This form is for new employees who are subject to automatic enrolment and want to opt out of KiwiSaver. You can also complete this online.

Use this form if you have been automatically enrolled and you don't want to be a member of KiwiSaver.

You will need to provide your:

• name
• address
• IRD number
• bank account number
• employer's name and IRD number.

After you finish

Please give this completed form to your employer or send it to Inland Revenue at the following address:

Inland Revenue
PO Box 1454
Hamilton  3240

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