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About this form

If you are entitled to working for families tax credits under the shared care arrangement for the child/children in your care.

Adobe Acrobat PDF | 53kb | 1 page

When to use this form

Use this form to advise us of the person you share the care of your child with and the details of the children and time that they are in your care.

Note: If you are the primary child carer, you can also use My family details and income online service to update your shared care arrangements directly.

What you will need

• The full name of the person that you share care of this child with
• The full name, date of birth, number of days in the year that the child  will be in your care and date that you started shared care of this child
• The child's IRD number
• Your IRD number.

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After you finish

Please print out this form, complete all the details and attach to your completed FS1 and return to your nearest Inland Revenue office.

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

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