About this Form

Return for employers who file quarterly FBT returns. You can also complete this online.

This form can be completed on-screen by typing content directly into the PDF document. Once you have completed the form it is important that you print it out as you will not be able to save the information you enter into the form.

When to use this form

Use this form if you haven’t received your return for the period.

What you will need

• The value of the fringe benefits you have provided to your employees.
• Your IRD number.

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