Questionnaire for NZ Tax Preparation Step 1 of 7 - Contact Information 14% 1. CONTACT INFORMATIONName* Dr.MissMr.Mrs.Ms.Prof.Rev. Prefix First Last Phone*Email* Address* Street Address Address Line 2 City ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country What Citizenship and Residency do you hold?* NZ Citizen NZ Resident NZ Visa Holder None of the Above When did you last reside in New Zealand?* MM slash DD slash YYYY 2. TAX SERVICESDo you need to file a NZ tax return for the last tax year (YE 31 Mar 2020)?* Yes No For which tax year did you last file a NZ tax return?* Can you supply a copy of the last NZ tax return you filed?* Yes No 3. GENERAL QUESTIONSPlease answer the following questions for the period 1 Apr - 31 Mar of the last tax year in which you did not file.Did you receive salary, wages and employment related benefits?* Yes No Were you self-employed?* Yes No Did you have an investment portfolio in any country other than NZ?* Yes None Did you receive Rental Income?* Yes None Did you receive any income from overseas?* Yes None this can include wages, interest, royalties, rental income etc.Did you make any donations?* Yes No 4. Companies and TrustsDid you hold ownership in a NZ corporation?* Yes No Please list the names of the companies below.*Were you a Trustee, Settlor or Beneficiary of a NZ based Trust?* Yes No Please list the names of the trusts below.* 5. Declaration:I hereby declare that the details provided above are true and correct to the best of my knowledge and belief and I undertake to inform you of any changes therein, immediately.SignatureHiddenDate DD slash MM slash YYYY CAPTCHA 6. Cost for ServiceBelow is the total estimated cost for service. This fee is only an estimate and may change if this questionnaire is submitted to NZ US Tax Specialists. This fee is for 1 year of tax filing. If you require more than one year of filing, this fee will increase. Fee Exclusive of GST. Fees are subject to GST (if any)Total $0.00 If the above fee is agreeable, please continue and submit this questionnaire. NZ US Tax Specialists does not offer discounts. 7. Additional InformationIs there any other information you wish to provide?Any special considerations for preparation?CommentsThis field is for validation purposes and should be left unchanged.