Practising fee refund application - PDF document

1 PAGE Practising fee refund application
PAGE Practising fee refund application Please use this form to notify the New Zealand Law Society (Law Society) that you wish to cancel your practising certicate and request a refund for the unused portion of your practising fees. This form must be completed by the practising certicate holder.Form information The information you provide helps the Law Society to assess your application and enables the Law Society to carry out its regulatory and representative functions under the Lawyers and Conveyancers Act 2006.The Law Society will collect, use, hold and disclose your personal information only for the purposes of assessing your application, and as provided for under the Lawyers and Conveyancers Act 2006 and regulations, Privacy Act 1993 or otherwise as permitted or required by law. Personal details Date of birth (dd/mm/yyyy) NZLS lawyer ID (if known) Ofce use only Approved by Registry Manager (signature)Date Refund amount PRACTISING FEE REFUND APPLICATION  FEB 2020, V1 PAGE Statutory declaration (your full legal name)of (your full residential address and occupation) Solemnly and sincerely declare that:I wish to cancel my practising certicate from(last day of employment/practice); and:since that date I have not undertaken any legal services or described myself as a lawyer or any of the descriptions under ss21–23 of the Lawyers and Conveyancers Act 2006 (cross out if you have not yet left your employer)I have deleted all electronic copies of my practising certicate and have destroyed any hard copies which have been Direct credit Account numberAny refund should be paid toand I make this solemn declaration conscientiously believing the same to be true and by virtue of the Oaths and Declarations Act 1957.Applicant signatureDeclared at (place)Before me (name of ofcial witness)On this date (dd/mm/yyyy) Email address of person to be notied of the refund Signature of ofcial witness Stamp(For example, a Justice of the Peace, barrister and solicitor or another person authorised to take a statutory declaration) Please send original completed form to:Registry, New Zealand Law Society PO Box 5041, Lambton Quay Wellington 6145For further information, contact:registry@lawsociety.org.nzwww.lawsociety.org.nz PRACTISING FEE REFUND APPLICATION  FEB 2020, V1 PRACTISING FEE REFUND APPLICATION  FEB 2020, V1 PRACTISING FEE REFUND APPLICATION  FEB 2020, V1 PAGE Statutory declaration (your full legal n

2 ame)of (your full residential address an
ame)of (your full residential address and occupation) Solemnly and sincerely declare that: wish to cancel my practising certicate from(last day of employment/practice); and: e that date I have not undertaken any legal services or described myself as a lawyer or any of23 of the Lawyers and Conveyancers Act 2006 (cross out if you have not yet left your employer) ve deleted all electronic copies of my practising certicate and have destroyed any hard copies which hav Cheque ect credit Account numberAny refund should be paid to e this solemn declaration conscientiously believing the same to be true and by virtue ofations Act 1957.Applicant signatureDeclared at (place)Before me (name of ofcial witness)On this date (dd/mm/yyyy) Email address of person to be notied of the refund Signature of ofcial witness Stamp(For example, a Justice of the Peace, barrister and solicitor or another person authorised to take a statutory declaration) Please send original completed form to: egistry, New Zealand Law Society PO Box 5041, Lambton Quay Wellington 6145For further information, contact: egistry@lawsociety.org.nz 0800 223 030 .lawsociety.org.nz PAGE Practising fee refund application Please use this form to notify the New Zealand Law Society (Law Society) that you wish to cancel your practising certicate and request a refund for the unused portion of your practising fees. This form must be completed by the practising certicate holder.Form information The information you provide helps the Law Society to assess your application and enables the Law Society to carry out its regulatory and representative functions under the Lawyers and ConveyancAct 2006.The Law Society will collect, use, hold and disclose your personal information only for the purposes of assessing your application, and as provided for under the Lawyers and Conveyancers Act 2006 and regulations, Privacy Act Only authorised staff will have access to your information which is held in a secure environment.The provision of information by you is voluntary. However, if ou do not provide full information, the Law Society may not be able to assess Under the Privacy Act General information about the Privacy Act is also available on the website of the Privacy Commissioner at Privacy and information handling Personal details Date of birth (dd/mm/yyyy) NZLS lawyer ID (if known) Full name Ofce use only Approved by Registry Manager (signature)Date Refund amoun