Full Name*
IRD Number*
Date of Birth*
Email Address*
Telephone Number
Mobile
Address*
If no bank details are provided your refund cheque will be posted to this address, if you do provide bank details it will be direct credited and this is faster.
Bank
Branch
Account Number
Account in the name of
Do you have a student loan?
Do you pay child support?
Do you receive, child support?
Have you received interest income from a bank?
Have you received rental property income?
Have you received any dividends, overseas income or Maori authority income?
Years to check for refunds
We can check for refunds for up to the last five years, please choose the years you have not already checked for refunds.
Declaration:
Please tick all boxes to show you understand and accept the terms of this agreement and that all data is true and correct
I certify that the IRD number given above is my own and that I am a resident for NZ tax purposes.
I authorise Devine Accounting to check and process any refunds due to me for the past five years and in order to do this, to act as my tax agent and to obtain my information from Inland Revenue on my behalf.
I hereby instruct Devine Accounting to request my Personal Tax Summary(s). I have supplied all information necessary to carry out such service and I am responsible for the accuracy and completeness of such information. I certify that my Personal Tax Summary(s) as requested from the Inland revenue Department by Devine Accounting is (are) true and correct.
I authorise Inland Revenue to deduct 10% (maximum $400) from my tax refund to be paid to the account of Devine Accounting for the cost involved in processing my refund.
I have supplied details of ALL income, interest dividends, rental income, overseas income or Maori authority income.
Disclaimer of liability:
Devine Accounting have not performed an audit or review and therefore neither we nor any of our employees accept any responsibility for the accuracy of the information from which the Return has been prepared. Further, the Return has been prepared at the request of and for the purposes of our client only and neither we nor any of our employees, accept any responsibility on any grounds whatsoever including liability in negligence, to any other person.
