Client Refund Request FormNB** You need to email info@halligan.ie, prior to completing this form. Please fill out your bank details to process your refund by EFT.Policy Type(Required)Life/SIC/PensionMotor/HouseholdStudent Health InsuranceOtherOther(Required) Contact DetailsTitle(Required)Mr.Ms.Mrs.Miss.Name(Required) First Last Customer Reference(Required) Policy Number Email(Required) Contact Number(Required)Home Address(Required) Street Address Address Line 2 City County / State / Region ZIP / Postal Code Your Bank DetailsBIC(Required) IBAN(Required) Company Details: Halligan Life & Pensions Ltd - Creditor’s ID No: IE95SDD303969 William Norton House, North Circular Road, Dublin 1. Ireland.PhoneThis field is for validation purposes and should be left unchanged.