Use this form to opt out if you have been automatically enrolled and you don’t want to be a member of KiwiSaver. Or go to to complete our online form. Please read the notes on the back to help you ll in this form.
Section A Personal details Please use
6. Bank account
Bank Branch Account number Sufx
7. I wish to opt out
of KiwiSaver
Section B Employment details Please use
8. Employer’s IRD
If you don’t have your employer’s IRD number ask them for it or leave it blank.
9. Employer’s business
10. Employment start
Give this form to your employer or send it to Inland Revenue.
Section C Late opt-out Please read the notes on the back of this form
11. If your request to opt out is more than eight weeks after you started employment, please give a reason for your late opt-out request.
New employee opt-out request
Name of account holder
Day Month Year
KS 10
May 2011
KiwiSaver Act 2006
1. Your IRD number
If you don’t know your IRD number or you don’t have one, call us on 0800 549 472
2. Your name Mr Mrs Miss Ms Other
Put a dash to indicate your title
3. Your postal
4. Your contact
Day Mobile
5. Your email
If you give an email address you may receive KiwiSaver information by email
Street number Street address or PO Box number
Suburb, box lobby or RD
Town or city Postcode
First names
Day Month Year
RESET form
This form is for new employees to opt out of
You can opt out on or after day 14 and on or before day 56 of
starting new employment.
You can’t opt out in the rst 13 days.
Every time you start new employment, you’ll need to opt out
Complete the form then, either:
give this form to your employer so they can stop deductions
immediately (for prompt return of your contributions, your
employer can direct refund any KiwiSaver deductions they
haven’t sent to us), or
send this form to Inland Revenue—see address below.
Late opt-out request
We may accept late opt-out applications if:
your employer didn’t give you a KiwiSaver information pack
within seven days of starting employment
we didn’t send you an investment statement when we’ve
allocated you to a default scheme
your employer didn’t give you an investment statement (for
their chosen KiwiSaver scheme)
events outside your control meant you couldn’t give us your
opt-out application within the eight-week time limit
you chose to opt in or were opted in to KiwiSaver but you did
not meet the criteria to (see Employee information pack (KS 3 )
for criteria).
Note: Give this form to your employer, or send it directly to
InlandRevenue, if you are making a late opt-out application.
Your request can only be considered if it’s received by
InlandRevenue or your employer within three months from
the day Inland Revenue receives your rst contribution. We
will advise you if your opt-out request has been accepted or
When we approve your opt-out request, we’ll send you
We’ll also advise your employer to stop making deductions.
Either Inland Revenue or your employer will refund any
deductions that have been made.
Bank account details
We need your bank account details so we can direct credit any
KiwiSaver funds we are holding for you to your bank account.
If you don’t have these details, send the form to us anyway.
You’ll nd more information in your
Employee information pack
(KS 3 )
or by going to
Meeting your tax obligations means giving us accurate
information so we can assess your liabilities or your
entitlements under the Acts we administer. We may charge
penalties if you don’t.
We may also exchange information about you with:
some government agencies
another country, if we have an information supply agreement
with them
Statistics New Zealand (for statistical purposes only).
If you ask to see the personal information we hold about you,
we’ll show you and correct any errors, unless we have a lawful
reason not to. Call us on 0800 549 472 for more information.
For full details of our privacy policy go to
(keyword: privacy).
What an employer should do with this completed
Send this form to Inland Revenue no later than the next time
you’re required to send an Employer monthly schedule (IR 348)
to Inland Revenue at the address below, or you can send the
information through ir-File (see for details
about ir-File).
Please send this completed form to:
Inland Revenue
PO Box 39090
Wellington Mail Centre
Lower Hutt 5045
For more information about KiwiSaver go to or call us on 0800549472.