Membership Form

Membership application Questions marked with * are required
Type of account *
1. Your name & contact details
What are your phone numbers and email address? *
Please provide two contact numbers.
2. Your address
3. Your personal details
Are you employed?
Have you or your join Applicant ever been declared bankrupt or gone through the No Asset Procedure? *
If yes, in what year?
What would you like your account password to be? *
What is your Mother's Maiden Name? *
Are you a NZ resident? *
IRD Number *
Do you pay tax? *
What is your tax rate? *
4. Outside of NZ
Are you a US citizen *
Are you a tax resident of country other than New Zealand? *
If you are a tax resident of country other than New Zealand, please provide which country and your Individual Identification Number number
If you are a tax resident of country other than New Zealand, please provide your Individual Identification Number number
There are incomplete fields. Please complete them first.