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Complete this form with information when you wish to apply for relief from debt for your business so we can assess your situation.
PDF | 74kb | 2 Pages
If you are an individual in business or a non-individual, complete and attach this form as supporting information when you are making an application for relief from payment of a debt.
It is important that you send this form in as soon as you can. We can only consider and/or accept an arrangement when we receive written application from you.
To successfully complete and submit this form you will need:
Please print and sign the completed form and send to your nearest Inland Revenue office including any supporting documentation.
You may wish to keep a copy for your personal records.