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About this form

This form is supplementary to the Working for families tax credits registration form (FS1). Use this supplementary form if you wish to check any entitlement for the tax year ended 2009.

Adobe Acrobat PDF | 120kb | 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

Only show details if they are different from the information shown on your Working for families tax credits registration form (FS1).

Remember, we will also send you an account with any tax to pay or refund.

What you will need

• Your partner's details:
  • their IRD number
  • their full names, and
  • the dates you were in a relationship.
• The details of the children in your care:
  • their IRD numbers
  • their full names
  • their dates of birth, and
  • the dates the children started living with you (if different from date of birth).
• Details of the number of hours you worked per week, if your total family income was below $22,645.

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After you finish

Please:

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

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

List of postal addresses for Inland Revenue >