session

Number of litres/kWh

Amount in euros incl. VAT

More information

Proof of payment

Browse…

Number of kilometres

Charging or refuelling session 2

Date of charging or refuelling session

Number of litres/kWh

Amount in euros incl. VAT

More information

Proof of payment

Browse…

Number of kilometres

Charging or refuelling session 3

Date of charging or refuelling session

Number of litres/kWh

Amount in euros incl. VAT

More information

Proof of payment

Browse…

Number of kilometres

Total refund claimed

KBC Autolease aims to process your personal data in a manner that is lawful, appropriate and transparent. Further details about how we process and share your personal data are set out in our privacy statement. It explains your rights and how you can exercise them. Our privacy statement is available at www.kbc.be/autolease/privacy, at your branch or from your intermediary and is regularly revised.

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