Face mask and RAT kit order form

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Face mask and RAT kit order form

As part of the government’s response to protecting Pacific communities from the impacts of COVID-19, the Pacific Aotearoa Community Outreach program has implemented an online order form to provide Pacific communities and those working with our Pacific peoples a way of bulk ordering medical grade face masks and rapid antigen tests (RATs) directly from our website.

Learn more about the mask/RAT types available.

Individual or non Pacific-focused organisation or group? Order RAT kits and face masks directly from the Ministry of Health's Request a RAT site.

Pacific-led organisation, community group or work with Pacific communities? Use the order form below to order face masks and RATs in bulk for community get togethers, vaccination events and other group activities. Our team may contact you to verify and confirm your order.

Important: Minimum and maximum orders are as follows:

Masks: Minimum order 1,500. Maximum order 7,500.

RATs: Minimum order 175. Maximum order 700.

You can also choose to order either masks or RATs only.

If you are in the South Island, expect your orders to arrive in about 5 – 10 business days. North Island recipients should receive orders within 1 - 3 business days.

Any questions about this initiative can be directed to [email protected].

Requester information

Full name*

Organisation name*

Email address* (required for orders)

Phone number*

Delivery address* (required for orders)

Which of the following ethnic group/s do you work with?* (choose all that apply)

Which of the following community groups do you work with?* (choose all that apply)

Who will be using these face masks and how will you supply them to people?*

Who will be using these RATs and how will you supply them to people?*

Requester declaration

In digitally signing this Declaration, I:

Confirm the information contained is true and accurate.
Confirm that any face masks or RAT kits received as a result of this order will be used for the intended purpose i.e. for distribution to Pacific organisations and/or communities.
Understand that there is no guarantee that my request will be successful in securing face masks or RAT kits from the Ministry for Pacific Peoples.
Agree that my personal information is being provided voluntarily, and that third parties are supporting MPP in distributing masks and RAT tests, so my personal information may be provided to them for the sole purpose of processing my order.
Confirm I have read and understood my rights regarding the Privacy Act 2020 and understand that I am entitled to have access to and to request correction of any personal information held by the Ministry.
Agree that the information provided in this application can be used by the Ministry for Pacific Peoples for statistical purposes and/or policy development.

I agree

Yes

Full name*

Once you press Submit order, the page should refresh and you should see a "Thanks, we've received your order" message indicating that your request has been submitted successfully. You should also receive an email confirming receipt of your order.

Face mask and RAT kit order form

Face mask and RAT kit order form

If you don't see the message or haven't received a confirmation email after 15 minutes, please re-submit this form.