Student loan borrowers who live in one of New Zealand Realm countries (the Cook Islands, Niue,
Tokelau and Ross Dependency) may be eligible to an interest free student loan.
• Complete the ‘Tell us about yourself’ section then give to your employer to add employment and income information.
Alternatively, attached copies of your employment contract/agreement.
• Read the notes page to help understand this form.
• More information about student loans can be found on our website ird.govt.nz/student loans
• If you haven’t already done so, register for a MyIR account
Tell us about yourself
1. Your name
First name(s) Surname
2. Your IR number
(8 digit numbers start in the second box )
(in the Realm
6. Contact number(s)
( ) ( ) ( )
Home phone number Mobile number Work phone number
7. State the time period/s you want to be treated as being in a Realm
Day Month Year Day Month Year
Your will need to supply employment information for each year.
Note: This can only be back dated to 1 April 2009
8. Have you been absent from a Realm country or New Zealand for more
than 31 consecutive days during the period/s you are applying for?
Go to declaration
Provide details below
Details of absence
To the best of my knowledge the information provided on this form is true and correct.
click to sign
click to edit