Reimbursement Claim Form

If you have a Novated lease with Summit Fleet, please complete your request through our
Summit Fleet Novated app on your mobile device for faster processing.

Click here to download the app.

Full Name *

Email Address *

Mobile *

Phone

Vehicle Registration Number *

Company *

Fuel

Please record the Odometer Readings and, if purchasing fuel, the number of Litres of each fill. This information is required to give running costs and fuel consumption history of the vehicle.

Date

Odometer Reading

Litres Purchased

Description of Expense

Amount $

Add Remove

Total $

Reason for Reimbursement Claim

Other

Please be sure to provide proof of payment for claim as well as an invoice with GST break up to assist in reimbursing you promptly.

Date

Odometer Reading

Description of Expense

Amount $

Add Remove

Total $

Bank Payment Details

BSB *

6 Number

Account Number *

Name of Account *

Please attach a copy of the payment receipt *

Maximum file size: 30MB

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Reimbursement Claim Form

Fuel

Other

Bank Payment Details

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