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. • • • • 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). Reset Form