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APPLICATION FOR REFUND OF HAZARDOUS DUTY RETIREMENT CONTRIBUTIONS State Employees Retirement System, Tier I & Tier IIA Members CO628c Rev. 12/2019 Page 1STATE OF CONNECTICUT OFFICE OF THE STATE COMPTROLLER
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How to fill out application for refund of

01
Download the refund application form from the official website.
02
Carefully read and understand the instructions provided in the application form.
03
Fill out the required personal information such as name, address, contact details, and identification number.
04
Provide the necessary details regarding the refund request including the reason for the refund, purchase date, invoice number, and amount paid.
05
Attach supporting documents such as receipts, invoices, or any other proof of purchase to validate the refund request.
06
Double-check all the entered information to ensure accuracy and correctness.
07
Sign and date the application form.
08
Submit the completed application form along with the supporting documents to the designated refund department either by mail or in person.
09
Keep a copy of the application form and supporting documents for your records.
10
Follow up with the refund department if necessary to inquire about the status of your refund.

Who needs application for refund of?

01
Anyone who has made a purchase and wants to request a refund for a valid reason.
02
Individuals who have encountered issues with a product or service they have paid for and wish to receive a refund.
03
Customers who believe they are entitled to a refund based on the terms and conditions set by the seller or service provider.
04
Consumers who have experienced unsatisfactory or inadequate services and want reimbursement for the amount paid.
05
Those who have followed the refund policy of a company or organization and meet the criteria for a refund.
06
People who want to recover their money after canceling a service or returning a product according to the refund policy.
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Application for refund of is a formal request made by an individual or entity to request the return of funds that were overpaid or incorrectly paid.
Any individual or entity who believes they are entitled to a refund of funds is required to file an application for refund of.
To fill out an application for refund of, individuals or entities must provide detailed information about the overpayment or incorrect payment, including supporting documentation.
The purpose of an application for refund of is to formally request the return of funds that were erroneously paid.
Information such as the amount of the overpayment, the reason for the overpayment, and supporting documentation must be reported on the application for refund of.
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