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About this form

This form reconciles all dividends/Māori authority distributions and RWT paid by agents and trustees for the year to 31 March 2011.

Adobe Acrobat PDF | 141kb | 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

This form is used as an end-of-year reconciliation on all dividends and RWT that have been paid by agents and trustees for the 2011 financial year.

What you will need

• IRD number
• total dividends/Māori authority distributions paid during the year by agents and trustees
• total dividends/Māori authority distributions not subject to RWT
• total foreign withholding tax already deducted from dividends/Māori authority distributions
• imputation/Māori authority tax credits attached to dividends/Māori authority distributions
• dividend withholding payment credits attached to dividends/Māori authority distributions.

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After you finish

Please print, sign, attach your RWT certificates 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 >