First name *
Date of birth (DD/MM/YYYY)*
Contact email address *
• I confirm that Public Trust have outlined in writing the remediation calculation process and given me the opportunity to raise any questions or seek further information.
• I confirm I have been provided an opportunity to seek independent advice before accepting the remediation payment.
• I confirm I understand the approach Public Trust has taken in respect of this remediation payment and based on the information I have received, accept the remediation payment amount as an accurate reflection of my entitlement.
• I confirm that all details I have provided are true and correct.
I am a current employee *
By clicking ‘Accept’ I agree that I have read and agree to the above statements.
We collect the personal information on this form in order to assist with making back payments of entitlements under the Holidays Act. Providing this information is optional, though if you choose not to provide all information, we may be unable to determine your eligibility. You have the right to ask for a copy of any personal information we hold about you, and to ask for it to be corrected if you think it is wrong. If you’d like to ask for a copy of your information, or to have it corrected, please contact us at firstname.lastname@example.org, or 0800 371 471, or The Privacy Officer, Public Trust, PO Box 1598, Auckland, 1140.