Use this form for paying RWT (resident withholding tax) deducted:
- from dividends treated as interest
- from amounts distributed by a Māori authority, and
- by agents or trustees from dividends received on behalf of another person.
Use this form for paying RWT deducted from dividends treated as interest that are dividends paid:
- by companies that:
- at the time aren't in New Zealand
- are prohibited by their constitution from distributing all income to any proprietor, member or shareholder, or
- have income that is exempt or who are solely engaged in life insurance or re-insurance.
- on specified preference shares.
These dividends have no imputation or FDP (foreign dividend payment) credits to attach:
- amounts distributed by a Māori authority
- agents or trustees from dividends received on behalf of another person.
To complete this form you'll need:
- your IRD number
- month and year the specified dividend/Māori authority distribution was paid
- gross dividends/distributions
- imputation/Māori authority credits
- foreign dividend payment credits (for tax years prior to 1 April 2017).
Please print, sign and send your completed certificate to us. Keep a copy for your records.