Refund Request Form

Refund details

Type of operation (required)	Refund Cancellation Closing my Current Account
References (required)	(file number, WIPO references, customer number, current account number)
Current account number (required)
Amount to be refunded
Electronic signature (required)	(Max size: 2 MB ; File type: .pdf, .doc / .docx, .jpg or .png) If the amount to be refunded is more than CHF 20'000, please upload your electronic signature here.
Reason for refund (required)
Date of original payment (required)
Supporting documents	(Max size: 2 MB ; File type: .pdf, .doc / .docx, .jpg or .png) (Max size: 2 MB ; File type: .pdf, .doc / .docx, .jpg or .png) (Max size: 2 MB ; File type: .pdf, .doc / .docx, .jpg or .png)

(Reimbursement will be issued to original payer only)

Name of bank (required)
Bank address (required)
Bank country (required)
Bank account number/IBAN (required)
Swift code (required)
Bank identification (routing, ABA, BLZ, sort code)
Proof of bank account details (required e.g RIB, Account Extract, Statement. Your document should match the details provided above.) (required)	(Max size: 2 MB ; File type: .pdf, .doc / .docx, .jpg or .png)
Verification	If you cannot tick the verification box, please ensure you are using Chrome, Firefox or Safari. In Internet Explorer the box may not function correctly.