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TaxRefunds.co.nz Ltd POSTAL: PO Box 248, Oamaru 9444 FAX: +64 9 353 1433 EMAIL: otherincome@taxrefunds.co.nz
If you have any questions please contact us at otherincome@taxrefunds.co.nz FREEPHONE: 0800 526 527
NON RESIDENT
INCOME FORM
Year ended 31 March
Personal Contact Details:
Please fll out the following contact details:
Personal IRD Number:
Surname: (family name)
First name/s:
Email address:
Postal Address:
Street number/name Suburb Town/City Postcode
Details of visit to New Zealand:
Arrival date in NZ: dd/mm/yy
Departure date from NZ: dd/mm/yy
Employment: What type of work were you employed in whilst staying in NZ?
New Zealand Property:
Do you own a property in NZ? Yes / No (please circle)
When was the property in NZ purchased? dd/mm/yy
Other Important Information:
Please provide any other information which would help TaxRefunds.co.nz Ltd to complete your taxation return:
Our support staff will contact you directly to obtain further details.
Checklist: Signed form Supporting documentation: Proof of income
Declaration
Signature: Print Name:
APPOINTMENT OF TAX AGENT
I, whose IRD number, name and personal details are completed above, by signing the above, acknowledge that those details are correct, and that I have read, and agree to be bound by
the Standard Terms and Conditions of Engagement of TaxRefunds.co.nz Limited as my tax agent.
I, by signing the above, hereby authorise TaxRefunds.co.nz Limited to link to my client details at the Inland Revenue, and to act as my registered tax agent for all purposes associated
with my income or other tax status for the above tax year.
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Date received: Date contacted: