Use this form to apply for a partial refund relating to an overpayment of a PBR examination fee. You may be entitled to a partial refund if your growing trial was conducted at an authorised Centralised Testing Centre (CTC) from 1996 onwards and you paid more than the discounted examination fee that applies to such applications. Applicable examination fees to 30 June 2012 were $800 and from 01 July 2012 are $920. Each edition of the Plant Variety Journal published the CTCs authorised at the time of their publication. IP Australia is unable to process a request for a refund without this completed form. For further information please contact us on: Phone: 1300 65 10 10 (9am to 5pm, Monday to Friday) Canberra time Your Contact details Your Name * Company Name and ABN Contact phone number * Contact email address * Address * Please select the most relevant option * Please note that refunds will only be made to a person or entity that was the applicant at the time the examination fee was paid (or their current Agent). If you are the current Agent representing the PBR applicant/owner you will need to provide a letter of authorisation from the applicant/owner to request a refund on their behalf. I was the Applicant at the time the examination fee was paid I am an Agent acting on behalf of an entity or person who was the Applicant at the time the examination fee was paid Other Please specify Letter of Authorisation * Upload Once you have chosen your file, it will automatically upload. You do not need to click the “Upload” button” More informationFiles must be less than 20 MB. Allowed file types: jpg jpeg png pdf docx. Proof of payment * Upload Attach proof of payment, i.e. receipt, bank statement, statutory declaration (evidence of payment is required for a refund to be issued) More informationFiles must be less than 20 MB. Allowed file types: jpg jpeg png pdf docx. Once you have chosen your file, it will automatically upload. You do not need to click the “Upload” button”. PBR Application details and Payment details We need to correctly identify the application and assess the entitlement to a refund. If you trialled more than one variety at the same CTC during the same time period you can combine their information in the application number and variety fields, using a comma (,) to separate them. For varieties trialled during a different time period, you will need to complete a separate form. Application Number(s) (i.e. 2020/399, 2020/400) * Applicant/Title Holder's name Variety Name(s) Plant Genus/Species Name of the Authorised CTC that your variety was tested at * Was the Centralised Testing Authority authorised for the genus/species of the plant for the duration of the trial? Yes No Period of trial (MM/YYYY-MM/YYYYY) Current status of application Accepted Granted Withdrawn Refused Terminated (surrendered or revoked) Expired Unknown Amount of examination fee paid Date of original examination fee payment Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year1994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024 Have you already received a partial refund of the examination fee that you paid * Yes No Unknown How much was the refund? * Method of Refund Note: Refunds will only be made to a person or entity that was the applicant at the time the examination fee was paid or their current Agent acting on their behalf. If you are entitled to a refund, how would you like to receive the refund? * Credit card Bank account Refund the credit card I used to make the original payment (IP Australia can only apply credit to a credit card if you previously used that card to make a payment with us, and the credit card is still current i.e., it has not expired. Bank account type Australian bank account Overseas bank account Country Account Name BSB Account Number International Bank Account Number (IBAN) SWIFT or Bank Identification Code (BIC) Privacy Notice All personal information you provide is handled in accordance with the Privacy Act 1988 and IP Australia’s Privacy Policy. The Privacy Policy contains relevant information, including: how you may seek access to and correction of the personal information we hold; how we protect your personal information; how you may make a complaint about a breach of the Privacy Act and how we will deal with your complaint; and the contact details for IP Australia’s Privacy Contact Officer. Any personal information you provide will be used for the purposes of evaluating and processing applications for partial PBR examination fee refunds. IP Australia may provide this information, including any personal information, to IP Australia staff and IP Australia's contracted service providers. IP Australia will not disclose any personal information collected through this process to any overseas recipients. As far as your personal information is concerned, if you do not provide the personal information required, we may not be able to process your refund. IP Australia will not otherwise use or disclose your personal information without your consent, unless authorised or required by or under law. By providing your personal information, you provide your consent to your personal information being handled in accordance with this privacy notice and the IP Australia Privacy Policy. Privacy Notice Declaration * I have read and agree with the Privacy Notice Leave this field blank Next