Fuel excise duty refund – Customer registration form
Bank account details
Name of bank account
Bank account number for refund to be direct credited to
Please provide a bank deposit slip conﬁrming the details supplied.
ANY PERSON MAKING A CLAIM OR FURNISHING ANY INFORMATION KNOWN TO BE FALSE
IN ANY MATERIAL PARTICULAR IS LIABLE FOR PROSECUTION.
This person must be directly related to the legal entity and have authority to make ﬁnancial decisions about it. If we are unable to
verify this authority, you will be contacted for further information or be asked to resubmit your registration.
Appoint an agent
I give authority to
Complete this section only if you authorise another person or company to complete your claim on your behalf.
to act as my agent from
for all purposes associated with the preparation of future fuel excise claims. Where an agent acts on your behalf, payment of the
refund of fuel excise duty to an agent extinguishes the entitlement for that refund. The NZ Transport Agency, acting as delegate of
the Chief Executive of the Ministry of Transport, will not be a party to any dispute between you and your agent.
Appointment of an agent does not remove you from the refund process and the Transport Agency reserves the right to contact you
at any time for corroboration of applications ﬁled.
This authority remains in place until the Transport Agency is advised otherwise. In the event that you cancel the relationship you
have with your agent, you will notify both your agent and the Transport Agency in writing.
(must be a legal entity) (date)
Fuel Excise Duty Refunds
NZ Transport Agency
Private Bag 11777
PALMERSTON NORTH 4442
Before submitting your application you have supplied the required documentation where applicable. We cannot process your
registration or any refunds unless you provide the correct applicable documentation:
Provided supporting documentation for your assets as outlined in ‘Vehicles and equipment’
(eg NZ Maritime Certiﬁcate, Certiﬁcate of Registration of Amusement Device)
Signed the declaration
Proof of commercial intent (eg certiﬁcate of incorporation, IRD document)
An ocial bank document verifying your bank account name and number
An email address for direct credit remittance advice
Completed all sections in ‘Customer details’
Have described your commercial activity type
Completed all sections related to fuel purchasing and recording
Provided details of all the assets you are claiming a refund for