Will you be employed
for the full year?
Yes No If not, enter dates: Start Stop
Gross income
Gross annual NZ Super/Veteran’s pension (don’t include any overseas social security pensions such
as the UK National Retirement Pension)
Type of NZ Super/Veteran’s pension
you are receiving
Single (living alone) Single (sharing)
Married, in a civil union or
de facto relationship
Will you be receiving
for the full year?
Yes No If not, enter dates: Start Stop
Gross overseas social security pensions or benefits
Will you be receiving
for the full year?
Yes No If not, enter dates: Start Stop
Gross overseas private pensions
Will you be receiving
for the full year?
Yes No If not, enter dates: Start Stop
Schedular payments (eg commission to real estate and insurance agents).
Expenses Gross Income
Current tax rate being deducted from your schedular payments
Gross interest
Show the tax rate that will be
deducted from the interest
10.5% 17.5% 30% 33% 45%
If you have not
provided your
IRD number to
the payer
Gross dividends
Provisional tax payments. If you’re going to make any provisional tax payments show the amount here.
Note: Contact us if you have been charged provisional tax but you’re applying for a tailored tax code or rate instead. You may
need to re-estimate your provisional tax liability.
Other income or losses from partnerships, self-employment, estates, overseas, interest or dividends, or rental losses (excluding
most residential, see below).
Note: If this is your first application and you haven’t filed tax returns including losses from these sources, you’ll need to provide
documents showing how you calculated the amount you’re claiming for.
Type of income
Estimate the amount of tax, if any, which will be deducted from this other income.
Lump sum payments, such as ACC or redundancy.
Declaration
I declare that the information on this form is true and correct.
/ /
Signature
Date
Notes
• This rate is based on your estimates and may not be the final amount you owe. Final tax can only be worked out on the actual
figures shown when you receive your income tax assessment.
• Complete this application in myIR or send this completed form to us at the following postal address:
Inland Revenue, PO Box 39010, Wellington Mail Centre, Lower Hutt 5045
Tailored tax codes and rates don’t apply to:
• student loan repayments
You can no longer use a tailored tax code to change the amount of your student loan repayment deductions. For more information
about working in New Zealand with a student loan go to ird.govt.nz/studentloans
• residential rental losses
You may have applied for a tailored tax code or rate in the past because you had residential rental losses to offset against other
income like salary and wages. Most of these losses are now ring-fenced, which means residential property deductions can generally
only be used to offset income from residential property. For more information go to ird.govt.nz/ring-fencing