Authorisation form for Nominated person Due to the Privacy Act 1993 My Refund 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 and return to My Refund Limited. Either: 1. Scan the information or snap a photo on your smartphone 2. Send it from your device straight to My Refund Ltd a. Send us a message through our website and select your photo/file b. Attach your photo/file and email [email protected] c. Chat live with My Refund and send your photo/file through our live chat service Or post it into FREEPOST, PO Box 6490, Christchurch 8442

Your details

IRD Number: Full Name: Date of Birth:

☐☐☐-☐☐☐-☐☐☐ ☐☐-☐☐-☐☐

I would like to nominate the below person to speak on my behalf regarding my tax situation with My Refund Limited

Their details

Name: Date of Birth:

☐☐-☐☐-☐☐

Relationship to client: 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.

☐☐-☐☐-☐☐ Your Signature

Date received:

Date OFFICE USE ONLY Entered By:

Authorisation form Nomiated person.pdf

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