Redirectionofbenefitpayment

form

Aredirectionofbenefitpaymentiswherepartorallofyourbenefitispaidtoanotherpersonororganisationby

theMinistryofSocialDevelopment.Requestsforaredirectionwillonlybeapprovedinspecialcircumstances

andforgoodreason.

Youwillneedtoshowuswhyyoucannotuseotheroptions,suchaspayingbydirectdebitorusingyourbank’s

automaticpaymentservice.

Theotherpersonororganisationwhoreceivesyourpaymentsdoesnothaveanypowertoactonyourbehalfin

relationtotherestofyourbenefitorotherdealingswithus.Ifyouwanttogiveextrapowerstoanotherperson

ororganisation,youwillneedtocompleteanAppointmentofAgentform.

Whenyouapplyforaredirectionofyourbenefitpayment,youwillneedto:

•Givethereasonswhyyouneedtohavepartorallofyourbenefitpaidtoanotherpersonororganisation

•Telluswhatotheroptionsyouhavetriedandattachprooftosupportyourapplication.Forexample,

arecommendationfromadoctororbudgetadvisor,atenancytribunaldecision,prooffromabank

thattheywillnotprovidetheserviceyouneed(suchasnotallowingyoutoopenanaccountorsetup

automaticpayments)

•Attachproofofthebankaccountofthepersonororganisationthatyouwanttoreceiveyourbenefit

payment

•Havetheperson(orarepresentativeoftheorganisation)whowillreceivepartorallofyourbenefitsign

thisformtoshowtheyagreetotheredirection.

Clientnumber

Tellusyour

details

Yourbenefit

payments

INFORMATIONFORQ3:

Youneedtohavegood

causeforthis.For

example,youareilland

unabletomanageyour

ownaffairs,oryouare

havingmajorproblems

managingyourfinances.

1

2

3

Whatisyourfullname?

FirstandmiddlenamesSurnameorfamilyname

Whatdatewereyouborn?

DayMonthYear

Whydoyouneedpartorallofyourbenefitpaidtoanotherpersonor

organisation?

V19–DEC2015

Page1

ATTACHMENTFORQ4:

Pleaseattachproofof

thistosupportyour

explanation.

4

Pleaseexplainwhateffortsyouhavemadetofindanotherwayforthese

paymentstobemade.

Payee’s

details

5

6

7

Howmuchofyourbenefitdoyouwanttoredirect?

Thewholeamount

PartofmybenefitWritehowmuch$aweek

Whatisthenameofthepersonororganisationyouwantyourbenefit

paymentredirectedto?

Whatistheirpostaladdress?

ATTACHMENTFORQ9:

Youwillneedto

provideproofofthe

payee’sbankaccount

details,suchasabank

statementordepositslip.

8

9

Whataretheircontactdetails?

Phone()

Mobilephone()

Whatbankaccountwouldyouwantthepaymentstobepaidinto?

Theaccountisinthenameof:

Theaccountnumberis:

DEC2015