Warning!
1. Select Print Report.
2. Complete the Declaration (9) and scan and email, or fax it to us on 04 495-8143.

Inland Revenue
Te Tari Taake

IR 920
February 2004

Employer linking to PAYE intermediary

       
  Please answer all questions and make sure you sign the declaration.
 
1. PAYE intermediary's IRD number
94-914-078
(If you do not know this, please obtain from PAYE intermediary)
 
2. PAYE intermediary's full name
iPayroll Ltd
 
 
3. Employer's IRD Number
26-980-658
 
4. Print your full name, or the name
of the estate, trust or partnership
or the registered name of the company
Angling Adventures Ltd
 
 
5. When will your arrangement begin with your PAYE intermediary?
        
Day      Month      Year                  
 
6. Print the full name of a contact person
 
 
7. Contact telephone number  
 
8. Position or title
 
 
9. Declaration
Signature
   /   /   
Date      
 
I declare that the information given in this form is true and correct and that my PAYE intermediary
has the authority to act on my behalf in respect of my PAYE obligations.