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TAX REFUND SPECIALIST


HOW DO I APPLY?

You can apply on line by completing the following application form.

Alternatively, you can print complete the PDF application form and fax, post or scan & e-mail it to us.

 

Tax NZ nztaxrefund calculator
Download Application Form PDF

email:info@mytaxback.co.nz
fax: 09-5799025
Ph: 0900 REFUND


 

* Required Fields

  *  *
First Name   *
Middle Names   *
Surname   *
Date of Birth   *
What was your last year at high school?   *
e-mail address

IRD Number

  *

Bank Account Number

  *

Postal Address

   *

Suburb

   *
Town   *
Home ph. Number   *
Mobile ph. Number
ID Type  *
Drivers Licence Other (Only check if you do not have a driver's license)
Drivers Licence  
Drivers License Number
(5a on license)
Drivers License Code
(5b on license)
Other ID IF no drivers licence details
Type
No.
Current Employer   *
Work Phone   *
How did you hear about us?
Any additional Information
I have read the declaration below Yes

DECLARATION

  • I certify that I am the above person and the IRD number and Bank Account number given above is my own.
  • All my income is derived exclusively from wages or salary. I have received no rental income, business income, overseas income, trust or Maori Authority income during the past 5 years.
  • I authorise MYTAXBACK to act on my behalf and obtain my information from Inland Revenue for the current and previous 5 tax years. This may include cancelling old bank accounts held by Inland revenue and I allow MYTAXBACK to sign any IR3 lodged on my behalf.
  • I instruct MYTAXBACK to request my Personal Tax Summaries or file my IR3 and have supplied all information necessary to carry out such service and I accept full responsibility for the accuracy and completeness of this information.
  • I understand that any refund may be first applied to any outstanding arrears for any tax type that I have with Inland Revenue prior to any remaining balance being refunded.
  • I agree to pay 17.4% plus GST fee for the service provided by MYTAXBACK in calculating and claiming my refunds due for all tax types and I understand that the fees apply to each year that any refund, for any tax type, is processed on my behalf and calculated prior to the payment of any tax type arrears.
  • I authorise the Inland Revenue to transfer any refunds in the nominated bank account of My Tax Back NZ Limited and agree and accept that MYTAXBACK will forward the balance to my bank account or post a refund cheque to the address given above after deducting the processing fees.
  • I would like to remain a client of MYTAXBACK and have future years automatically checked for tax refunds. I will notify MYTAXBACK if I decide to withdraw authority to access my IRD information or if I receive other income listed above or if any of my personal details change.

By ticking this box I acknowledge that the above information is true and correct and that I have read and understand the terms of this agreement
By ticking this box you agree to appoint My Tax Back NZ Ltd or MYTAXBACK as your registered tax agent with the Inland Revenue Department. *
By ticking this box you agree this constitutes execution by electronic signature and authorises MYTAXBACK to verify by Drivers Licence details with the NZTA.


Disclaimer of Liability
We have not performed an audit or review and therefore neither we nor any of our employees or agents accept any responsibility for the accuracy of the information from which this person’s return has been prepared. Further, the Return has been prepared at the request of and for the purposes our client and we accept no responsibility on any grounds whatsoever including liability for negligence, to any person.
Your refund cheque will be made out in the name of the person above and will be sent to the address given above. If you have any enquires, please feel free to contact us at any time.

 
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