Complete this form in order to update records held by ACC and/or to authorise eBusiness activity if you are an existing vendor providing goods or services to ACC. Please return this completed form to ACC Provider Vendor Registrations, PO Box 30823, Lower Hutt 5040, or email email@example.com. If you need help or have any questions, please email us or call us on 04 560 5211.
Part A – Vendor information
1. Changing your contact information
Your vendor code:
Your vendor name:
You’ll find both of these on your remittance advice.
Date details will change:
Please do not give us any private and confidential addresses as they may be visible on client records.
NB: If you don’t give us a work postal address then we will send letters and payment remittance advices to your physical address.
Current physical work address:
Current work postal address:
New physical work address:
New work postal address (if different from physical address):
Please supply the names of any new authorised signatories who can approve change requests on behalf of your organisation and ask them to complete and sign this section. We ask for at least 2 signatories. However, if you’re a sole trader who has no other authorised signatories please go to section 5
All forms transmitted electronically to ACC must be true and correct
Invoices must only be submitted for services provided to a client, in accordance with the provisions of the applicable ACC legislation or contract
ACC may cancel its permission for you to submit forms electronically at any time without liability for any costs or compensation by giving two weeks’ written notice
Forms must be submitted in line with the specifications and protocols notified by ACC from time to time
Adequate procedures must be put in place to ensure the ACC system security standards, as set out in ‘ACC Security Policy for Electronic Business’, are met.
6. Vendor declaration
I declare that:
the information given in this application is true and correct
I have read, understood and accept the conditions specified in section 6
I am authorised to make this declaration on behalf of the organisation.