TAX RESIDENCY AND FOREIGN TAX INFORMATION
Page 2ANZ Bank New Zealand Limited 08/20 19567
SECTION 2. YOUR TAX RESIDENCE DETAILS
Tick one option that applies to you:
I am a tax resident in New Zealand only. Go to section 3.
I am a tax resident of one or more countries other than New Zealand. Complete the table below.
The rules on whether you are a tax resident vary between countries, and are usually based on whether you work or live in a country. In some circumstances,
you may be a tax resident in more than one country at the same time. If you’re a US citizen, you’re considered to be tax resident in the United States of America.
If you are a tax resident in countries other than New Zealand, list them along with your Tax Identication Number (TIN) in the table below.
If you are unable to provide a TIN for any country, select a reason using the list below and tick the relevant box in the table below.
A: TINs are not issued by this country B: This country does not require me to provide my TIN
C: I have applied for a TIN and will inform you immediately Q: This country has not issued a TIN to me
Country of tax residence TIN
If no TIN provided,
tick reason A, B, C, or Q
A B C Q
A B C Q
A B C Q
Need help working out what your TIN is? It’s a combination of letters or numbers issued by tax authorities or other agencies, and used to identify you for tax
purposes in your country of tax residence. For what this may mean in your country search ‘TIN’ on oecd.org
SECTION 3. YOUR DECLARATION
As an account holder or controlling person, you conrm and declare:
• You have authority to provide the information in this form and the information is true and complete.
• You understand that if you don’t give information, or give false information, it could be serious under New Zealand law.
• You’ll provide any extra information we need about your tax residency status, if asked.
• You’ll contact us if any of the information you’ve given in this form changes.
• If another person completes this form and signs this declaration for you they have the authority to do so, and you’ll provide evidence, if asked,
(please print rst and last name)
D D M M 2 0 Y Y
If you’ve been asked to complete this as a controlling person of an entity please write the name of the entity below:
We take your privacy seriously and understand the need to keep your information condential and secure. You can access or correct information
we have about you – we may charge you a fee for access. For more information about how we can collect, use, and disclose information about
you, including from this form, please see our Privacy Statement at anz.co.nz
BANK USE ONLY