This return is used to declare your company's dividend withholding payments.

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.

Complete this return only if the company has elected to maintain a dividend withholding payment account.

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After you finish

Please print, sign and attach this form to your IR4 return and post to your nearest Inland Revenue office.

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