Complete this form to support a proposal to pay using instalments, or if you've been asked to complete one as part of a hardship application.
You need to send us this form as soon as you can.
Gather your information
- your IRD number
- details of your income after tax has been deducted
- details of your expenses
- details of any assets or liabilities.
Download and fill in the form
Sign the form and send it to us
PO Box 39090
Wellington Mail Centre
Lower Hutt 5045
What happens next
We'll assess your situation and let you know your options.
You can still make payments to your account while we do this.
If you're in New Zealand, we'll start by using the Household Expenditure Guide - AD164 to get an idea of living costs in your region.