Request personal information for someone else

In the collection, use, disclosure, and storage of information, ACC will at all times comply with the obligations of the Privacy Act 2020, the Health Information Privacy Code 2020 and the Official Information Act 1982. For further details see ACC’s privacy policy.

Our privacy notice

Use this form to request personal information for someone else.

Confirm you have authority

To make sure you have the right to act on behalf of someone else and request their personal information, we need you to complete an authority to act form.

Complete this form to authorise someone to act on your behalf:

Give someone authority to act

Complete this form to authorise someone access to your business levy account:

Give someone access to your levy account

At the completion of this online form, we will be in touch with you to organise you returning this form to us by email.

Your contact details

Enter your details so we can verify your identity. We may contact you if we need more information.

Your verified email address for correspondence

Your current street address

Your phone number

Select the preferred time to receive a call (Monday to Friday)

8am to 9am

9am to 10am

10am to 11am

11am to 12pm

12pm to 1pm

1pm to 2pm

2pm to 3pm

3pm to 4pm

4pm to 5pm

Details of the person you are acting for

Enter the details of the person you are acting for so we can verify their identity. We may contact you if we need more information.

Their first name

Their last name

Their previous names known by

Their date of birth

Their email address

Their current street address

We may contact you if we need more information about your request.

What information are you looking for?

ACC claim number (if known)

Add another claim number

Emailed results will be sent in a password protected PDF. We encrypt your information to keep it safe. You’ll need a program that can open 256 bit encrypted PDF files such as Adobe Reader X or newer.
If you select password protected PDF on CD or USB, you’ll need a program that can open 256 bit encrypted PDF files such as Adobe Reader X or newer. We encrypt your information to keep it safe.

Please check your information is correct before submitting

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