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This form is a statutory declaration you can use to prove your relationship with a child in your care when applying for paid parental leave.
PDF | 82KB | 1 page
If you are applying for paid parental leave in respect of a child under six years old in your care, you can use this form if you do not have any other documents which show your relationship to the child.
You will need to provide your own IRD number on the form and complete and sign this declaration in front of a person who is authorised to take the declaration.
If you haven't already done so, you will also need to complete a paid parental leave application form: Paid parental leave application (IR880) form
Complete and sign this declaration in front of the person taking the declaration. Once this declaration is completed, include it with a completed Paid parental leave application (IR880) form.
When all sections of the form have been completed, send the form to us at the following address:
PO Box 39090
Wellington Mail Centre
Lower Hutt 5045.