Direct Debit Authority

Fields marked with an * are mandatory
IMPORTANT
Please fill out your details below. When you hit the FINISH button below a PDF of the Direct Debit Authority will be created. If you do not have access to a printer at the time you fill out the form, you can save the pdf and access it later.
1. Member Details
First name *
Middle name(s)
Last name *  
IRD number * - -  
eg 12-345-678 or 123-456-789
Email address
Daytime phone number    
2. Payment Details
Payment amount (minimum $20) *  
Frequency of payment *  
First payment date1 *        
1 Your bank requires 10 business days to process the Direct Debit Authority. If there are less than 10 business days from when the Authority is received and the start date indicated on the form, the initial direct debit may not occur on the day indicated on the form. We will notify you of the proposed date for the initial direct debit, and all subsequent direct debits will occur on the day of the month you've indicated on the form.
3. Bank Instructions
Account name *  
Name of Bank *  
Branch *  
Bank account number *
Bank 
2 No.s
Branch 
4 No.s
Account2
7 No.s
Suffix 
2-3 Numbers
 
2 If your account number has less than 7 digits, please insert zeros at the front of the account number so that the total digits adds up to 7. For example, if your account number was 12345, you would enter 0012345.
Branch Street / PO Box *  
Branch Town / City *  
Post Code   Find  
Information to appear on your statement3
Payer code  
Payer reference  
3 If you're anything like us, you never know which of these fields to use! If you're only going to use one, the reference field is probably best. It's the field that describes the transaction on your bank statement.
I consent to Electronic Mail being used by Kiwi Wealth KiwiSaver to provide me with written notices relating to Direct Debits