Gather your information
You'll need your:
- IRD number
- current address
- contact details
- employer's information
- bank account number.
You'll also need to give details of people you support financially, your income, expenses, assets and debt.
Download the form and save it
You can complete this form online before printing.
Sign the form and send it to us
PO Box 39010
Wellington Mail Centre
Lower Hutt 5045
What happens next
If you do not return the completed form to us in time or do not give us enough information, we may set the amount you must repay.
You must send this form to us within 10 working days of being asked.
If we agree with you on a payment arrangement, we may review it at a later date. These are checks to see if the payment amount fits your situation.
You must make the payments in full by the agreed dates. If not, we'll cancel the arrangement and take action to get the child support you owe.