Fp 57 2026

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The document provides instructions for customers to obtain a refund for their prescription charge related to a recalled Jext® adrenaline auto-injector. Customers are required to fill out their personal details and return the form along with their FP57 NHS Receipt to ALK-Abelló Ltd, after which a cheque will be issued within 28 days.

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Click ‘Get Form’ to open the fp 57 in the editor.
Begin by entering your NAME in the designated field. Ensure that it matches the name on your prescription.
Next, fill in your ADDRESS accurately. This is where the refund cheque will be sent.
Provide your POST CODE to ensure proper delivery of the cheque.
Specify the ACCOUNT PAYEE for the cheque in the corresponding field. This should be the name of the person or entity receiving the payment.
Indicate the DATE when you are returning this receipt to ALK. This helps track your submission.
Finally, review all entered information for accuracy before submitting. Once confirmed, save and export your completed form.

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