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Get Application for Withdrawal of KiwiSaver

2006 Use this form to apply for a withdrawal of KiwiSaver contributions if you are suffering, or likely to suffer either serious illness or significant financial hardship. Section A - General 1. IRD number If you don’t know your IRD number, call the IRD, 0800 549 472 If you have an 8 digit IRD no., leave first box blank 2. Membership no. 3. Your name Mr Mrs Miss Please mark one of these boxes Ms Other eg Doctor First & middle names Surname 4. Your postal Address Street number .

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