Authorisation For Nominated Person

Authorisation For Nominated Person

Due to the Privacy Act 2020, My Refund Limited is unable to disclose specific information about your account records to an unauthorized person. If you wish to nominate a person to have the authority to discuss matters relating to your tax situation, complete the below form.
IRD#*
Date of Birth*

MonthDayYear
Date
Name of Client*

First NameLast Name
I would like to nominate the below person to speak on my behalf regarding my tax situation with My Refund Limited
Name of Nominee*

First NameLast Name
Relationship to Client*
Date of Birth*

MonthDayYear
Date
I understand it is my responsibility to contact My Refund Limited if I no longer wish for the above person to have authority to my account records.
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty: