Forms and brochures
A list of all our forms and brochures for individuals.
A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z
A
Accommodation Supplement Application Form [PDF, 328 KB]
Form code: M43 – SEPT 2010
Accommodation Supplement Application Form (existing clients) [PDF, 97.75KB]
Form code: S01-DEC 2008
Adverse Event - Payments to Hosts for Accommodation Application Form [PDF, 117.58KB]
Form code: CD1 – JUN 2010
Application for New Zealand Payment Overseas [PDF, 119.71KB]
Form code: WIS7W – JAN 2010
Appointment of an Agent Form [PDF, 262 KB]
Form code: V01 – AUG 2011
Form code: ALLA0020 SEP 2009
Do you know that Work and Income can help you financially?
Form code: ALLA0010 – JUL 2011
A guide to what happens with your income support if you are going overseas.
Are you on a Sickness Benefit?
Form code: ALLA0052 - APR 2011
Let's talk about what you can do
Form code: JOBS0015 – APRIL 2006
Find out how we can help through In Work Support.
Australia Automatic Payments Form (PDF 22.45KB)
Complete this form to arrange regular automatic payments to repay your debt if you're living in Australia.
C
Change of bank account form [PDF, 80.15KB]
Form code: V03 – MAR 2011
Child Disability Allowance Application Form [PDF, 191 KB]
Form code: M08 – NOV 2011
Child Disability Allowance - Medical Certificate [PDF, 96.91KB]
Form code: V12CW – NOV 2011
Child Inclusion Form [PDF, 102.32KB]
Form code: R30 - FEB 2011
Complete this form if you'd like to have a child included in your benefit.
Childcare Subsidy Verification Form [PDF, 70.92KB]
Form code: S33W – AUG 2009
Childcare and OSCAR Subsidy Application Form [PDF, 209.66KB]
Form code: S02 – DEC 2011
Childcare and OSCAR Subsidy - Change of Circumstances Form [PDF, 87.24KB]
Form code: R24 – DEC 2010
Civil Defence Payments to Evacuees Application Form [PDF, 89.84KB]
Form code: CD2 – FEBRUARY 2006
Civilian Amputee Assistance Application Form [PDF, 143.91KB]
Form code: SW288W – DEC 2008
Form code: ALLA0056W – Dec 2011
A weekly payment for people in short-term residential treatment programmes, to help meet essential ongoing living costs.
Community Costs Payment Application
Form code: S29W – Dec 2011
Form code: ALLA0005 – APR 2011
How a Community Services Card can help you with the costs of health care.
CSC3 - APR 2011
You could save on health-related costs with this card.
Community Services Card Application Form [PDF, 299.42KB]
Form code: CSC1 - FEB 2011
Community Services Card Application Form for New Zealand Superannuation Clients [PDF, 138.23KB]
Form code: CSC2 – APRIL 2010
This application form for a Community Services Card is for clients applying for or already receiving New Zealand Superannuation.
Course Participation Assistance Application Form [PDF, 108.97 KB]
Form code: LAB 300 – DEC 2010
D
Debt Repayments Authority Form [PDF, 100.36KB]
Form code: ISS570 - MAY 2009
Form code: ALLA0014 – APR 2011
A guide about the Disability Allowance, Special Disability Allowance, Modification Grant and the Child Disability Allowance.
Disability Allowance Application Form [PDF, 113 KB]
Form code: S03 – OCT 2011
Extra Help for people that don't already receive Work and Income assistance.
Disability Allowance Application Form (existing clients) [PDF, 114.66KB]
Form code: S03 – MAR 2009
For clients already receiving Work and Income assistance.
Disability Allowance - Medical Alarms Factsheet
Form code: ALLA0046W - APR 2010
Disability Allowance - Medical Alarm Assessment Form [PDF, 100.1KB]
Form code: S21 – SEP 2011
Disability Certificate [PDF, 64KB]
Form code: S22 – SEP 2011
Disability Certificate - Counselling Form [PDF, 84.27KB]
Form code: S23 – AUG 2011
Domestic Purposes And Widow's Benefits
Form code: JOBS0007 – APR 2011
Financial assistance for sole parents, some women living alone and caregivers.
Domestic Purposes Benefit - Care of Sick or Infirm Application Form [PDF, 379 KB]
Form code: M03 – SEP 2011
Domestic Purposes Benefit - Care of Sick or Infirm Medical Certificate [PDF, 117.42KB]
Form code: M03CW – SEP 2009
Domestic Purposes Benefit - Caring for Sick or Infirm (DPB - CSI) - Carer Statement [Word, 93KB]
The Carer Statement is an application form that is part of the assessment process for retrospective applications for Domestic Purposes Benefit - Care of Sick or Infirm.
Also available in [RTF 895KB]
Domestic Purposes Benefit - Caring for Sick or Infirm (DPB - CSI) Retrospection Factsheet
Information for those who may want to apply for a retrospective Domestic Purposes Benefit Caring for Sick or Infirm.
Domestic Purposes Benefit - Sole Parents Application Form [PDF, 209 KB]
Form code: M04 – AUG 2011
Domestic Purposes Benefit – Sole Parent Assistance for Study Costs Factsheet
Form code: ALLA0044W - JAN 2011
Domestic Purposes Benefit – Sole Parent Study Assistance Loan Application Form [PDF, 183 KB]
Form code: S13W – DEC 2010
Extra recoverable assistance is available for Domestic Purposes Benefit - Sole Parent clients who are undertaking study at level 4 or above.
Domestic Purposes Benefit - Women Alone Application Form [PDF, 200 KB]
Form code: M05 – SEPT 2010
Form code: JOBS0018W - JUN 2011
Support and assistance for women who are looking for a way into work.
E
Early Learning Payment Application Form [PDF, 290.97KB]
Form code: S32W – APR 2009
Emergency Benefit Application Form [PDF, 248 KB]
Form code: M06 – NOV 2011
Emergency Maintenance Allowance Application Form [PDF, 255 KB]
Form code: M07 – SEP 2011
Form code: EMPL0007 APR 2010
Information about a service for employers looking for workers.
Extra Help Application Form [PDF, 328 KB]
Form code: M43 - JUL 2011
Contains applications for Accommodation Supplement, Disability Allowance and Temporary Additional Support for people who don't already receive Work and Income assistance.
Form code: SUPE0200 FEB 2011
F
Financial Assistance for Live Organ Donors
Form code: ALLA0023 – APR 2011
Financial assistance for people donating a kidney or liver tissue for transplant within New Zealand
Financial Assistance in a Civil Defence Emergency Factsheet
Form code: CD5W–Apr 2011
Information about financial assistance you and your family may qualify for if you’ve been affected by a civil defence emergency.
Financial Assistance for Foreign Nationals in a Civil Defence Emergency Factsheet
March 2011
Information about financial assistance you and your family may qualify for if you’ve been affected by a civil defence emergency.
Financial Assistance in a Pandemic Factsheet
July 2009
The financial assistance Work and Income may be able to assist you and your family if you have been affected by a pandemic (such as the current Influenza A (H1N1) pandemic).
Financial Assistance when you're having a baby
Form code: ALLA0027 – APR 2009
Find a job build a future [PDF, 848.13 KB]
Form code: JOBSW0007 – NOV 2010
Tools to help you find work.
Finding job leads [PDF, 148.88KB]
Form code: JOBSW0003 – OCTOBER 2005
Tips on how to go about finding job leads and making contact with employers.
Also available in [RTF 106KB]
Form code: ALLA0045W – MAY 2011
Help with some of the funeral costs of someone close to you who has died.
Funeral Grant Application Form [PDF, 113.09KB]
Form code: S04 - JUL 2011
G
Form code: ALLA0013 - OCT 2010
Getting Netherlands pensions paid in New Zealand
Getting United Kingdom pensions paid in New Zealand
Getting work skills and experience
Form code: JOBS0004 – APR 2011
Training and subsidies to help you get the job you want.
H
Help for Employees in Canterbury Factsheet
Brief outline of the services and support available to employees during the aftermath of the Canterbury Earthquake, 4 September 2010.
Form code: ALLA0030 – APR 2009
A guide for people who are raising someone else's child.
Form code: JOBS0012 – APR 2011
Form code: ALLA0002 – APR 2011
Home Help Payments Application Form [PDF, 133.75KB]
Form code: M29 – DEC 2010
Housing Modification Grant Income and Asset Details Form [PDF, 83.97KB]
Form code: M27W – AUG 2009
Form code: CM0001 – OCT 2010
Form code: ALLA0008 – APRIL 2007
I
Income-tested Superannuation Factsheet
Form code: SUPE0010W - JAN 2011
Information concerning income tested superannuation.
Form code: JOBS0014 – APR 2011
A weekly payment which helps 16 and 17 year-olds who can't live with their parents and are not supported by them or anyone else.
Independent Youth Benefit Application Form [PDF, 190 KB]
Form code: M09 - SEP 2011
Form code: ALLA0006 - JULY 2002
A guide to how we match records to find benefit fraud.
International Custody Dispute Payment Factsheet
International Custody Dispute Payment Application Form [PDF, 182.84KB]
Form code: S30W - DEC 2010
International Social Security Agreements
A guide to New Zealand's social security agreements with other countries.
Also available as in Dutch text
Form code: ALLA0001 – APR 2011
A guide for people with a permanent injury, sickness or disability.
Invalid's Benefit Application Form [PDF, 251 KB]
Form code: M10 – SEP 2011
J
Job Ops with Training Employer’s View flowchart (PDF 88.04KB)
Process flowchart for employers.
Job Ops with Training factsheet
Form code: EMPL1012W - AUGUST 2011
Helping you to employ young people in entry-level positions.
L
Limited Service Volunteer (LSV)
A six-week motivational course run by the New Zealand Defence Force.
Living Alone Payment Application Form [PDF, 100.44KB]
Form code: S07 – SEPT 2008
M
Form code: WS46 Dec 2008
Form code: ALLA0022 – APRIL 2007
How to repay your debt and stay out of debt in the future
Managing your money: What it means to have a budget
Form code: ALLA0016 – DECEMBER 2007
N
Form code: JOBS0005 – APR 2011
A guide to allowances and extra payments for people on a benefit.
Form code: SUPE0001 – APR 2011
Financial assistance for people aged 65 years or more.
New Zealand Superannuation Application Form [PDF, 350.53KB]
Form code: M12 – JUN 2011
New Zealand Superannuation Application Form - Current Clients [PDF, 294 KB]
Form code: M11 - FEB 2011
New Zealand Superannuation Application Form - Partner [PDF, 310 KB]
Form code: M13 – JUN 2011
New Zealand Superannuation, Missionary and Humanitarian work overseas factsheet
O
Orphan's and Unsupported Child's Benefit
Form code: ALLA0003 – APR 2011
A guide for caregivers who are raising someone else's child.
Orphan's and Unsupported Child's Benefit Application Form [PDF, 193 KB]
Form code: M14 - JUN 2011
Form code: ALLA0031 – APR 2011
A quick guide about OSCAR programmes and OSCAR Subsidy.
Also available in Maori text
OSCAR Subsidy Declaration [PDF, 94.44KB]
Form code: R18 – DEC 2011
OSCAR Subsidy Verification Form [PDF, 69.11KB]
Form code: S34W – DEC 2011
Other income you earn factsheet
What you need to know if you get other income and financial assistance from us.
Form code: ALLA0017 – OCT 2010
Overseas Pensions: Treatment of overseas pensions or benefits payable in New Zealand
P
Pacific Earthquake/Tsunami factsheet
Parent's Income Verification for Sickness Benefit or Emergency Maintenance Allowance Form [PDF, 123.01KB]
Form code: V10W – SEP 2009
Pathways to Arts and Cultural Employment (PACE) 2010 Resource Pack
Resource pack containing information about assistance and funding available for people who are looking for work in the arts and cultural sector.
Payment options for overseas pensions
Form code: SUPE0006 – AUG 2011
A guide for people who qualify for a pension from the United Kingdom, the Netherlands, Australia, Jersey, Guernsey, or the Republic of Ireland.
Privacy Statement [PDF, 45KB]
Form version: SEP 2011
R
Redundancy services for employees
Form code: EMPL0006 – OCT 2009
Reimbursement of Health Overcharges Application form [PDF, 116.07KB]
Form code: C04W – FEB 2010
Relationships and income assistance
Form code: ALLA0011 – MAY 2007
Things you need to know about relationships when getting income assistance.
Rena Grounding factsheet (PDF 85.39KB)
October 2011
How we can support employers and staff affected by the Rena grounding
Repayment Financial Circumstances Form [PDF 600.35KB]
Form code: D003W – OCT 2010
If you are unable to afford to pay the standard repayment rate on the amount you owe us, please use this form to provide us with more information about the amount you may be able to repay.
Repayment Form [PDF 579.78KB]
Form code: D002W – OCT 2010
This form provides you with different options on how you can repay Work and Income.
When changes to gift duty are introduced on 1 October 2011 there will be some more specific questions about gifting and family trusts included on the application form for Residential Care Subsidy Financial Means Assessment.
Residency requirements for New Zealand benefits and pensions factsheet
Residential Care Loans factsheet
Helps older people who can’t get Residential Care Subsidy to pay for the cost of their contracted care services.
Residential Care - Deferred Loan Factsheet
Form code: RSU10W - JUL 2011
When a Residential Care Loan becomes repayable, a deferred loan can be offered to people in certain circumstances.
Residential Care - Deferred Loan Application
Form code: RSU09W - JUL 2011
Residential Care Subsidy and Residential Care Loan
Form code: SUPE0005 – JUL 2011
Financial assistance for people in rest homes or hospitals.
Residential Support Subsidy Factsheet
Form code: RSU11W - JUL 2011
Residential Support Subsidy Authorisation Form
RSU08W - SEP 2011
Residential Support Subsidy - Resident's Details Notification
Form code: RSU12W - NOV 2011
Residential Support Subsidy - Sole parent's dependent children notification
Form code: RSU13W - DEC 2011
Form code: SUPE0004 – OCT 2011
A guide to receiving New Zealand Superannuation or the Veteran's Pension overseas.
Review of Decision Application Form [PDF, 223.88KB]
Form code: R10 - OCT 2008
Review Rights and Responsibilities
Form code: WS47 May 2009
Information concerning your rights and responsibilities in dealing with Work and Income.
A payment to meet the essential living expenses of farming families affected by an adverse event such as a flood, drought or other natural disaster.
Rural Assistance Payment Application Form [PDF, 164.45KB]
Form code: RUR01W - SEPT 2008
Rural Assistance Payment (Continuation) Application Form [PDF, 76.19KB]
Form code: RUR02W - APR 2008
Form to complete to ensure that your Rural Assistance Payment continues.
S
Seasonal work and how we can help
Form code: JOBS0009 – OCT 2010
Finding seasonal work and how we may be able to help.
Form code: ALLA0018 – APR 2011
A guide to the sickness benefit which helps people who aren't currently working, or are working less hours, because they are sick, injured, disabled or pregnant.
Sickness Benefit Application Form [PDF, 255 KB]
Form code: M15 - SEP 2011
Social Security Agreements and guides, and the special arrangement with Pacific countries
New Zealand has a number of agreements and arrangements with other countries with regard to benefits and pensions.
The Special Banking Option (SBO) enables you to receive overseas and New Zealand benefits or pension payments as one regular payment.
Also available in Dutch text
Special portability arrangement with Pacific Countries
A guide for getting benefits or pensions if you have lived, live or are going to live in a Pacific country.
Special Portability of New Zealand Superannuation or Veteran's Pension
A guide to getting your New Zealand Superannuation or Veteran’s Pension when you move to certain Pacific countries.
Also available in Cook Island Māori text, Samoan text and Tongan text
Form code: JOBS0003 - APR 2011
Starting your job search worksheet [PDF, 33.18KB]
Form code: JOBSW0001 – NOVEMBER 2001
A worksheet to help you start your job search and plan your career.
Also available in [RTF]
T
Form code: SUPE0009 – JAN 2010
The Great Little Cookbook [PDF, 1.06MB]
The Great Little Cookbook - hints and healthy eating on a tight budget.
Also available in [RTF 283KB]
Form code: ALLA0051 - SEP 2010
Your guide to the benefit changes from 27 September 2010
Training Incentive Allowance Factsheet
Form code: JOBS0016-DEC 2008
Training Incentive Allowance Application Form [PDF, 123.19KB]
Form code: S12 - FEB 2009
Training Statement [PDF, 75.28KB]
Form code: R12 – JAN 2011
Transition to Work Grant Application Form [PDF, 106 KB]
Form code: LAB 995 – DEC 2010
U
Form code: JOBS0006 – APR 2011
A guide for people who are out of work.
Unemployment Benefit Application Form [PDF, 255 KB]
Form code: M18 – JUL 2011
Unemployment Benefit Re-Application Form [PDF, 155 KB]
Form code: M26 – SEP 2011
V
Veteran's Pension Application Form [PDF, 340KB]
Form code: M19 – NOV 2010
Veteran's Pension - Partner Application Form [PDF, 286KB]
Form code: M20 – NOV 2010
Veteran's Pension - Transfer from New Zealand Superannuation Application Form [PDF, 92.39KB]
Form code: S14W - NOV 2011
W
Form code: SUPE0002 – APR 2011
A guide to the War Disablement, Surviving Spouse or Partner and Veteran’s pensions.
Widows Benefit Application Form [PDF, 204 KB]
Form code: M21 – OCT 2011
Working for Families - Childcare Assistance and Accommodation Supplement chart
Form code: WFF006 – APR 2011
Current rates for childcare and housing costs
Writing your CV worksheet [PDF, 39.82KB]
Form code: JOBSW0002 – NOVEMBER 2001
Some guidelines to follow when writing your CV.
Also available in [RTF 82KB]
Y
Young Parent Childcare Payment
Form code: ALLA0028 – 24 SEP 2007
A payment which helps parents aged under 18 years who need support to pay childcare costs while they attend secondary school.
Young Parent Childcare Payment Application Form [PDF 252.32KB]
Form code: S25W – MAY 2011
