DECLARATION

By submitting this application I declare and certify that:

	I certify that the information given above is correct.
	I certify that I have been made redundant by my New Zealand employer and I have received redundancy pay as compensation for loss of employment.
	I am a New Zealand resident for tax purposes.
	I do not owe any arrears in child support
	I authorise Kiwi Financial Services Limited to act as my tax agent and to obtain any tax information, on my behalf, from Inland Revenue by phone, fax, mail, email or via online services.
	I instruct Kiwi Financial Services Limited to apply for my Redundancy Tax Credit. I have supplied all information necessary to carry out such service and I am responsible for the accuracy and completeness of such information.
	Any personal tax data requested, on my behalf, from the Inland Revenue Department by Kiwi Financial Services Ltd is true and correct.
	I agree to the published fee structure and agree to pay this fee as the cost involved in processing my redundancy tax credit.
	I authorise the Inland Revenue Department to direct credit all tax refunds and processing fees, as detailed below, to the bank account of Kiwi Financial Services Limited.
	I understand that Kiwi Financial Services Limited will deduct the agreed processing fee from my refund(s) before paying the remaining funds to me either by cheque or directly to my nominated bank account.

	If your total tax credit turns out to be	Processing cost will be
	Less than $100	$10 (tax credit of $30 or less processed free)
	More than $99 and less than $2000	10% of Refund
	More than $1999	$200

To support your claim you will need to provide supporting documentation from your employer that clearly shows the amount of the redundancy payment received - this could be any of the following:

• a signed letter from your employer, including the amount and date of the redundancy payment

• a calculation sheet showing a breakdown of how the redundancy amount was calculated

• payslip(s) clearly showing the amount of the redundancy payment(s).

Post us a copy of your documentation to:

Kiwi Refund
PO Box 13-406
Johnsonville
Wellington 6440

Please Note: If you do not have the documentation on hand, you can post or email it to us after you have submitted the Redundancy Tax Credit Application.

DISCLAIMER

We have not audited or reviewed the information you have provided, therefore neither we nor any of our employees, associates or agents accept any responsibility for the accuracy of the information from which any Personal Tax Summaries or Tax Returns have been prepared. All Personal Tax Summaries and Tax Returns have been prepared at the request of, and for the sole benefit of our customer only. Kiwi Refund, Kiwi Financial Services Ltd, it's employees  and agents do not accept any responsibility on any ground whatsoever, including liability in negligence, to any other person.

Please note: any refund, less processing fees, will be deposited into your nominated bank account or paid by cheque which will be sent to you at the address provided above.  All fees are inclusive of G.S.T

View Our Standard Terms and Conditions.