Redirection of Benefit Payment

Redirection of benefit
payment form
A redirection of benefit payment is where part or all of your benefit is paid to another person or organisation by
the Ministry of Social Development. Requests for a redirection will only be approved in special circumstances
and for good reason.
You’ll need to show us why you can’t use other options, such as paying by direct debit or using your bank’s
automatic payment service.
The other person or organisation who receives your payments doesn’t have any power to act on your behalf in
relation to the rest of your benefit or other dealings with us. If you want to give extra powers to another person
or organisation, you’ll need to complete an Appointment of Agent form.
When you apply for a redirection of your benefit payment, you’ll need to:
• Give the reasons why you need to have part or all of your benefit paid to another person or organisation
• Tell us what other options you’ve tried and attach proof to support your application. For example, a
recommendation from a doctor or budget advisor, a tenancy tribunal decision, proof from a bank that
they won’t provide the service you need (like opening an account or setting up automatic payments)
• Attach proof of the bank account of the person or organisation you want to get your benefit payment
• Have the person (or a representative of the organisation) who’ll get receive part or all of your benefit sign
this form to show they agree to the redirection.
Client number
Tell us your 1 What’s your full name?

details First and middle names Surname or family name
2 What date were you born?
Day Month Year
Your benefit 3 Why do you need part or all of your benefit paid to another person or
payments organisation?
INFORMATION FOR Q3:

You need to have good
cause for this. For
example, you have a
health condition and can’t
manage your own affairs,
or you’re having problems
managing your finances.
V19 – MAY 2019 Page 1

ATTACHMENT FOR Q4:
4 Please explain what efforts you have made to find another way for these
Please attach proof of payments to be made.
this to support your
explanation.
5 How much of your benefit do you want to redirect?
The whole amount
Part of my benefit Write how much $ a week
Payee’s 6 What’s the name of the person or organisation you want your benefit
details payment redirected to?
7 What’s their postal address?
8 What are their contact details?
Phone ( )
Mobile phone ( )
ATTACHMENT FOR Q9:

9 What bank account would you want the payments to be paid into?
You’ll need to
provide proof of the The account is in the name of:
payee’s bank account
details, such as a bank
statement or deposit slip.
The account number is:
10 Is there a Payee’s Reference that should be added?
No
Yes Please tell us the Payee Reference
Page 2 V19 – May 2019

Client declaration
By signing this form, I understand that:
• this redirection of benefit will continue until I ask the Ministry of Social Development or my Contracted
Service provider (if I have one assigned to me) to stop it
• I’ll advise the Ministry of Social Development or my Contracted Service provider (if I have one assigned to
me) of any changes to this redirection, including the amount of benefit being redirected
• if this redirection is to pay bills or debts, I’m responsible for them, and for advising the payee of any changes.
• the Ministry of Social Development will only pay the benefit due.
The information I have given is true and complete.
Client’s name (print) Client’s signature Date
Day Month Year
Helper’s statement
Complete this if you’ve helped the client to complete this form.
What is your full name?

First and middle names Surname or family name
What are your contact details?

Address
Phone number
• I completed this form at the request of the person applying for a redirection of their benefit. They told me
they understood what they were signing.
• The statements and answers I’ve completed are true and complete as given to me by the person applying.
Helper’s signature Date
Day Month Year
Agreement of the person or organisation receiving the benefit

payments
• I agree to receive benefit payments, from the client named above, at the amount stated in question 5.
• I understand I’m receiving all or part of the client’s benefit, and I agree to use these payments as directed by
the client or their agent.
• I understand the payment will only be made where the client’s payment is sufficient to cover the redirection.
The client or their agent may change the redirection at any time.
Full name (print) Signature Date
Day Month Year
V19 – MAY 2019 Page 3

Page 4 V19 – May 2019

Redirection of Benefit Payment

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Redirection of benefit

Tell us your 1 What’s your full name?

2 What date were you born?

Day Month Year

INFORMATION FOR Q3:

V19 – MAY 2019 Page 1

5 How much of your benefit do you want to redirect?

The whole amount

Part of my benefit Write how much $ a week

7 What’s their postal address?

8 What are their contact details?

ATTACHMENT FOR Q9:

10 Is there a Payee’s Reference that should be added?

Yes Please tell us the Payee Reference

Page 2 V19 – May 2019

Day Month Year

What is your full name?

What are your contact details?

Day Month Year

Agreement of the person or organisation receiving the benefit

Day Month Year

V19 – MAY 2019 Page 3

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