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Mandatory fields are marked with an asterisk (*).
Format: 12-345-678 or 123-456-789
Suburb, city, town or region*
Daytime phone number*
This can be your home, work or mobile phone number. We may need to contact you to ask for more information, or to clarify any aspect of your instalment arrangement proposal.
Format: (07) 123 4567 or 027 123 4567
Mobile phone number
Format: 021 123 4567
If you provide your email address you give consent to communicating with Inland Revenue via email. You accept that these emails may contain confidential information. Inland Revenue will take all reasonable steps to mitigate any risk of emails being sent to the wrong recipient, but cannot guarantee that emails will not be intercepted while in transit. All documents will be converted to PDF and password protected prior to being sent unless otherwise agreed. You acknowledge that, once the email has been received, it is your responsibility to keep this information secure, and ensure it is not accessed by an unauthorised individual.
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