Make a payment
Forms and guides Ngā puka tāke me ngā puka tohutohu

Contributions holiday request (employee to complete) (KS6)

(published May 2011)

About this form

This form is for employees to request a contributions holiday.

PDF | 60kb | 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

An employee should complete this form to request a contributions holiday.

What you will need

You will need to provide your name, address and IRD number.

You can provide your employer's details if you want Inland Revenue to notify your employer/s of the contributions holiday.

After you finish

Please print 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 >