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
*
-
-
Invalid IRD number
eg 12-345-678 or 123-456-789
Email address
Daytime phone number
03
04
06
07
09
020
021
022
027
029
2. Payment Details
Payment amount (minimum $20)
*
Required
Frequency of payment
*
Weekly
Fortnightly
Monthly
Bi-monthly
Quarterly
Six-monthly
Annually
Frequency required
First payment date
1
*
DD
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
MM
January
February
March
April
May
June
July
August
September
October
November
December
YYYY
2018
2019
Payment date invalid
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
*
Account name required
Name of Bank
*
ANZ Banking Group (New Zealand) Limited
ASB Bank Limited
Bank of New Zealand
Citibank NA
HSBC Bank
Kiwibank Limited
The Co-operative Bank
Rabobank
Southland Building Society
TSB Bank Limited
Westpac Banking Corporation
Bank name required
Branch
*
Branch required
Bank account number
*
Bank
2 No.s
Branch
4 No.s
Account
2
7 No.s
Suffix
2-3 Numbers
Invalid account number
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
*
Street address required
Branch Town / City
*
Town/City required
Post Code
Find
Incorrect post code.
Information to appear on your statement
3
Payer code
Numbers and letters only
Payer reference
Numbers and letters only
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
Yes
No
Please select Yes or No