Form Ks 6 - Contributions Holiday Request
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2KS 6
April 2007
Contributions holiday request (employee to complete)
KiwiSaver Act 2006
Use this form to request a contributions holiday. Or go to to complete our online form. If you have been a member
for less than 12 months and you are experiencing financial hardship, attach an explanation of your situation or call us on 0800 549 472.
Please read the notes on the back to help you fill in this form.
Section A
Personal details Please use
B L OC K L E T T E R S
1. Your IRD number
2. Your name
Mr
Mrs
Miss
Ms
Other
Put a dash to indicate your title
First names
Surname
3. Your postal
address
Street number
Street address or PO Box number
Suburb, box lobby or RD
Town or city
Postcode
4. Your contact
numbers
Day
Mobile
5. Your email
address
If you give an email address you may receive KiwiSaver information by email
6. You may take a contributions holiday for any period between
Years
Months
three months and five years. Please indicate how long your
contributions holiday is for.
Section B
Employment details Please use
B L OC K L E T T E R S
7. I f you want us to tell an employer to stop making KiwiSaver deductions, please enter their details below. If you have other
employers who you want us to tell, please attach a list to this form.
E mployer’s business
name
Employer’s address
Street number
Street address or PO Box number
Suburb, box lobby or RD
Town or city
Postcode
Please send this completed form to:
Inland Revenue
PO Box 1454
Hamilton 3240
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