FED refund Customer registration form

Use this form to register with the NZ Transport Agency so you can claim fuel excise duty refunds using the MR70.

Customer Details

Full legal name (Company/partnership/organisation/individual)

Authorised representative

Phone

Mobile

Email*

example@example.com

Trading name (if applicable)

Please provide full names of all trustees, partners or directors (continue on a separate sheet if necessary)

1.

3.

2.

4.

Physical Address

Address Line 1

Address Line 2

Postal address (if different to physical address)

Address Line 1

Address Line 2

IRD number (please provide your IRD number for the Transport Agency to determine your eligibility to apply for a refund. Please also provide a copy of documentation from the IRD confirming you are in business, eg a copy of a GST101)

Alternative contact (a person of your choosing who can access your fuel excise duty information on your behalf)

Phone

Mobile

Email

example@example.com

Commercial activity

Describe your commercial activity (please tick)

Farm/orchard/vineyardCommercial maritime activities (fishing, tourism, etc)Commercial lawn mowing/landscapingCommercial carpet cleaningCivil/agricultural contractingOther (must be a commercial activity – fuel excise duty refunds are not available for domestic, household or personal use)

Please provide a brief description of your commercial activities:

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Business details

BIC code

Website address(if applicable)

Number of staff (full-time equivalent)

Area of operation

Describe seasonal impacts on your fuel usage

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How do you purchase your fuel? (tick as applies to you and answer the questions that follow)

Bulk

What volume of fuel does your bulk tank hold?

How do you gauge how much fuel is left in the tank at the end of each quarter?

Service

How do you purchase and transport your fuel?

How do you store your fuel? (eg jerry can)

Do any vehicles, vessels or machinery that are not eligible for a refund extract fuel from your bulk tank or purchase fuel through your business fuel account? If so, please list these vehicles/machinery.

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What is your estimated average fuel usage for the previous year (in litres)?

What security is in place for your fuel supply to guard against theft, use for non-commercial purposes or personal use.

How do you determine what fuel purchased is eligible for a refund (ie how do you record usage)?

Farm/vineyard/orchard details (fill in this section only if applicable to your commercial activity)

Size (hectares)

Stock type(s)

Orchard/crop type

Description of farm/land (how many paddocks, contour, stock numbers)

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Physical address for additional locations

Size (hectares)

Vehicles and equipment

Vehicles licensed in classes A or B

	Make/model	Licence plate number	Tank size	Purpose/use

How do you record on-road use?

Unregistered vehicles (eg farm bikes, tractors, hydroladders and ride-on mowers)

	Make/model	Year of manufacture	VIN/chassis number	Tank size	Purpose/use

Commercial purposes (not vehicles, eg chainsaws, water blasters and push mowers)

	Description	Tank size	Quantity	Purpose/use

Vehicles subject to RUC (eg motorhome over 3500kg)

	Make/model	Licence plate number	Approx. Fuel Efficiency (eg km to litre)

Commercial vessels (must hold NZ Maritime Certification)

	Name of vessel	Maritime certification number	Tank size	Purpose/use

Commercial vessels (must hold NZ Maritime Certification)

I have attached a copy of my NZ Maritime Certification

Bank account number for refund to be direct credited to

Name of bank account

Checklist
Before submitting your application you have supplied the required documentation where applicable. We cannot process your registration or any refunds unless you provide the correct applicable documentation:

Proof of commercial intent (eg certificate of incorporation, IRD document)An official bank document verifying your bank account name and numberAn email address for direct credit remittance adviceCompleted all sections in ‘Customer detailsHave described your commercial activity typeCompleted all sections related to fuel purchasing and recordingProvided details of all the assets you are claiming a refund forProvided supporting documentation for your assets as outlined in ‘Vehicles and equipment' (eg NZ Maritime Certificate, Certificate of Registration of Amusement Device)Signed the declaration

Appoint an agent

Complete this section only if you authorise another person or company to complete your claim on your behalf.

I give authority to

(must be a legal entity)

to act as my agent from

Date

for all purposes associated with the preparation of future fuel excise claims. Where an agent acts on your behalf, payment of the refund of fuel excise duty to an agent extinguishes the entitlement for that refund. The NZ Transport Agency, acting as delegate of the Chief Executive of the Ministry of Transport, will not be a party to any dispute between you and your agent. Appointment of an agent does not remove you from the refund process and the Transport Agency reserves the right to contact you at any time for corroboration of applications filed. This authority remains in place until the Transport Agency is advised otherwise. In the event that you cancel the relationship you have with your agent, you will notify both your agent and the Transport Agency in writing.

Declaration

WARNING:
ANY PERSON MAKING A CLAIM OR FURNISHING ANY INFORMATION KNOWN TO BE FALSE IN ANY MATERIAL PARTICULAR IS LIABLE FOR PROSECUTION.

Authorised signature

Phone

Print name

Date

Fuel excise duty refund Customer registration form