This form is for employees to request a contributions holiday.

An employee should complete this form to request a contributions holiday.

You will need to provide your name, address and IRD number.

You can provide your employer's details if you want Inland Revenue to notify your employer/s of the contributions holiday.

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After you finish

Please print, sign and send this completed form to the following address:

Inland Revenue
PO Box 1454
Hamilton  3240

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