Ov Train Card Cancelling

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Termination and credit refund

You can use this form to terminate use of your personal or anonymous OV-chipkaart and apply for a
credit refund if necessary.

If there are one or more travel products on your personal OV-chipkaart, please contact your public
transport company to check what you need to do about these products before using this form.

Once this form has been processed, you will receive a written confirmation of the credit refund. You
will receive the credit in the bank account you provided within 15 days. Unless Automatic Reloading
is activated on your card, you can also apply for a refund of up to € 30.00 credit at a Sales and
Information point for a public transport company. Enter everything in block capitals and use a black
or blue pen to ensure this form can be processed correctly.

1 Reason for termination


I no longer use public transport The cardholder is deceased

I am switching to an anonymous OV-chipkaart Other

My card has expired

2 Cardholder details

OV-chipkaart card number, 16 digits


N.B.! Make a copy or photo of the completed form
3 5 2 8 showing the card number. We will then be able to
Initial(s) Surname prefix(es) help you more quickly if you have any questions.

N.B.! If the cardholder is deceased, please enter the


initials, surname and date of birth of the cardholder.
Surname

Street

House number Suffix

Postcode Town
Vrouw

Date of birth, dd-mm-yyyy Gender


Male Female

Daytime phone number (without dashes), not compulsory

0
Bank account number

Please turn over


0921_v071

0900-0980 (normal phone cost) | www.ov-chipkaart.nl TLS 071 A 710


3 Signature
The undersigned declares that he or she accepts TLS B.V.’s OV-chipkaart General Terms
and Conditions and declares that he or she has entered the details on this form correctly.

If you are aged under 18 or if you do not have legal capacity,


please ask your legal representative to sign this form.
Date, dd-mm-yyyy

Signature

Please remember: Stick your OV-chipkaart here


• to sign this form
• to stick on your OV-chipkaart (not compulsory
in the case of a deceased cardholder)

Send the fully completed form to the following


address, along with the OV-chipkaart.

Termination and credit refund OV-chipkaart


Postbus 365
NL 3800 AJ Amersfoort

General Terms and Conditions Privacy policy


The OV-chipkaart is subject to the ‘OV-chipkaart General Terms and Conditions’. You Translink processes your details to ensure good functioning of the OV-chipkaart, the OV-
can find these General Terms and Conditions at www.ov-chipkaart.nl, through OV- chipkaart system and the implementation of the agreement made with you. In our privacy
chipkaart Customer Services: 0900-0980 (normal phone cost) or through a Sales and statement on www.ov-chipkaart.nl/privacy we have set out how we handle your personal
Information point. These will be sent to you free of charge on request. data for you. Send your questions about privacy to [email protected] or contact our
Customer Services on 0900-0980 (normal phone cost).

TLS 071 B 710

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