Registration of Voluntary Agreement for Child Support Form
Page 1
Receiving carer’s details
1
IRD number
(8 digit numbers start in the second box.
)
2
Name (Tick one)
Mr Mrs Miss Ms
First name(s)
Surname
3
Home address
Street address
Town or city Postcode
4
Postal address (if different from
above)
Street address or PO Box
Town or city Postcode
5
Contact details
( )
( )
( )
Day Evening Mobile
Email
6
Is the receiving carer on a
NewZealand benet?
No Ye s
Work and Income customer number
7
Bank account to pay child support
into
Bank name Branch
Account name
Bank Branch Account number Suffix
Child Support www.ird.govt.nz/childsupport
IR 102
Registration of voluntary agreement for child support
Use this form to register or
make changes to a voluntary
agreement for the payment of
child support.
Please answer every question.
Both parties to the agreement
must sign this form.
Any formula assessed child
support for the children
named in this application will
stop from the date we accept
your voluntary agreement.
Agreed payments will be
collected monthly from the
liable parent and passed on to
the receiving carer monthly.
If the receiving carer is on
a sole parent benefit, you
can only register a voluntary
agreement if the amount is
equal to, or more than, the
amount payable under a
formula assessment.
More information including who can
apply, can be found on our website
or read our fact sheet Child support
– voluntary agreements (IR 157).
If you need help completing this
form, you can call 0800221221.
April 2015
Page 1/3
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Registration of Voluntary Agreement for Child Support Form PDF
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