Form Ir880 - Paid Parental Leave (Ppl) Application Page 3
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8880
IR
Paid parental leave (PPL)
July 2017
application
Office use
?
There are notes on page 6 of this form to help you answer some of the questions.
Your details
First name
Surname
IRD number
(8 digit numbers start in the second box.
)
Postal address
Street address or PO Box number
Suburb, box lobby or RD
Town or city
Postcode
Phone number
Daytime
Other
Ethnic group - Optional
We collect the following information for statistical purposes. Please tick the ethnic group(s) you belong to:
NZ European
Cook Island Māori
Chinese
Other
(please specify)
Māori
Tongan
Indian
Samoan
Niuean
Your relationship to the child
1.
I'm applying for PPL as (tick one option)
the expectant mother
You must provide evidence of pregnancy or birth
(I am pregnant or have a baby under 1 year old)
- see the checklist on page 5.
a primary carer:
You must provide evidence of care of the child
(I have permanent primary responsibility for a child
- see the checklist on page 5.
under 6 years old)
Note: Permanent primary responsibility does not include part-time or temporary responsibility such as foster care or childcare
arrangements.
Your child
2.
Child's birth date (DOB) or expected due date (EDD).
DOB
EDD
Day
Month
Year
3.
Are you caring for a pre-term baby?
Yes
No
Note: If your baby is born pre-term (before the 37th week of pregnancy), you'll be entitled to additional payments.
If your baby arrives early after you have sent in this application contact Inland Revenue to receive your correct entitlement.
Your PPL period
4.
Enter the date your PPL period will start.
?
Day
Month
Year
See note 1 on page 6 for help working out your start date.
5.
Are you transferring any of your unused paid parental leave to your spouse or partner?
Yes
No
?
See note 2 on page 6 for information on transferring payments.
If you're transferring any entitlement, you must complete and attach a Paid parental leave (PPL) transfer (IR881) form.
6.
If you're:
•
not taking your full entitlement for PPL, or
•
transferring any entitlement to a spouse or partner
Day
Month
Year
enter the date your PPL period will end.
Note: If you're transferring any entitlement, only show the period you will claim.
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