ilumin Annual Non-Resident Questionnaire

B NZ Interest, Dividend and Portfolio Investment Income

Please provide the following:

	to be provided	N/a
- Statement of any New Zealand interest income received during the year
- Statement of any New Zealand dividends received during the year
- Details of any Portfolio Investment Income (including the year-end tax report)

C Purchase and Sale of New Zealand Property

Have you sold any residential property during the year? -if so please provide:

	to be provided	N/A
- A copy of the sale and purchase agreement for the sale.

When was the property purchased (date of Purchase)

MonthDayYear
Date
When was the property sold (date of sale)

MonthDayYear
Date

If it was within 10 years of the sale date:

	Amount ($)
- What was the original purchase price?
- What was the sale price

Please provide

	to be provided	N/A
A copy of the sales and purchase agreement at original purchase date.

D Income from Rental Properties
Address of the property

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Please provide the following:

	to be provided	N/A
- Bank statements for the full year (if a separate rental bank account is kept)
- Loan statements for the full year
- Property Manager statements for the full year and year-end rental summary statements

	$
-Rental Income
-Rates
- Insurance
- Interest
- Repairs and maintenance (please provide copies of invoices for repairs and maintenance of $1000 or more)
- Body corporate fees
- Legal fees
- General expenses
- Travel expenses (you can only claim travel directly related to visiting your rental property)

Did you purchase or sell any fixed assets

YesNo

If yes please complete the following section and attach copies of invoices

	Date purchased/sold	Description of asset	Amount $	Invoice provided (Yes/No)
- Asset 1
- Asset 2
- Asset 3
- Asset 4
- Asset 5

E Salary and Wages / Withholding Income
Did you receive New Zealand salary or wages during the year? (we will receive a summary of these earnings from Inland Revenue)

YesNo
Did you receive New Zealand Income from which withholding tax was deducted? (we will receive a summary of these earnings from Inland Revenue)

YesNo

Please provide the following:

	to be provided	N/A
- Details of any expenses relating to your withholding income

F Shareholding in a New Zealand Company (that ilumin does not act for)

Please provide the following:

	to be provided	N/A
- Details of shareholder/director remuneration for which PAYE/withholding Tax was not deducted

G Shareholding in a New Zealand Look Through Company LTC (that ilumin does not act for)

Please provide the following

	to be provided	N/A
- Details of all profit loss allocations received

H New Zealand Partnership Income (from a partnership that ilumin does not act for)

Please provide the following:

	to be provided	N/A
- Details of your share of income, share losses

I New Zealand Income of any other nature

For each income item please provide the following:

	to be provided	N/A
- Amount received
- Type of income
- From whom it was received

J Income Protection Insurance

Please provide the following details:

	to be provided	N/A
- Letter from your insurance provider that notes the tax-deductible premiums paid for the year

K Student loan
Have you been granted a repayment holiday?

YesNo
If yes, please provide the date of the repayment holiday:

MonthDayYear
Date

L Any Other Information
Please add anything else you would like to make us aware of:

Should be Empty:

	to be provided	N/A
- Overseas interest statements
- Overseas dividends statements
- Overseas rental income and expenses

ilumin - Annual Non-Resident Questionnaire

A Leaving New Zealand

B NZ Interest, Dividend and Portfolio Investment Income

C Purchase and Sale of New Zealand Property

D Income from Rental Properties

E Salary and Wages / Withholding Income

F Shareholding in a New Zealand Company (that ilumin does not act for)

G Shareholding in a New Zealand Look Through Company LTC (that ilumin does not act for)

H New Zealand Partnership Income (from a partnership that ilumin does not act for)

I New Zealand Income of any other nature

J Income Protection Insurance

K Student loan

L Any Other Information