Self-certification declaration

Valid for all Unity members

Important notes:

This is a self-certification form provided by an account holder to a reporting financial institution for the purpose of automatic exchange of financial account information. The data collected may be transmitted by the reporting financial institution to Inland Revenue for transfer to the tax authority of another jurisdiction. This form is intended to request information consistent with New Zealand Tax law.
An account holder should report all changes in his/her tax residency status to the reporting financial institution.
Unity does not provide tax advice. Please contact a specific tax adviser if you require guidance regarding how to determine your tax status.

Full name

Physical address

Date of birth DD-MM-YYYY

Jurisdiction of Residence and Taxpayer Identification Number or its Functional Equivalent (“TIN”)

Enter below the country of residence where you are a resident for tax purposes and your TIN for each jurisdiction indicated. Indicate all countries of residence.

If you are a tax resident of New Zealand only, you can skip the 'Jurisdiction of Residence' questions and just tick the "I am a tax resident of New Zealand only" box below.

What is a TIN? (Need help working out what your TIN is? It's a combination of letters or numbers issued by tax authorities or other agencies, and used to identify you for tax purposes in your country of tax residence. For what this may mean in your country search 'TIN' on oecd.org)

Jurisdiction of Residence

TIN

If TIN is unavailable please select a reason why

Reason A: The jurisdiction where I am a resident for tax purposes does not issue TINs to its residents.

Reason B: You are unable to obtain a TIN. Explain why you are unable to obtain a TIN if you have selected this reason.

Reason C: TIN is not required. Select this reason only if the authorities of the jurisdiction of residence do not require the TIN to be disclosed.

If you selected Reason B, please explain why the account holder is unable to obtain a TIN.

If you are tax residence of another country please provide Jurisdiction of Residence details and the TIN number (or reason why the TIN is unavailable) below.

I am a tax resident of New Zealand only

Declaration

I certify/acknowledge that:

I have authority to provide the above information and it is true, correct and complete;
I will notify Unity of any change that would affect the tax residency information provided;
Unity may obtain, use and/or disclose information held about me to enable Unity to comply with any laws, rules or regulations in New Zealand or any other country including any laws, rules or regulations reasonably expected to be implemented.
Information collected is handled in accordance with Unity's Privacy Statement available at unitymoney.co.nz

Tick to confirm that you acknowledge and agree to the above declaration.