Declaration - COVID-19 Wage Subsidy

By submitting this form, you (the employer or self-employed person) are declaring that you:

• meet the eligibility criteria for the subsidy:
  • your business is registered and operating in New Zealand; and
  • the employees named in your application are legally employed in New Zealand; and
  • your business has experienced a minimum 30% decline in actual or predicted revenue:
    • over the period of any month from January 2020 through to the end of this scheme when compared to the same month last year, or a reasonably equivalent month for any business operating less than a year; and
    • that loss is attributable to the COVID-19 outbreak; and
  • your business has taken active steps to mitigate the impact of COVID-19 on their business activities (such as engaged with your bank, Chamber of Commerce, industry association or the Regional Business Partner programme); and
  • you agree you will, using best endeavours, retain the employees named in your application in employment on at least 80 percent of their regular income for the period of the subsidy
• will notify the Ministry of Social Development if anything changes that may affect your eligibility
• have discussed this application with the employees named in your application and that they have consented (in writing, if practicable) to the information about them in the application being:
  • provided to the Ministry of Social Development; and
  • used by the Ministry of Social Development to make decisions about your application and to audit and review any subsidy that is granted; and
  • shared by the Ministry of Social Development with other agencies to the extent required by MSD, it's staff and auditors to make decisions about your application and to audit and review any subsidy that is granted
• will provide the Ministry of Social Development with information about you, your business or (with their consent) your employees to the extent required by the Ministry of Social Development, it's staff or auditors to make decisions about your application and to audit and review any subsidy that is granted
• consent to the Ministry of Social Development sharing information provided in this application about you or your business with other agencies to the extent necessary to make decisions about your application and to audit and review any subsidy that is granted
• consent to us publishing basic identifying information about your business and the level and duration of any subsidy provided to you (excluding any personal information about your employees) on a publicly accessible register
• acknowledge and agree all of the information you have provided to us is true and correct
• agree to repay any subsidy made to you if you:
  • were not or stop being entitled to the subsidy
  • provide false or misleading information in your application;
  • receive business interruption insurance
• acknowledge if you have provided false or misleading information, or receive any subsidy or payment that you were not entitled to receive, you may be subject to an investigation including for offences under the Crimes Act 1961
• acknowledge that this declaration forms part of your application
• acknowledge that the Ministry of Social Development may amend this agreement at any time and at their discretion.

In submitting your application you also acknowledge and/or agree:

• the Ministry of Social Development collects the information in this application and form to determine whether you are eligible to receive assistance
• the Ministry of Social Development will use the information provided in this application to assess your eligibility to receive the COVID-19 Wage Subsidy. We may also use the information to contact you or for research and reporting purposes, or to advise you on the matters relating to the assistance you applied for
• the Ministry will not use the information provided in this application for any other purpose or for assessing entitlement to any other assistance available from the Ministry unless required or authorised by law
• under the Privacy Act 1993 you have the right to request access to all information held about yourself and to request corrections to that information.