Payment Package Registration Form

If you think you may be eligible for the Pre-October 2014 Payment Package, please click on this link, which will redirect you to our electronic registration form page

For a printable version of the Registration Form, please click here: 

Download PDF

Your printed form can be scanned and emailed to: registration@southernresponse.co.nz or posted to: 

Southern Response Earthquake Services Ltd.
PO Box 9052
Tower Junction
Christchurch 8149

You can also call us on our freephone number 0800 501525

  1. Home
  2. Payment Package
  3. Payment Package Registration Form