Authorisation For Nominated Person

Authorisation For Nominated Person

To protect your privacy, My Refund can only discuss your tax information with you — unless you authorise someone else to speak on your behalf. Use this form to nominate a trusted person who can communicate with My Refund about your tax matters.
IRD Number*
This helps us identify your tax records.
Date of birth*

MonthDayYear
Used to verify your identity
Your name*

First NameLast Name
I would like to authorise the following person to speak with My Refund on my behalf regarding my tax matters.
Name of nominated person*

First NameLast Name
Relationship to you*
For example: partner, parent, accountant, friend.
Date of birth*

MonthDayYear
Used to verify the nominated person’s identity if required.
I understand that it is my responsibility to notify My Refund if I no longer want this person to have authority to discuss my tax information.
Signature*

Clear
Date*

DayMonthYear
Date
Should be Empty: