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IRD Number (e.g. 123-456-789 or 12345678)

First Name

Last Name

Phone

Living Address

Email Address

Did you receive any income other than salary and wages?

Yes

No

(e.g. self-employment, rental property, overseas income, partnership, company, trust)

If Yes, please provide details

Did you receive any interest, dividends, or Maori Authority income?

Yes

No

If Yes, please provide details

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