Registration of voluntary agreement or court order for child support IR 102 •

IR 102
October 2010
Registration of voluntary agreement or court order
for child support
Child Support
• Use this form to register a voluntary agreement or court order for the payment of child support or spousal maintenance.
• This form is not the agreement. Please attach a copy of your agreement to this application.
• By registering this voluntary agreement or court order, you are asking Inland Revenue to administer payments for you.
This means that payments will be collected from the paying person by Inland Revenue. Once payments are collected,
they will be passed on to the custodian or eligible spouse monthly.
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Please complete all parts of this form.
Read the notes on the back about voluntary agreements, court orders and providing your child’s IRD number.
If you need to talk to an Inland Revenue Child Support staff member, please phone us on 0800 221 221.
Child Support forms and other information are available on our website at www.ird.govt.nz/child support/
Custodian’s or eligible spouse’s details
1. Custodian’s or eligible spouse’s IRD
number
2. Custodian’s or eligible
spouse’s name
(8 digit numbers start in the second box.
Mr
(Tick one)
Mrs
Miss
)
Ms
Surname
First names
3. Any other name used (such as an alias)
Surname
First names
4. Custodian’s or eligible spouse’s
home address
Street address
Town or city
5. If the custodian’s or eligible spouse’s
postal address is different from the home
address, print it here
Street address or PO Box number
Town or city
6. Custodian’s or eligible spouse’s date of
birth
7. Custodian’s or eligible spouse’s
contact number(s)
Day
Month
Year
Age (if date of birth not known)
Daytime
Evening
Fax
8. Does the custodian or eligible spouse
receive a benefit? (Tick “No” for
New Zealand Superannuation)
Email
No Go to Question 9
Yes
Complete the panels below
Work and Income office
customer number
(if known)
Benefit
type
Work and Income office
9. Bank account that
child support can
be paid into by direct
credit. Attach a
preprinted deposit
slip or bank statement.
Bank name
Branch
Account name
Account number
Bank
Office use only
Verified by Child Support
officer
Branch
Account number
Suffix
Paying person’s details
10. Paying person’s IRD number
11. Paying person’s name
(Tick one)
Mr
Mrs
Miss
Ms
Surname
First names
12. Any other name used
(such as an alias)
Surname
First names
13. Paying person’s home address (or
last known address)
Street address or PO Box number
Town or city
Yes
Do they live there now?
14. If the paying person’s postal
address is different from the home
address, print it here
No
Don’t know
Street address or PO Box number
Town or city
15. Paying person’s date of birth
Day
16. Does the paying person have a job?
Month
Year
Age (if date of birth not known)
No
Show who they last worked for
Yes
Show who they work for now
Name of business or company
Address
17. Paying person’s contact number(s)
Daytime
Evening
Fax
Email
18. Does the paying person receive a
benefit?
No
Go to Question 19
(Tick “No” for New Zealand
Superannuation)
Yes
Show their Work and Income office
(if known)
Voluntary agreement or court order details
the payment of child support only, complete Question 20
19. If the agreement or court order is for:
the payment of spousal maintenance only, complete Question 21
t he payment of both child support and spousal maintenance, complete
Questions 20 and 21
20. Amount of child support payable in the voluntary agreement or court order
First child
Surname
First names
Date of birth
Day
Month
Year
Amount payable
IRD number
Each week
month
year
(Tick one)
month
year
(Tick one)
month
year
(Tick one)
month
year
(Tick one)
Second child
Surname
First names
Date of birth
Day
Month
Year
Amount payable
IRD number
Each week
Third child
Surname
First names
Date of birth
Day
Month
Year
Amount payable
IRD number
Each week
Fourth child
Surname
First names
Date of birth
Day
Amount payable
Month
Year
IRD number
Each week
If there are more than four children, please write their details on a separate sheet of paper and attach it to this form. Write
your name and IRD number on the paper and tick this circle.
21. How much spousal maintenance
does the voluntary agreement or
court order state must be paid?
Each week
month
year
(Tick one)
Declaration
Both the custodian or eligible spouse and the paying person must sign this form for voluntary agreements involving
child support only, or voluntary agreements combining child support and spousal maintenance.
Either party to the agreement may sign this form for voluntary agreements involving spousal maintenance only.
To the best of my/our knowledge the information given, including that provided about the children named in
this application, is true and correct.
Custodian or eligible spouse
Paying person
Checklist
Have you:
answered
every question?
attached
a copy of the voluntary agreement or court order?
provided
a preprinted deposit slip or bank statement and completed details of a bank account that child support
payments can be paid into?
answered every question?
Notes
A voluntary agreement must be:
ll in writing
ll signed by both parties
ll made between a custodian of qualifying children and the paying parent or, for spousal maintenance, made between parties
of that relationship
ll for payment of a regular amount of not less than $10 per week.
If the voluntary agreement is for the maintenance of children, and the custodian is receiving a sole parent rate of
a benefit, the amount being paid under the agreement must be equal to or more than the amount which would be
payable under a formula assessment of child support.
If you are currently a party to a formula assessment of child support, this form is also your election to withdraw from
that assessment.
Child’s IR number
Your child will need an IR number if you are applying for child support. To apply for an IR number for your child use
the IRD number application – Individual (IR 595) form included in the Working for Families Tax Credits registration pack.
You will need to provide two identification documents and photocopies of those documents. See the front page of the
application form for further information.
Privacy
Meeting your child support obligations involves giving accurate information to Inland Revenue. We ask you for information
so we can assess your liabilities and entitlements under the Child Support Act 1991.
We may also exchange information about you with:
• some government agencies
• another country, if we have an information supply agreement with them
• Statistics New Zealand (for statistical purposes only).
If you ask to see the personal information we hold about you, we’ll show you and correct any errors, unless we have a lawful
reason not to. Call us on 0800 221 221 for more information. For full details of our privacy policy go to www.ird.govt.nz
(keyword: privacy).
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