Tax credit claim form
Donations, childcare or housekeeper payments
PO Box 39090
WELLINGTON MAIL CENTRE
Lower Hutt 5045
(8 digit numbers start in the second box.
Your daytime telephone
Are you eligible to make a claim?
You can’t claim a tax credit for
You can claim a tax credit if, in the tax year:
tuition, exam, tertiary education or private school fees
you received taxable income, eg, salary, wages, and
donations you’ve made through payroll giving at your
you have valid receipts for donations made to approved donee
payments made where there is direct benefit to the donor
or the donor’s family.
you made childcare and/or housekeeper payments.
For more information including “WHAT CAN I CLAIM?” and “HOW MUCH CAN I CLAIM?” see page 2.
Donation tax credits – Multiply the amounts in Boxes 3, 4 and 5 by 33.3333% and enter the answers in Boxes 3A, 4A and 5A.
Tax credit amount
Total school/kindergarten donations made
Total church donations made
Total remaining donations made to donee
Childcare and/or housekeeper tax credits – Multiply the amount in box 6 by 33% and enter the answer in box 6A up to the maximum of $310.
Tax credit amount
Total childcare and/or housekeeper payments
Total donations, childcare and housekeeper entitlements
Add Boxes 3A, 4A, 5A and 6A
Print new total here
Print your spouse/partner’s details if you are sharing any receipts
Bank account details
Account holder’s name
If a bank account number isn’t shown below, enter the bank
account number you would like your tax credit to go to, in Box 8.
Transferring your tax credit
If you want to transfer your tax credit to your or
someone else’s income tax account, enter the
Transfer to year ending
Name of person receiving the tax credit
Amount to transfer
Please sign and date the declaration
I declare the information I have provided
on this form is true and correct.
We’ll send you confirmation of the amount
of your tax credit within six weeks unless we
need to wait for your IR 3 income tax return
to be filed.