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IRD NUMBER:
Title:
Mr
Mrs
Ms
Miss
First Name:
Middle Names(s)
Surname:
Email:
Date Of Birth:
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)
Yes
No
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
Yes
No
(if yes go to
[A]
, if no then complete below)
I arrived in NZ on: (dd/mm/yyyy)
I left NZ temporarily on: (dd/mm/yyyy)
I arrived back in NZ on (dd/mm/yyyy)
I left NZ Permanently on (dd/mm/yyyy)
[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)
Yes
No
(if yes go to
[B]
, if no then complete below)
I have received interest
*Amount and date required if yes
No
Yes
Amount:
Date(s) Received:
I have received dividends:
*Amount and date required if yes
No
Yes
Amount:
Date(s) Received:
I have received Maori Authority Distribution:
*Amount and date required if yes
No
Yes
Amount:
Date(s) Received:
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 )
Yes
No
If yes, please give details below
Dependent 1
Date of Birth:
Date Care Ended:
Dependent 2
Date of Birth:
Date Care Ended:
Dependent 3
Date of Birth:
Date Care Ended:
Dependent 4
Date of Birth:
Date Care Ended:
Dependent 5
Date of Birth:
Date Care Ended:
Dependent 6
Date of Birth:
Date Care Ended:
Do you receive Working for Families Tax Credits?:
Yes
No
Do you have a partner/Spouse?:
Yes
No
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)
Straight into my bank account thanks
(fill bank details below)
Account Holder:
Enter your bank account number:
Legal Stuff:
By ticking this box I acknowledge that the above information is true and correct and that I have read and agree to the
terms & conditions
.
*
By ticking this box you agree this constitutes execution by electronic signature.
*
IRD Stuff:
I agree to allow My Tax Help (Trading as Adminguru) to...
Talk to Inland Revenue for me
Find out my wages, tax and other things
Update my details
Sort my tax
Manage my refund money
Stop when I tell you to
