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IRD NUMBER:
Title:
First Name:
Middle Names(s)
Surname:
Email:
Date Of Birth: Pick a date
 
Street and Number:
Suburb:
Town / City:
Home Phone:
Mobile Phone:
Have you left Secondary School in the last five years?:
How did you hear about us?:
 

Drivers licence:

Do you have a Drivers Licence? (read below if no licence)
NZ Drivers Licence No:
Card Version:
No NZ Drivers Licence? Please print off this application form to apply and send it to My Tax Help with a copy of an approved form of ID.   Please email us for our postal details
 

Tax Details:

I have always lived in NZ or I have since 1st April 2010 and will live here at least until March 2016 (if yes go to [A], if no then complete below)
I arrived in NZ on: (dd/mm/yyyy)   Pick a date
 I left NZ temporarily on: (dd/mm/yyyy)   Pick a date
 I arrived back in NZ on (dd/mm/yyyy)   Pick a date
 I left NZ Permanently on (dd/mm/yyyy)   Pick a date
 
[A] In any of the last 5 years and until at least 31 March 2015 my only income has been / will be from salary/wages and/or government benefits Working for Families, Student allowance, pension, ACC etc) (if yes go to [B], if no then complete below)
I have received interest
*Amount and date required if yes
Amount:
    Date(s) Received: Pick a date
I have received dividends:
*Amount and date required if yes
Amount:
    Date(s) Received:   Pick a date
I have received Maori Authority Distribution:
*Amount and date required if yes
Amount:
    Date(s) Received:   Pick a date
I am self employed:
I am in a partnership:
I receive income from a shareholder salary:
I have a rental property:
I have expenses to claim:
Loss of earnings insurance:
Commission on Interest or dividend income:
 
[B] I have had dependent children living with me in the last 6 years ( 1 April 2011 to 31 March 2015 )  If yes, please give details below
Dependent 1 Date of Birth:Pick a date Date Care Ended:Pick a date
Dependent 2 Date of Birth:Pick a date Date Care Ended:Pick a date
Dependent 3 Date of Birth:Pick a date Date Care Ended:Pick a date
Dependent 4 Date of Birth:Pick a date Date Care Ended:Pick a date
Dependent 5 Date of Birth:Pick a date Date Care Ended:Pick a date
Dependent 6 Date of Birth:Pick a date Date Care Ended:Pick a date
Do you receive Working for Families Tax Credits?:
Do you have a partner/Spouse?:
 

Paying You:

How would you like to be paid?: Send me a cheque to my postal address (Note a cheque will take a little longer)
  (fill bank details below) 
  Account Holder:  
  Enter your bank account number:
 
 

Legal Stuff:

  *
*
 

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