This information will be used to match you to our employment data.
Claim Reference Number (if known)
Date of Birth
Has your name changed since you were a team member of a WISNZ entity?*
Old First Name*
Address Line 1*
Address Line 2
City / Town*
Preferred Contact Method*
Payment will made into a New Zealand bank account only
Bank Account Number*
Are you a contributing KiwiSaver member?*
Select your contribution rate
Are you a current member of Wesfarmers AMP fund?
Do you wish to make an after-tax contribution to your AMP fund?
AMP Member Number*
AMP Contribution Percentage*
Please scan or photograph and upload these documents with your claim. Ensure the images are in JPEG, PNG, GIF or PDF format.
Please note: If your identity document has text on both sides (e.g. driver licence), both sides need to be scanned for it to be accepted
You can download the IR330 form here
You can download the KS2 form here
Proof of Name Change*