For assistance with completing this form please go to www.whairawa.com, or contact us on 0800 WHAI RAWA (0800 942 472). SECTION 1: Details of Account Owner Title: First Names: Last Name: Postal Address: Country (currently living in): Post Code: Email: Male Female Home Phone: Work Phone: Mobile: Date of Birth: Place of Birth: Mother s Maiden Name: D D M M Y Y Y Y Your six digit Whai Rawa number: Tax details Tax Information I would like help with supplying this tax information. Please contact me via Phone / Mobile Email IRD Number: NZ Resident (Please complete PIR and RSCT details below) PIR: 10.5% 17.5% 28% RSCT: 10.5% 17.5% 30% 33% For help with this section Tick the checkbox above and we will contact you. To work out your PIR and RSCT tax rates and for further information, see pages 18 & 19 of the Investment Statement. Non NZ Resident (Please continue to next section) SECTION 2: Details of Course All applicants to complete this section. I have attached evidence of course being undertaken or; I have attached evidence of the completed and if you have competed the course, provide evidence of completion. If the course is not New Zealand based, please provide evidence that demonstrates the course is approved or recognised in the country it is based in. SECTION 3: Amount Requested How much money are you requesting? All applicants are to complete this section, please state the amount you wish to withdraw. Amount The full account balance of my Whai Rawa 1
SECTION 4: Payment Options Please complete one of the following three options: 4.A Payment during course of study Complete this section if you are seeking a withdrawal to assist with meeting the costs during your course of study. ; 4. B Where the withdrawal is for repayment of a student loan, payment will be to your student loan account. Complete this section if you a applying for a withdrawal on completion of course to be made to your Student Loan account ; 4. C Withdrawals during course of study Complete this section if you a applying for a withdrawals on completion of course to be made to reimburse your personal bank account ; Go to Section 5 if you are applying for a special circumstances withdrawal 4.A Payment on completion to your student loan account If you have completed a your course of study, payment will normally be made into your Student Loan account with Studylink or IRD. 4.B Payment on completion to reimberse fees incurred by you If you have completed a your course of study and you have met the cost of fees yourself, you may apply to withdraw you Whai Rawa funds to reimburse these costs. Please note where these costs have been met by any other party including employer, scholarship, grant and/ or a family member, you may not apply under this section. 4.C. Payment during course of study Please complete this section if you are seeking a withdrawal to assist with meeting the costs during your course of study. 1. Confirm what other sources of funding you have sought; Student Loan entitlements Grants Please name: Scholarships Please name: Any other sources Please describe: 2. Proof of fees a fee receipt a studylink statement confirming all fees have been paid 3. List the course costs or course related costs which funds are sought: 2
SECTION 5: Special Circumstances Withdrawals Special circumstances withdrawal requests may be considered where the criteria outlined above have not been met and where the Manager is satisfied that the overall intent of the education withdrawal request is the pursuit of tertiary education. These requests will be considered on a case by case basis, and may require the Manager to seek further inforamtion. Please complete A, B, C and D if you are applying for a special circumstances withdrawal. 5.A Outline here the special circumstances that you consider justify the approval of a special circumstances withdrawal (call 0800 942 472 if you need further information) 5.B Please provide any relevant supporting information such as a budget and brief statement of assets and liabilities I have attached a supporting document 5.C Outline here what the funds which you are seeking to withdraw will be used for: 5.D Payment details (in the event of a successful Special Circumstances Withdrawal) If your application is successful payment will normally be made into your Student Loan account with Studylink or IRD or into your bank account. I have attached certified bank account details 3
SECTION 6: Declaration (please read) 1. I understand that I am responsible for my own personal tax implications, if any, of a Whai Rawa withdrawal. 2. I am requesting a withdrawal from my Whai Rawa account for the circumstances outlined above. 3. If my request is for repayment of fees originally paid by me I have not had assistance to meet the cost of these fees from any other party including: my employer/s, scholarship/s or grant/s, or family member. 4. (If I am applying during my course of study) the Education withdrawal will only be used to meet costs and expenses related to tertiary education and that I have taken all other reasonable steps to secure funds to meet my costs. 5. All information provided in this form and any other information provided by me relating to this withdrawal request is true and correct. 6. There is no additional information that I have not provided that may be relevant to this withdrawal request. 7. If any of the information provided becomes incorrect or if I become aware of any other information that may be relevant to this request before payment of the withdrawal is made, I will immediately notify Whai Rawa. 8. If I am signing this application on behalf of someone else (including as a legal representative), I am lawfully able to provide the above declarations. 9. I understand that the personal investor rate (PIR) at which earnings are taxed and which are payable annually and when funds are withdrawn or transferred, is either 10.5%, 17.5% or 28% depending on my income (see chart below to work out your PIR). I confirm my PIR is (PLEASE NOTE IF YOU ARE NOT A NZ RESIDENT YOU DO NOT NEED TO CONFIRM YOUR PIR) 10. I authorise Whai Rawa to disclose to and to collect from any person, personal and financial information about me for the purposes of processing the withdrawal for which I have applied. Signing and dating this section confirms you have re ad and understand section 6 above. I, (full name of applicant) of (address) Signature: Date: D D M M Y Y Y Y Check List WITHDRAWAL CHECK LIST Section 1 is complete Section 2 is complete Section 3 is complete Section 4 is complete - a statement of iwi participation attached. Section 5 is complete - supporting evidence attached Section 6 is complete - you have the declaration pre-printed, or bank verified deposit slip or current bank statement attached. If you have already finished your tertiary study, evidence of completion of qualification including date and name of qualification and evidence of outstanding student loan account and balance details If you are making a special circumstances application or a request for assistance during your course of study, evidence of enrolment, payment of fees, and record of papers completed to date If the course is not NZ-registred, evidence that demonstrates the course is approved or recognised. Evidence of your bank account where payment sought to bank account. Other evidence to support any part of the application. 4
Guide for Tertiary Education Withdrawal Please note: Processing of request will normally take up to five working days from receipt of completed application If we approve your application we ll send you confirmation and pay the withdrawal to your nominated bank account. If we don t approve your application we ll send you a letter giving you reasons If you have any queries about the criteria or completion of this form call 0800 WHAI RAWA (800 942 472) You are encouraged to contact Te Tapuae o Rehua regarding other possible sources of funding for tertiary education: Ph: 03 3777305, Fax: 03 3712699, Email: scholarships@tetapuae.co.nz For the purposes of Whai Rawa withdrawal requests, bona fide tertiary course of study is defined as; a Tertiary Education Commission approved course and either: the course will result in a qualification ie not a one-off course/paper/unit/credit or a series of courses/papers/units/ credits which, taken together, do not count towards a complete qualification. or: a full-time or part-time course of 32 weeks or longer. (StudyLink criterion for Student Loan) Criteria Subject to these criteria, and to any exclusions outlined below, a Member may apply for, and Whai Rawa Fund Limited ( the Manager ) may approve, an Education Withdrawal, being a withdrawal from the Member s Accounts for the purposes of financing tertiary education. The Manager may approve the payment and amount of an Education Withdrawal if all the following conditions are satisfied: (a) The Education withdrawal is used for the purpose of tertiary education; and (b) The Education withdrawal is being paid on completion of a bona fide tertiary course of study and the Education withdrawal will be applied to repay or reduce your Student Loan or, at the Manager s discretion to refund tertiary fees paid; or (c) The Education withdrawal will be applied to meet costs, fees and/or expenses related to tertiary education provided the Manager is satisfied in its sole opinion funds to meet these costs, fees and/or expenses are not otherwise reasonably available to the Member while the Member is undertaking the course of study; and (d) You are not under 16 years; and (e) The amount of the Education withdrawal is not greater than the total balances of your Whai Rawa accounts. The Manager may, at its discretion, modify or waive any of the above conditions (other than (d) and (e)) in special circumstances, provided the Manager is satisfied that the overall intent of the Education Withdrawal is the pursuit of tertiary education. Exclusions Withdrawals will not be able to be made for courses completed prior to the member s Whai Rawa account being opened. Completing This Form All applicants are required to complete Section 1, 2 & 3 All applicants other than those seeking a special circumstances withdrawal are required to complete either A, B or C of Section 4 4. A Where the withdrawal is for repayment of a student loan, payment will be to your student loan account. Where a withdrawal is for refund of tertiary fees paid by you, payment will be made to your nominated bank account. Refunding of tertiary fees will only be approved where the fees have not been subsidised or reimbursed from any other source. Such other sources could include: scholarships, grants and employer contributions. 4.B Withdrawals on completion of course Your education withdrawal, if approved, may be applied to either repay or reduce your Student Loan or, at the Manager s discretion to refund tertiary fees paid. 4.C Withdrawals during course of study Whai Rawa education withdrawals can now be made during the course of study where the member has exhausted other funding avenues. Applicants seeking a special circumstances withdrawal are required to complete all of Section 5 All applicants are required to complete Section 6 5