Request for reimbursement of maintenance and repair costs

This form is only available for clients of Private Lease

If any costs of maintenance or repair were paid by the driver, they will be eligible for reimbursement by KBC Brussels Autolease provided that:

The contract conditions are met
It concerns an original and valid invoice. This means:
- Invoice addressed to KBC Brussels Autolease
- Company number BE 0422.562.385
- Stating correct mileage, registration plate number, detailed description of the work
- Stating the consent number
No more than three months have passed since the intervention

1Identification details

Driver's first name

Driver's surname

Vehicle registration plate

E-mail address

2Account for making the refund

Name of account holder

IBAN

BIC

3Attatchments

Reason for reimbursement

Copy of your repair bill

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Copy of the payment receipt

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KBC 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.kbcbrussels.be/en/privacy, at your branch or from your intermediary and is regularly revised.