Public Transport Scheme Salary Sacrifice Declaration
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Salary Reduction

1. By completing this form I acknowledge my salary will be reduced from today's date, by the amount I have requested to receive each pay period for a period of twelve months, unless I request to remove myself from the scheme.
2. I acknowledge this agreement forms part of my employment agreement.
3. I acknowledge that the Scheme limitations and Rules from the my employers employment policy form part of this agreement.
4. I acknowledge that I am not entitled to any refund of the amount sacrificed under this agreement for any reason.
5. I acknowledge the change in my salary will impact other components of my income calculated based on salary, such as KiwiSaver employer contributions and other payroll deductions.
6. I acknowledge that if I exit the scheme, I will not be able to re-enter until the 12-month anniversary of my original scheme start date.

Other matters

• My employer will supply me with an Extraordinary payment card as part of my use of the Public Transport Scheme.
• I agree that I intend to mainly use public transport purchased using the Extraordinary payment card for the purpose of commuting between my home and workplace, including if I cease employment.
• I agree that I will only use the Extraordinary payment card to top up my own public transport card and that the amount of the public transport funds will only be spent on public transport for myself.