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Application for withdrawal of initial KiwiSaver contribution KS5

April 2019

Use this form to apply for a refund of KiwiSaver contributions held by Inland Revenue on the grounds of significant financial hardship or serious illness.

To apply for a serious illness refund, you will need to ask your doctor to complete the doctor's declaration section of this form.

To apply for a significant financial hardship refund, you will need to provide details of your financial situation, complete a declaration of significant financial hardship and have it witnessed.

Inland Revenue can only consider your situation during the first three months after receiving your first contribution. After the first three months your contributions are passed to your KiwiSaver scheme provider and you'll need to contact them to discuss your eligibility for a  refund.

To complete this form you'll need your:

  • IRD number and 
  • bank account.