April 2019
Statutory declaration
to support your IRD number application - individual (IR595) for a child under 16 years of age
Oaths and Declarations Act 1957
Tax Administration Act 1994
Crimes Act 1961
Enter your own IRD number here.
(8 digit numbers start in the second box. )
When to complete this declaration
Complete the declaration over the page if you are applying to Inland Revenue for an IRD number for a child under 16 years of age, who is
not yours because you are not the child’s legal parent or guardian.
is declaration formally records the link between you and the child the IRD number is for.
You can also use this declaration if you are the legal parent or guardian and unable to provide other official or formal documentation to
confirm the child is in your care.
Read carefully before starting to fill in this declaration
is form is a statutory declaration. It is an offence to give any altered, false, incomplete or misleading information or to make a false
statement or declaration. Any person who does so is liable for imprisonment for up to three years.
Complete and sign this declaration in front of the person taking the declaration - see the list of authorised people below. is may be a
different person to an Inland Revenue appointed verifier.
ere is a list of Inland Revenue appointed verifiers on the IRD number application - individual (IR595)
is declaration must be completed before taking the IRD number application to the Inland Revenue appointed verifier.
People authorised to take this declaration
a Justice of the Peace
a person enrolled as a barrister and solicitor of the High Court
a registered legal executive (fellow of the NZILE)
a notary public
a registrar or deputy registrar of the High Court or a district court
the registrar or a deputy registrar of the Court of Appeal
the registrar or a deputy registrar of the Supreme Court
a member of parliament
other government officer authorised to take statutory declarations.
Complete all sections of this declaration. If a question does not apply to your situation, complete the question by writing
“not applicable”.
Remember, if you are attaching copies of any documents, such as an authorisation from the legal parent(s) or guardian(s) or other
authority to this declaration, you must have the original document(s) with you when you take the IRD number application - individual
(IR595) to be verified by an Inland Revenue appointed verifier.
Complete a separate declaration and IRD number application for each child you are applying for.
For more information
If you have any questions go to or call us on 0800 227 774.
Your full legal name here
Current residential street address/place of abode
/ / ( )
Occupation Your date of birth Contact number
solemnly and sincerely declare that: (cross out any statements that do not apply)
I have the day-to-day responsibility for the child
I have the ongoing care of the child
I have control of the child’s activities
e child is maintained as a member of my family
e child depends on me financially
I am responsible for making the decisions concerning the child
I provide emotional support for the child.
/ /
Child’s full legal name Child’s date of birth
Parent’s name, if known Parent’s name, if known
is child is in my care because:
State your relationship to the child and the reason why the child is in your care
is child came into my care from/on:
/ /
(please be as accurate as possible) Day Month Year
Attach any supporting documentation eg a copy of the authorisation from the legal parent(s) or guardian(s), or other authority.
If you cannot provide or do not have this, explain why and set out the steps you have taken to get this information.
And I make this solemn declaration conscientiously believing the same to be true and by virtue of the Oaths and Declarations Act 1957.
Your signature
Your full name
Declared at this
/ /
Place Day Month Year
Declaration taken by
Signature of person taking this declaration
Full name of person taking this declaration
eg Justice of the Peace