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About this form

You can fill out this this form to make an agreement with Child Support to pay off your child support. You can download the form or complete it online.

Adobe Acrobat PDF | 88kb | 1 page

This form can be completed on-screen by typing content directly into the PDF document. Once you have completed the form it is important that you print it out as you will not be able to save the information you enter into the form.

When to use this form

Use this form if you will be in prison for 13 consecutive weeks or more, you are entitled to an exemption and you have a child support debt.  Arrears payments will start once you are released from prison.

What you will need

• Your IRD number - if you don't have this, please contact us on 0800 227 774.
• Your date of imprisonment and expected release date.
• You will also need to fill in the Application for exemption from child support payments (IR105) form and get this authorised and stamped by a prison officer. 

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After you finish

Please print, sign and post the completed form together with the IR105 to your nearest Inland Revenue office.

You may wish keep a copy of this form for your personal records.

List of postal addresses for Inland Revenue >