Correct as at 29th March 2020. It may be superseded at any time.

Extract taken: from NZTA Vehicle Portal > VIRMs > Entry certification > Reference materials > Sample TSD agent’s single-sensitive seatbelt declaration

40 Sample TSD agent’s single-sensitive seatbelt declaration

TSD agent’s single-sensitive seatbelt declaration (PDF)
For exemption from Specified Seatbelt Requirements of the Traffic Regulations 1976 and the Transport (Vehicle Standards) Regulations 1990