Reparation check form

Complete this form to find out if you are owed reparation.

If you have any questions, you can call us on 0800 909 909 between 8am and 7pm, Monday to Friday.

Reparation details

Is this inquiry for an: *

Individual
Organisation

Your details

We need to be able to identify and contact you to complete this check. Please complete as many fields as possible.

First name

Middle name

Last name

Are you known by any other names?

Date of birth

Email address

Phone number (include area code/prefix)

New Zealand drivers licence

Street address

City

Postal code

Address at time of order for reparation (If different)

Organisation details

Name of organisation

Name of contact person

Email address

Phone number (include area code/prefix)

Street address

City

Postal code

Address at time of order for reparation (If different)

Payment Information

We will use this information to set up payment by direct credit if your details are confirmed. You must include all the required information before your payment can be made.

Bank account number *

If your bank account number ends with a 2 digit suffix, please add a zero to the front. For example, if your suffix is 21, enter 021.

Account name *

Bank name *

Are you aware of any reparation which is owed to you? *

Description of Reparation

This information helps us to locate any reparation which is owed to you.

If you have a PPN reference number, please enter it here

Court name

When would that offence have occured?

Briefly describe what the reparation may be for (e.g. theft)?

Declaration

By ticking this box I confirm that the information given is true and correct. *

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