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ERA employer details form

Your privacy

We know your privacy is important to you. Handling your information with care and respect is important to us, too. To understand how we handle your personal information, read our privacy notice.

Our privacy notice

Contact details

Your organisation name:

Your ACC employer number (if known):

Postal Line 1

Postal Line 2

Postal Line 3

Suburb

Region

City

Postcode

Postal Line 1

Postal Line 2

Postal Line 3

Suburb

Region

City

Postcode

Email address (this is for ERA specific correspondence eg payment notfications)

Your main organisational contact person for ERA claims

Contact name:

Their work phone number:

Their mobile number:

Alternative contact person

Alternative contact name:

Their work phone number:

Their mobile number:

Payment information

Bank details

Attach a copy or screenshot of the bank account details for the account you want us to make payment into. Please ensure that your bank account name, number and bank logo are clearly visible in the uploaded attachment.

IRD number:

Bank account number:

Bank account name:

Payment frequency

How often would you like to receive ERA payments?

Two weekly

Four weekly

Monthly

Please indicate what you’d like us to do when we receive a weekly compensation application for one of your employees:

Choose to use ERA by default

Employer declaration

I declare that the information given in this application is true and correct and I am authorised to make this declaration on behalf of the organisation.

Full name:

Job title:

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