Tax Refund Application

Received additional income other than salary, wages or benefit? *

No

Yes

Select your additional source(s) of income. Supporting documentation may be requested.

Self Employed

Date you first received this income

Will you continue to still receive this income?
Yes No

Upload supporting documents

Partnership Business Income

Date you first received this income

Will you continue to still receive this income?
Yes No

Upload supporting documents

Company Profit/Loss

Date you first received this income

Will you continue to still receive this income?
Yes No

Upload supporting documents

Shareholder Income

Date you first received this income

Will you continue to still receive this income?
Yes No

Upload supporting documents

Rental Income

Date you first received this income

Will you continue to still receive this income?
Yes No

Upload supporting documents

Trust Income

Date you first received this income

Will you continue to still receive this income?
Yes No

Upload supporting documents

Untaxed Income

Date you first received this income

Will you continue to still receive this income?
Yes No

Upload supporting documents

Overseas Income

Date you first received this income

Will you continue to still receive this income?
Yes No

Upload supporting documents

Foreign Superannuation or Pension Scheme

Date you first received this income

Will you continue to still receive this income?
Yes No

Upload supporting documents

Other Income

Date you first received this income

Advise what the income was

Will you continue to still receive this income?
Yes No

Upload supporting documents

Bought or sold residential property on/after 1st October 2015? *

No

Yes

Date purchased

Date sold

Was this your main home?

Yes

No

Was this a new build?

Yes

No

Earned Dividends, Interest, or Maori Authority Distributions? *

No

Yes

Dividends

Entrust Dividends

Interest

Maori Authority Distributions

Was it over $200?

No

Yes - Supporting documentation may be requested.

Attach a copy now ( PDF / JPG / PNG, Max File Size: 10MB ) Clear

Alternatively, send copies of your receipts to info@myrefund.co.nz or post a copy into My Refund.

FREEPOST
PO Box 6490
Christchurch, 8442

Do you pay premiums for Income Protection Insurance or Loss of Earnings Insurance, where a payout would be taxable? *

No

Yes

Attach a copy now ( PDF / JPG / PNG, Max File Size: 10MB ) Clear

Alternatively, send copies of your receipts to info@myrefund.co.nz or post a copy into My Refund.

FREEPOST
PO Box 6490
Christchurch, 8442

You or your partner received Working for Families payments? *

No

Yes

Working for Families details may be requested.

I receive payments and have a partner

I receive payments and DO NOT have a partner

My partner receives payments

Arrived from overseas or been overseas more than 183 days? *

No

Yes

I arrived in New Zealand

I left New Zealand

I temporarily left New Zealand

( Departure )

( Arrival )

Made donation(s) to any charitable organisations? *

No

Yes

Donations made to school or kindergarten's general fund, religious organisations and charitable organisations are entitled to a tax credit claim, only if you can provide receipts.

Attach a copy now ( PDF / JPG / PNG, Max File Size: 10MB ) Clear

Alternatively, send copies of your receipts to info@myrefund.co.nz or post a copy into My Refund.

FREEPOST
PO Box 6490
Christchurch, 8442

I give My Refund permission to create a REB Tax Type at IR to process your donation tax credits

Do you have any Schedular Expenses to claim?

No

Yes

Schedular Expenses are specific costs that can be deducted from income received from schedular payments, reducing taxable income. Examples include material costs, administrative costs, tools and equipment, vehicle expenses, and insurance premiums.

Attach a copy now ( PDF / JPG / PNG, Max File Size: 10MB ) Clear

Alternatively, send copies of your receipts to info@myrefund.co.nz or post a copy into My Refund.

FREEPOST
PO Box 6490
Christchurch, 8442

Do you have any Accountant/Tax Agent Fees to claim that are not associated with My Refund?

No

Yes

If you have previously used My Refund Limited's services, we will automatically include any fees charged to you in your tax

Attach a copy now ( PDF / JPG / PNG, Max File Size: 10MB ) Clear

Alternatively, send copies of your receipts to info@myrefund.co.nz or post a copy into My Refund.

FREEPOST
PO Box 6490
Christchurch, 8442

Bank Account Do Not Use a CREDIT/DEBIT Card OR EFTPOS Card.

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