Let us know if you’re an Essential Worker
We’re a not-for-profit initiative that provides a way for Kiwis to donate fuel, supermarket and café vouchers to support our Essential Workers who continue to provide the services that keep us safe during the COVID-19 pandemic.

If you’re you an Essential Worker, then we’d love to hear from you. Complete this form and we’ll add you to our list of deserving Essential Workers.
Sign in to Google to save your progress. Learn more
Full name *
Phone *
Email *
Full address (if known)
Your full address including postcode
Type of Essential Worker *
Place of work *
e.g. ED at Middlemore Hospital
Workplace suburb *
What voucher would be most helpful to you? *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Tilt Software. Report Abuse