Te Ātiawa o Te Waka-a-Māui - To shine as Te Ātiawa, the few, the many, all of us.

Kaumātua Christmas Koha

If you would like to receive the Kaumātua Christmas 2019 Koha please complete this form or contact the office on 0800 284 292 or
+64 3 373 5170.

Kaumātua Christmas 2019 Koha Form

Name of Kaumatua *

[Registered member who is aged 60 years or older on the 25th December, 2019]

First Name

Middle Name

Last Name

Phone (NZ Residents)

Phone (International Residents)

Email *

Physical Delivery Address *

(Note: Courier delivery requires a signature)

Address Line 1

Address Line 2

City

Province/State

Post / Zip Code

Country

Pātai (Question)

Would you prefer the Christmas 2019 koha payment to be made to you via direct payment into your bank account or would you prefer a cheque sent to you? *

Please choose your preference:

Internet Bank Payment
Cheque

NOTE: Bank Account information will be kept confidential and safeguarded.

(FOR INTERNET & CHEQUE PAYMENT)

Account Holder's Name

(FOR INTERNET PAYMENT ONLY)

Bank Account Number

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