Fillable Fuel excise duty refund Customer registration form (New Zealand Transport Agency)

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Fuel excise duty refund Customer registration form (New Zealand Transport Agency)

On average this form takes 37 minutes to complete

The Fuel excise duty refund Customer registration form (New Zealand Transport Agency) form is 4 pages long and contains:

  • 0 signatures
  • 18 check-boxes
  • 140 other fields

Country of origin: NEW-ZEALAND
File type: PDF

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page 1
02/18
Fuel excise duty refund – Customer registration form
Fuel excise duty refund
Customer registration form
Customer details
Please provide full names of all trustees, partners or directors (continue on a separate sheet if necessary)
Use this form to register with the NZ Transport Agency so you can claim fuel excise duty refunds using the MR70.
Full legal name (Company/partnership/organisation/individual)
Alternative contact (a person of your choosing who can access your fuel excise duty information on your behalf)
Authorised representative
Email
Email
Trading name (if applicable)
Physical address Postal address (if dierent to physical address)
IRD number (please provide your IRD number for the Transport Agency to determine your eligibility to apply for a refund. Please also
provide a copy of documentation from the IRD confirming you are in business, eg a copy of a GST101).
MobilePhone
MobilePhone
Transport Agency use only
BP number Signed
Approved
Declined
Commercial activity
Describe your commercial activity (please tick)
Farm/orchard/vineyard
Commercial lawn mowing/landscaping
Civil/agricultural contracting
Commercial maritime activities (fishing, tourism, etc)
Commercial carpet cleaning
Other (must be a commercial activity – fuel excise duty refunds are not
available for domestic, household or personal use)
Please provide a brief description of your commercial activities:
page 2
02/18
Fuel excise duty refund – Customer registration form
How do you purchase your fuel? (tick as applies to you and answer the questions that follow)
Bulk
• What volume of fuel does your bulk tank hold?
• How do you gauge how much fuel is left in the tank at the end of each quarter?
Service
stations
• How do you purchase and transport your fuel?
• How do you store your fuel? (eg jerry can)
Business details
Describe seasonal impacts on your fuel usage
BIC code (Business Industry Classification code)
Number of sta (full-time equivalent)
Website address(if applicable)
Area of operation
What is your estimated average fuel usage for the previous year (in litres)?
What security is in place for your fuel supply to guard against theft, use for non-commercial purposes or personal use.
Do any vehicles, vessels or machinery that are not eligible for a refund extract fuel from your bulk tank or purchase fuel
through your business fuel account? If so, please list these vehicles/machinery.
How do you determine what fuel purchased is eligible for a refund (ie how do you record usage)?
Farm/vineyard/orchard details (fill in this section only if applicable to your commercial activity)
Size (hectares)
Description of farm/land (how many paddocks, contour, stock numbers)
Size (hectares)
Physical address of all additional locations (continue on a separate sheet if necessary)
Orchard/crop typeStock type(s) OR
page 3
02/18
Fuel excise duty refund – Customer registration form
Vehicles and equipment (continue on a separate sheet if necessary following the same format as below)
Vehicles licensed in classes A or B
Make/model
Licence plate
number
Tank size Purpose/use
How do you record on-road use?
Unregistered vehicles (eg farm bikes, tractors, hydroladders and ride-on mowers)
Make/model
Year of
manufacture
VIN/chassis number
Tank
size
Purpose/use
Commercial purposes (not vehicles, eg chainsaws, water blasters and push mowers)
Description Tank size Quantity Purpose/use
Vehicles subject to RUC (eg motorhome over 3500kg)
Make/model
Licence plate
number
Approximate fuel eciency
(eg km to litre)
Commercial vessels (must hold NZ Maritime Certification)
Name of vessel
Maritime certification
number
Tank size Purpose/use
I have attached a copy of my NZ Maritime Certification
page 4
02/18
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.
Declaration
Phone
Print name
Authorised signature
Date
WARNING
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
Send to
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:
Checklist
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 ocial 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
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Fuel excise duty refund Customer registration form (New Zealand Transport Agency)

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Completed 15 February 2021

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