Application to Surrender Farmlands Shares

Please type into the fields below and attach required documents before pressing submit.

To be eligible to surrender your shares, you must cease to be a transacting Farmlands shareholder for a period of 12 months and the account must be paid in full, or the shareholder has died, or you are applying under hardship ground.

I confirm that I/we meet the criteria to submit this application to surrender shares

Account Name:

Account Number:

Account Postal Address:

Email Address:

Full name of individual completing form:

Full name of first shareholder

Full name of second shareholder

Full name of third shareholder

Full name of fourth shareholder

Relationship to shareholder:

Please attach a copy of the power of attorney and certificate of non-revocation

Identification eg: Passport, Drivers Licence

Identification of eg: Passport, Drivers Licence

Reason for account closure?

Any refund/repayment will be direct credited to the supplied bank account. Please upload a bank deposit slip, or similar, with this Notice for the direct credit to be made.

Please attach a copy of the death certificate and either probate or the will:

Proof of New Zealand bank account number

I have cancelled all services billed through this account

Yes

I acknowledge that I am either the sole shareholder or am authorised by the shareholder (or any joint shareholders) to make this surrender and payment request in respect of the Farmlands shares. In the event this authority is defective I accept I will be personally liable to repay any refunded amounts to Farmlands..

1. The rules of the Society state that where a request for surrender is accepted, the shares will be paid out within 5 years and that any shares paid out will be subject to any offset or deduction of any amount owing by the Shareholder.

2. Non-shareholding accounts linked to the shareholding account will also be closed. Card holders requiring their own shareholding account must contact 0800 200 600 to arrange.

3. The shareholder must notify all Suppliers paid via the Farmlands account that the account is being closed and for direct invoicing to be arranged with immediate effect.

4. The Account balance must be paid in full before the surrender request will be actioned

Yes

Any further comments

Contact Information