Police Welfare Fund - Benefit Application

Welfare Benefits

This form should be used when applying for the following Welfare Benefits:

  • Birth Benefit
  • Adoption Benefit
  • Public Hospital TV Hire
  • Relationship Counselling

You can print a blank claim form and complete, or edit the claim form online.

Make sure you have Adobe Acrobat Reader downloaded (not Adobe Preview). Download Adoble Acrobat Reader

To edit the Benefit Application form online please

1. Open the 'editable' pdf  using either Firefox or Internet Explorer internet browsers for optimal results.

2. SAVE it to your computer before you complete the form.

3. Complete the form and save again, then send the completed form to us (see details below).


Completed Forms can be submitted:

By post: Claims submitted by post must include receipts and birth certificate/newspaper notice of birth (if applying for Birth benefit)

Send to: NZ Police Association, PO Box 12344, Wellington 6144.

By email: Attach your completed form to an email, along with your receipts, which have been scanned as a JPG or PDF file. Please don't embed these in the email. 

The scanned JPG or PDF must be easily readable or processing your claim may be delayed. Please keep your original receipts so they can be produced if requested.

Email: enquiries@policeassn.org.nz

When emailing forms, documents or pictures:
Please use the attachment function to attach your jpeg, png or PDF to your email. Do not insert them into your email as this will delay processing.