Use this form to make a resident withholding tax (RWT) on dividends return and payment. This form is not to be used for RWT deducted from specified dividends - for specified dividends, use an IR17P.

This form can be completed on-screen by typing content directly into the PDF document. Once you have completed the form it is important that you print it out as you will not be able to save the information you enter into the form.

Resident withholding tax (RWT) is a tax deducted from investment income before the investor receives it. The RWT deducted is then credited against the investor's tax payable.

A company must deduct RWT at the time it pays shareholders a dividend. For this purpose, "pay" means:

• to distribute to
• credit to an account
• to deal with in a person's interest, or on behalf of that person.

The current rate for RWT on dividends is 33 cents in the dollar.

RWT on dividends must be paid to us by the 20th of the month after the month in which the dividend was paid.

To make a payment, use the correct payment form:

• an IR17P for RWT on specified dividends, or
• an IR4K for RWT on all other dividends.

For more information on RWT on dividends see the Resident withholding tax on dividends guide (IR284).

IRD number

Adobe Reader 9 http://www.adobe.com/products/reader/

After you finish

Please print, sign and post the completed return and payslip to your nearest Inland Revenue office.

You may wish keep a copy of this return for your personal records.