You need to send all original receipts which show the amount and date you paid for the NHS wig or fabric support, along with your HC5(W) form.
I wish to claim a refund of: write the total amount of money you have paid for the NHS wig or fabric support.
Paid on: write the date you paid the NHS charge.
Any refund due will be paid directly into your bank account.
Write the bank or building society account details you want to receive any refund you are entitled to.
Name(s) of account holder(s): write the name as shown on the bank account.
Full name of bank, building society or other account provider: find the name of the bank or building society on a bank statement or debit card.
Sort code: a six-digit number.
Account number: an eight-digit number.