Authorisation For Organisation

Authorisation For Organisation

Stuck trying to obtain requested information/documentation for your tax refund? My Refund can help! This form is for you to provide authority for My Refund to contact a specific organisation or company to obtain copies of documentation for tax purposes. Complete the below form.
Please complete your details below!
IRD#*
Date of Birth

DayMonthYear
Date
Your Name *

First NameLast Name
I would like to give authority to my tax agent 'My Refund Limited', to contact the below organisation on my behalf to obtain copies of documentation for tax purposes.
Please complete the Organisation Details Below!

This is the Organisation you would like My Refund Ltd to obtain documentation from for you, on your behalf.
Donee ID Number
(optional)
Organisation Name*
Organisation Address

Street Address

Street Address Line 2

SuburbPostal / Zip Code

City
Phone Number

Area CodePhone Number
Email
example@example.com
DECLARATION
- I confirm all information provided by myself is true and correct.
- I understand that changes made will also be updated on my file held at Inland Revenue.
- I have read the Terms and Conditions.
- I understand it is my responsibility to contact My Refund Limited if I no longer wish for them to act on my behalf.
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty: