OMR2_Individual Registration Form

Māori Land Court Information
Shareholder Name (as appears in the MLC records)*

First NameMiddle NameSurname
Minute Court Reference*
e.g. 55 WAIARIKI MB 345-346
Date of Court Hearing*

DayMonthYear
Upload Succession/Vesting Orders from Maori Land Court*

Browse to Upload Succession/Vesting Orders

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Shareholder Bank Details
NZ Bank Details
Bank Account Name*
Bank Account Number*
Please enter like example 00-0000-0000000-00
Upload Electronic Copy of Bank Verification*

Require either a copy of a Bank Account statement, pre-printed deposit slip or bank print-out
Upload document to verify your bank account Cancelof
Overseas Bank Details
Your Bank Account Name*
BSB Number*
Account Number*
Name of Bank*
e.g.
Bank's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Upload Electronic Copy of Bank Verification*

Require either a copy of a Bank Account statement, pre-printed deposit slip or bank print-out
Upload document to verify your bank account Cancelof

Declaration Page
Applicant Signature (Type Name)*
By signing this registration form you confirm that you have read and understood the notes below.
I am not a robot*
Date Signed*

DayMonthYear
Should be Empty:

Office Use