This form or form 6 must be completed and accompany the following applications:
an application for paid parental leave if the person applying is self-employed:
an application for the transfer of a parental leave payment if the mother’s spouse or partner to whom all or part of the entitlement to a parental leave payment is to be transferred is self-employed.
Information to be provided in respect of self-employed person
[Name of self-employed person] of [address, occupation]—
is self-employed because he or she is working, other than as an employee, doing 1 or more of the following:
providing goods or services for hire or reward under a contract for services:
carrying on business (including a profession, trade, manufacture, or undertaking carried on for pecuniary profit), including in partnership with another person:
working for a trust in a business (as defined in paragraph (ii)) carried on by the trust; and
his or her net income in the *6 months/*12 months immediately preceding the *expected date of delivery of his or her child (or children)/*date on which he or she will assume the care of a child (or children) with a view to adoption is or will be $[amount]; and
his or her average weekly earnings in the *6 months/*12 months immediately preceding the *expected date of delivery of his or her child (or children)/*date on which he or she will assume the care of a child (or children) with a view to adoption are or will be $[amount].
Declaration by *chartered accountant/*tax advisor
I, [name], am a *chartered accountant/*tax advisor for the person named above and I declare that I have nothing in my knowledge or possession to suggest that the information provided above is incorrect.
(*chartered accountant/*tax advisor)
Name of *chartered accountant/*tax advisor
This statement and declaration must be completed by a person who is—
a chartered accountant; or
a tax advisor as defined in section 20B(4) of the Tax Administration Act 1994.