Household Representative (HHR) form - Tauhara North No.2 Trust

Household Representative (HHR) Registration

Use this form to let us know who will be the main contact for your household (HHR).

They would be able to receive any news, information and updates as well as any grant payments on behalf of the household. E.g. State of Emergency if activated. Please ensure we have correct bank account details.

Please complete online form below:

Household Representative Registration

Personal Details - must be over the age of 18
First Name*
Middle Name
Surname*
Date of Birth*
DD slash MM slash YYYY
Contact Information
Phone
Mobile*
Email*
Address
Address*
Physical Address City Suburb Postcode Country
Do you have a different postal address?
Postal Address (if different from above)
Physical Address City Suburb Postcode Country
Bank Account
Bank Account Name*
Bank Account Number*
Upload Documents*
Drop files here or

Max. file size: 250 MB.
(e.g. Bank Statement, deposit slip or bank chit)
Household Members Details
Name of household member (1)
Relationship to HHR
Date of Birth
MM slash DD slash YYYY
Name of household member (2)
Relationship to HHR
Date of Birth
MM slash DD slash YYYY
Name of household member (3)
Relationship to HHR
Date of Birth
MM slash DD slash YYYY
Name of household member (4)
Relationship to HHR
Date of Birth
MM slash DD slash YYYY
Name of household member (5)
Relationship to HHR
Date of Birth
MM slash DD slash YYYY
Declaration
Declaration*
- Agree
As the nominated Household Representative, I agree that all information given is true and correct to the best of my knowledge and understand that household grants will be paid into my Bank Account for the benefit of my household