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 included in the charge you pay
Bought the fuel less than six months ago
Submit no more than three fuel expense claims per form

If you’d like to have the cost of your (home and public) charging sessions reimbursed, contact your employer.

1) Particulars

Vehicle registration plate

Company

2) Driver details

Driver's first name

Driver's surname

Street

Number

Postal code

Town/City

E-mail address

3) Account for making the refund

Name of account holder

IBAN

BIC

4) Refuelling details

Refuelling session 1

Date of refulling session

Number of litres

Amount in euros incl. VAT

More information

Proof of payment

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Number of kilometres

Refuelling session 2

Date of refulling session

Number of litres

Amount in euros incl. VAT

More information

Proof of payment

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Number of kilometres

Refuelling session 3

Date of refulling session

Number of litres

Amount in euros incl. VAT

More information

Proof of payment

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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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Fuel expense refund form

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