1. NameYou must be named on your local council’s rating information database (RID) to be eligible.
First name:
Last name:
2. Address The property you pay rates for must be your usual place of residence.
You cannot claim a rates rebate on a property that is used principally for business, farming, commercial or industrial purposes,
or a home that is not your usual place of residence.
Street number and name:
Suburb and town:
Postcode:
Postal address (if dierent):
Best phone number:
Email:
Were you living with a spouse/partner* or joint home owner(s) on 1 July 2020? Yes No
*‘Partner is a person you are married to or with whom you are in a civil union or de facto relationship
If yes, please include their income details in section 4.
Do you earn money from home or run a business from home?
Yes No
If yes, how?
If yes, please include income details in section 4.
Were you living at this address on 1 July 2020? Yes No
If yes, go to section 3.
Did you move here from another property after 1 July 2020? Yes No
If yes, what is the address of your previous property? ............................................................................
.............................................................................
What date did you settle the sale of your previous property? $....................................
How much did you pay in rates on your previous property for this rating year? $....................................
Did you receive any rebate on those rates? Yes $........................ No
Rates Rebate
Application Form
Application for the rating year 1 July 2020 to 30 June 2021
TA Ref:
Council use only
APPLICATIONS CLOSE ON 30 JUNE 2021 AND CANNOT BE ACCEPTED AFTER THIS DATE
Unique Property ID
Council use only
3. Dependants - Must have been living with you on 1 July 2020. Your partner is not a dependant.
These are:
children you care and provide for under the age of 18 on 1 July 2020 and who at this time were not married and for whom you
were not receiving payments under section 363 of the Children, Young Persons, and their Families Act 1989
relatives in receipt of a benet (but not NZ Superannuation) on 1 July 2020.
Last name First name Birth date Benet type (if applicable)
4. Income DeclarationFor the tax year 1 April 2019 to 31 March 2020.
We assess income on the tax year previous to the current rating year.
Income means money received, before tax, 1 April 2019 to 31 March 2020.
Proof of income may be required.
Satisfactory proof of income includes:
income conrmation from Work and Income
income conrmation from Inland Revenue
investment earning statement for the tax year
statement of earnings from your employer
Additionally for self employed people:
a copy of your complete set of nancial accounts, IR3B or
IR10 you provided to Inland Revenue for the income year 1
April 2019 to 31 March 2020
you cannot oset business losses against other income
business losses should be entered as $0
In the table below, please show the total income, before tax, that you and your spouse/partner and/or joint homeowner
received for the tax year 1 April 2019 to 31 March 2020. Please indicate your occupation and tick the relevant boxes to show the
source(s) of your income.
Jobseeker Self-employment Employment Occupation: .......................................................................
Supported Living Sole Parent New Zealand Superannuation
Other (please specify): ............................................................
Source of income (enter gross amounts unless otherwise indicated) Your income
Partner/joint homeowner
income
New Zealand Superannuation $ $
Personal superannuation $ $
Interest / dividends $ $
Wages or salary $ $
Work and Income benets $ $
Work and Income supplements (e.g. Accommodation Supplement) $ $
Working for Families Tax Credits (excludes Family Tax Credits) $ $
Net prot before tax from any business – enter ‘0’ if you sustained
a loss
$ $
Rental income - enter ‘0’ if you sustained a loss $ $
ACC earnings compensation $ $
Trust income paid to you $ $
Overseas income (converted to $NZ) $ $
Income from other sources (please identify) $ $
$ $
Individual total
$ $
Total combined income $
RR103/104 06/2020
5. Rates Refer to your 2020/21 rates notices to complete this section.
Show the total amount you pay for local, regional and council water rates (if applicable) on your home. Your council or retirement
village operator will be able to help you with this information.
Local council rates $
Council Use only
Regional council rates $
Council water rates $
Total rates $
6. Important Information
Rates rebates are granted under the Rates Rebate Act 1973. You must provide the requested information on this form so your
rebate can be worked out. Your council will process the application. You have the right to see this information, and have it corrected.
Section 14 of the Rates Rebate Act 1973
14. Oences
(1) Every person commits an oence who-
(a) for the purpose of obtaining any rates rebate under this Act, for himself or for any other person, makes any statement or declaration
knowing it to be false in any particular, or wilfully misleads or attempts to mislead any person concerned in the administration of this
Act or any other person whatsoever; or
(b) refuses or fails to comply with any requirement under section 11, or refuses or fails to answer any question put to him pursuant to
that section, or knowingly gives any false or misleading answer to any such question.
(2) Every person who commits an oence against this Act is liable on conviction before a District Court Judge to imprisonment for a term not
exceeding 12 months or to a ne not exceeding $500, or to both.
7. Declaration An authorised person must witness your declaration.
I ....................................................................................................................................................................................
(name in full)
of ....................................................................................................................................................................................
....................................................................................................................................................................................
(residential address)
....................................................................................................................................................................................
(occupation)
solemnly and sincerely declare that I believe the information I have given on this form is true and correct, and I make this solemn
declaration conscientiously believing the same to be true and by virtue of the Oaths and Declarations Act 1957.
....................................................................................................................................................................................
(signature of ratepayer - to be signed in the presence of an authorised person)
Declared at ........................................ this ................................... day of ..................................... 20 ................
before me .........................................................................................................................................................................
(signature AND printed name of person authorised to witness the declaration)
authorised council ocer chartered accountant barrister/solicitor court registrar/deputy court registrar
Justice of the Peace minister of religion Member of Parliament
other authorised person (see below) ...............................................................................................................................................................
A number of people can authorise a declaration. To nd a full list go to www.govt.nz/rates-rebates or contact your council.
• Take or post this form to your council once completed
• Council sta will work out your rebate and provide it to you
• Note that applications close on 30 June 2021 and cannot be accepted after this date.
What Next?
click to sign
signature
click to edit
Applying for a rates rebate
1 July 2020 to 30 June 2021
The purpose of the Rates Rebate Scheme is to provide a subsidy to low income home owners on the cost
of their rates. The maximum rebate for this rating year is $655.
Am I eligible?
I was a legal ratepayer for the property that was my home on 1 July 2020 and I am named on the council Rating
Information Database (RID).
I am not applying after the deadline, which is 30 June 2021.
Can people living in retirement villages apply?
Most retirement village residents are able to apply. If you hold a licence to occupy agreement, a seperate declaration form
is required to be lled in by the retirement village operator and must be included with this form for submission. Contact
your village operator or local council for more information.
Can owners of owner-occupier ats apply?
An owner-occupier at forms part of a group of two or more dwellings that are separately owned by the occupants, but
built on a single rating unit. The rates are shared by the owners. If you are the owner of an owner-occupier at, you might
be eligible for a rebate. You will need to complete a separate rates rebate owner-occupier declaration form which can be
obtained from your local council, or downloaded from www.govt.nz/rates-rebates. Once completed, the form should be
submitted with this application form.
Can residents of trust owned properties apply?
Only if you are a named trustee and are also named on the council Rating Information Database (RID)
How much will my rebate be?
Your rebate is determined by the level of rates payable in the 2020/2021 rating year, your household income for
2019/2020 and the number of dependants living with you. To check your entitlement, please refer to the table below or
visit www.govt.nz/rates-rebates and enter your details into the rebate calculator.
Rates rebate income eligibility table for households with no dependants. Estimate only.
Household
Income
Level of Rates
$1,200 $1,400 $1,600 $1,800 $2,000 $2,200 $2,400 $2,600 $2,800 $3,000 $3,200 $3,500
Rates Rebate
$24,000
$655.00 $655.00 $655.00 $655.00 $655.00 $655.00 $655.00 $655.00 $655.00 $655.00 $655.00 $655.00
$25,000
$655.00 $655.00 $655.00 $655.00 $655.00 $655.00 $655.00 $655.00 $655.00 $655.00 $655.00 $655.00
$26,000
$655.00 $655.00 $655.00 $655.00 $655.00 $655.00 $655.00 $655.00 $655.00 $655.00 $655.00 $655.00
$27,000
$637.33 $655.00 $655.00 $655.00 $655.00 $655.00 $655.00 $655.00 $655.00 $655.00 $655.00 $655.00
$28,000
$512.33 $645.67 $655.00 $655.00 $655.00 $655.00 $655.00 $655.00 $655.00 $655.00 $655.00 $655.00
$29,000
$387.33 $520.67 $654.00 $655.00 $655.00 $655.00 $655.00 $655.00 $655.00 $655.00 $655.00 $655.00
$30,000
$262.33 $395.67 $529.00 $655.00 $655.00 $655.00 $655.00 $655.00 $655.00 $655.00 $655.00 $655.00
$31,000
$270.67 $404.00 $537.33 $655.00 $655.00 $655.00 $655.00 $655.00 $655.00 $655.00 $655.00
$32,000
$279.00 $412.33 $545.67 $655.00 $655.00 $655.00 $655.00 $655.00 $655.00 $655.00
$33,000
$287.33 $420.67 $554.00 $655.00 $655.00 $655.00 $655.00 $655.00 $655.00
$34,000
$295.67 $429.00 $562.33 $655.00 $655.00 $655.00 $655.00 $655.00
$35,000
$304.00 $437.33 $570.67 $655.00 $655.00 $655.00 $655.00
$36,000
$312.33 $445.67 $579.00 $655.00 $655.00 $655.00
$37,000
$320.67 $454.00 $587.33 $655.00 $655.00
$38,000
$329.00 $462.33 $595.67 $655.00
$39,000
$337.33 $470.67 $655.00
$40,000
$345.67 $545.67
$41,000
$420.67
$42,000
$295.67
$43,000
$170.67
$44,000
$45.67
$45,000
$0.00
QUESTIONS: If you have any questions about the Scheme contact your local council or visit
www.govt.nz/rates-rebates
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome