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About this form

Use this form for paying RWT (resident withholding tax) deducted from specified dividends, from amounts distributed by a Maori authority, and by agents or trustees from dividends received on behalf of another person.

Adobe Acrobat PDF | 144kb | 2 pages

This form can be completed on-screen by typing content directly into the PDF document. Once you have completed the form it is important that you print it out as you will not be able to save the information you enter into the form.

When to use this form

Use this form for paying resident withholding tax (RWT) deducted:

• from "specified dividends" which are one of the following:
  • dividends paid by companies which at the time are not resident in New Zealand; or are prohibited by their constitution from distributing all income to any proprietor, member or shareholder; or whose incomes are exempt; or who are solely engaged in life insurance or re-insurance, or
  • dividends paid on specified preference shares

These dividends have no imputation or FDP (foreign dividend payment) credits to attach.

• amounts distributed by a Maori authority
• by agents or trustees from dividends received on behalf of another person.

What you will need

• your IRD number
• month and year specified dividend/Maori authority distribution paid
• gross dividends/distributions
• imputation/Maori authority credits
• FDP credits.

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After you finish

Please print, sign and post the completed form to your nearest Inland Revenue office.

You may wish keep a copy of this form for your personal records.

List of postal addresses for Inland Revenue >