Fluxx Engagement Form

13 Fusion Road, Flatbush Manukau Auckland 2019

Email : contact@fluxx.co.nz www.fluxx.co.nz

Authority to Act as Tax Agent -Engagement/Contract

(All information treated with strict Confidentiality)

FULL NAME *

IRD Number *

I authorise 2M Systems Limited Trading as Fluxx to act as my Tax Agent to prepare returns, using information I supply, and file them with the Inland Revenue Department.

I also give permission to you and your staff to discuss my tax affairs, provide and obtain information for all current and future revenues from the Inland Revenue Department.

Tick one only*

ALL tax typesFollowing tax types only :

Specify here if you ticked the second option above:

e.g. INCOME Tax, GST

Also, I understand that information about my tax affairs may be obtained by telephone, correspondence, internet online services or any other appropriate means. ( All channels including electronic ones) .

This authority also includes the signing of tax returns for Inland Revenue and registering for NZBN. (please tick one below).

YesNo

ID Presented: NZ Driver's License (please scan and email)

Signed*

Date*

Date

Email*

example@example.com

Address*

Contact Nos.*

As a client of an agent, you receive an extension of time to file your income tax returns. If you do not give us the records in time to prepare the returns by the due date you will receive a letter from Inland Revenue outlining your obligations. You may be charged with a late filing penalty. If you are charged a late filing penalty, you lose your extension of time privilege.

2M SYSTEMS LIMITED