WFFTC Questionnaire

Client Information
Full Name

First NameMiddle NameLast Name
Financial Year Ended

DayMonthYear
Date
IRD Number
Phone Number
E-mail
Children's Details
Please provide details of the children you would like a Tax Credit entitlement calculated:
Name of Child 1

First NameLast Name
IRD Number
Date of Birth
Date Left School
Add another child?

Yes
Name of Child 2

First NameLast Name
IRD Number
Date of Birth
Date Left School
Add another child?

Yes
Name of Child 3

First NameLast Name
IRD Number
Date of Birth
Date Left School
Add another child?

Yes
Name of Child 4

First NameLast Name
IRD Number
Date of Birth
Date Left School
Add another child?

Yes
Name of Child 5

First NameLast Name
IRD Number
Date of Birth
Date Left School
General Information
Did you receive Working for Families Tax Credits during the year?

YesNo
Have you made or received any child support payments?

YesNo
Do we prepare your spouse or partner's taxation return?

YesNo
Has there been any changes to your family circumstances?

YesNo
Do you share custody of your child(ren) with anyone other than your partner?

YesNo
Are you single and work on average less than 20 hours per week or do you and your spouse/partner combined work less than 30 hours per week?

YesNo
Additional Income
Have you received income from any of the sources listed below?
Attributable Fringe Benefits

YesNo
PIE Income

YesNo
Passive Income of Children

YesNo
Income of Non-Resident Spouse

YesNo
Tax Exempt Salary or Wages

YesNo
Pensions and Annuities

YesNo
Other Payments

YesNo
Income Equalisation Scheme Deposits (excludes 'Adverse Events' deposits)

YesNo
Major Shareholder in a Close Company

YesNo
Certain distributions from superannuation schemes and retirement savings schemes

YesNo
Fringe benefits to Shareholders

YesNo
Losses

YesNo
Attach Your Documents
Please attach your supporting documents to accompany this form. The preferred file formats are: Microsoft Word documents, PDF's or Microsoft Excel spreadsheets.

Based on the answers you have supplied in this questionnaire, the documents you need to supply to us to complete your return are:
- The certificate issued to you by IRD detailing the Working for Families Tax Credits you received during the year.
- Details of the child support or maintenance payments you have made.
- Details of your spouse/partners income.
- Details of the change to your family circumstance. For example a marriage or separation.
- Details on the person you share custody with that is not your partner.
- Details on the hours you work per week and your partners hours if applicable.
- Details on your Attributable fringe benefits income.
- Details on your PIE income.
- Details on the passive income of children.
- Details on the income of your non-resident spouse.
- Details on your tax exempt salary or wages.
- Details on your Pensions and annuities.
- Details on the other payments received that are used for your family's day -to-day living.
- Details on your Income Equilisation Scheme deposits.
- Details on your Shareholdings in a Close Company.
- Details on your distributions from superannuation schemes and retirement savings schemes.
- Details on your fringe benefits as a shareholder.
- Details on your losses from other businesses/investments/rental properties.
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Declaration
I confirm that I have examined all the matters mentioned, and I accept responsibility for the accuracy and completeness of the information supplied and the relevant details as requested.

I hereby request Tax Link to compile my financial statements based on the information supplied and acknowledge that Tax Link is not to complete an audit to substantiate the accuracy of my information and therefore Tax Link will be unable to detect any error or fraud, nor to provide any assurance as to the accuracy of my financial statements to any person or any party for any reason.

I agree that my financial statements are prepared as a service to me and agree to Tax Link attaching to these financial statements their standard accountant’s statement of responsibilities.
Full Name

First NameLast Name
Todays Date

DayMonthYear
Date
Signature

Clear
Should be Empty:

Client Information

Children's Details

General Information

Additional Income

Attach Your Documents

Declaration