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About this form

Use this form for paying your approved issuer levy.

Adobe Acrobat PDF | 103kb | 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

If you pay interest to a non-resident lender, and want to pay it at a zero rate of NRWT (non-resident withholding tax), you have to apply to us to become an approved issuer. Instead of deducting NRWT, approved issuers (or a person on their behalf) must pay a levy on the securities they register with us.

Use this form to advise us of the interest paid (in New Zealand dollars) and the approved issuer levy (also in New Zealand dollars) that has been deducted for the period, when sending us in your payment.

What you will need

• IRD number
• period that you are making the payment for
• amount of interest paid (in NZ dollars)
• amount of approved issuer levy (in NZ dollars).

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After you finish

Please print, sign and attach your cheque for payment and post to your nearest Inland Revenue office.

Please keep the top portion of this form for your copy.

List of postal addresses for Inland Revenue >