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About this form

This form reconciles all specified dividends / Māori authority distributions and RWT paid for the year to 31 March 2006.

Adobe Acrobat PDF | 81kb | 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

Use this form to advise us of all your resident withholding tax deductions.

What you will need

• IRD number
• total specified dividends / Māori authority distributions paid during the year including any foreign withholding tax credits
• specified dividends / Māori authority distributions not subject to RWT

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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 >