•   by keyword  
•   by title  
•   by number  

About this form

This form reconciles all dividends and RWT paid by agents and trustees for the year to 31 March 2005.

Adobe Acrobat PDF | 79kb | 1 page

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

This form is used as an end of year reconcilliation on all dividends and RWT that have been paid by agents and trustees for the 2004 fincancial year.

What you will need

• IRD number
• total dividends paid during the year by agents and trustees
• total dividends not subject to RWT
• total foreign withholding tax already deducted from dividends
• imputation credits attached to dividends
• dividend withholding payments attached to dividends

Download Acrobat Reader to view PDF files

Report an accessibility problem for this page

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 >