Salary Packaging Application Form Standard Benefits

Transcription

1 Personal Information Surname: Date of Birth: / / Payroll Identification Number: Payroll Cycle: q Weekly q Fortnightly q Monthly q Other Your contact details: Work Mobile Home Employer Name: Nominated account for reimbursements: Bank Branch Account name BSB number Account number Salary Package Allocation Please refer to your Employer Salary Packaging Policy to determine which benefit items you are eligible to package. You can access your Employer Salary Packaging Policy at Contact our Customer Care Centre on for the User Name and Password. Benefit Allocation per FBT year * Notes Motor Vehicle Lease $. 1 Additional Superannuation $. 2 FBT Free Benefits $. 3 Administration Fee $. 4 TOTAL $. Notes 1. Complete Part A of this form if you have included a novated motor vehicle. 2. Complete Part B of this application form to provide details in relation to your superannuation fund. 3. This amount is allocated for payments which are not subject to FBT. Complete Part C of this form to provide payment details for reimbursements. 4. Employees who choose to participate in salary packaging will be required to pay an administration fee. For all details of administration fees applicable please refer to your employer policy at * FBT year commences on 1 April each year. ALL EMPLOYEES MUST COMPLETE THE DECLARATION AT THE END OF THIS FORM. Full FBT Salary Packaging Application Form Page 1

2 Part A: Motor Vehicle Lease Self Managed Motor Vehicle Lease Complete this section only if your Motor Vehicle Lease is a Self Managed Motor Vehicle Lease that is to be salary packaged through Maxxia. If you are interested in a Fully Maintained Novated Lease, please call to speak to a Maxxia MyCar Consultant. Motor Vehicle Details Novated Lease Registration number: Model: Make: Colour: Cost of vehicle: $. Opening odometer reading: kms Opening odometer date: Estimated number of kilometres: (kilometres travelled on an annual basis) kms Name of Financier: Address of Financier: Lease Payment Amount: $. (regular monthly payment) Lease Commencement Date: Lease Expiry Date: Do you use the Employee Contribution Method? q Yes q No * Please check your Employer Policy regarding ECM. Substantiation Attach a copy of the following: Lease schedule from the Lease Financier; The signature page of the Deed of Novation; and A copy of the dealer s Invoice. Motor Vehicle Running Costs Novated Lease Registration costs $ Insurance $ Maintenance & Servicing $ Club membership $ Fuel costs $ Fuel type q LPG q Diesel q Unleaded Comments Fuel cost may only be paid by use of the motor vehicle charge card provided by Maxxia. Other operating costs cannot be charged to the motor vehicle charge card. You may submit the original receipt for reimbursement. Whenever a claim is made a completed Reimbursement Claim Form needs to be submitted. The Federal Government has decided to change the current statutory percentage package for calculating Fringe Benefits Tax from a tiered rate to a flat rate of 20%, regardless of the kilometres travelled. This is to be applied progressively over the next four (4) years to all new leases as follows: Distance travelled during the FBT year (1 April 31 March) Statutory Percentage From 10 May 2011 From 1 April 2012 From 1 April 2013 From 1 April ,999 km 20% 20% 20% 20% 15,000 24,999 km 20% 20% 20% 20% 25,000 40,000 km 14% 17% 20% 20% More than 40,000 km 10% 13% 17% 20% The change in rates will apply to leases commenced after 7.30pm on 10 May Commencement date is defined as when the customer receives the benefit. This is the finance settlement date, or finance lease start date. Full FBT Salary Packaging Application Form Page 2

3 Part B: Additional Superannuation Please tick the box if you would like to salary package additional superannuation. To set this up, we will be sending you a separate superannuation form for you to complete, which you will need to send back as a hard copy to Maxxia in our pre-paid postal envelope, rather than via electronic submission. We can only accept the form in hard copy because of strict privacy requirements around the collection and storage of personal information (e.g. TFNs). CHECKPOINT! The form we will send to you will ask for your fund s Unique Super Identifier (USI), or if you have a Self-Managed Fund, your Electronic Service Agreement (ESA). It is not compulsory for you to provide your fund s USI or ESA. However, not doing so will mean we are unable to make additional super payments to your superannuation account. You are required to provide your Tax File Number (TFN) to salary package additional superannuation. Part C: FBT Free Benefits Reimbursement Only* Disability/Income Protection Insurance Financial Counselling Fees Home Office Expenses Laptops (one per FBT year only) Mobile Phone Expenses Newspapers and Periodicals Professional Memberships and Subscriptions Portable Printers (one per FBT year only) PDAs / Electronic Diaries / Palm Pilots Relocation Expenses Self Education Expenses Investment Loan Interest Repayments Comments: An Investment Loan Interest Repayment Declaration will need to be completed and sent to Maxxia to package this benefit. The declaration can be obtained by contacting the Maxxia Customer Care centre on: or info@maxxia.com.au. * Please submit the original receipt for reimbursement as well as a completed Reimbursement Claim form. Full FBT Salary Packaging Application Form Page 3

4 Part D: Employee Declaration I understand and accept the terms and conditions of my Employer Salary Packaging Program. In addition, I understand and confirm that: 1. I will be ineligible to claim a taxation deduction for all salary packaging payments made in relation to otherwise deductible items. 2. I will meet any cost including FBT liability arising from the implementation of my salary package. 3. I acknowledge that my Employer has recommended that I obtain financial counselling prior to commencing salary packaging. 4. I undertake to retain and maintain all records in relation to any payments made by Maxxia for a period of five years (5). I also undertake to make these records available to Maxxia or my Employer or the Australian Taxation Office if requested. Employee Name (print): Employee Signature: Date: / / Send your completed Application Form to: Maxxia Pty Ltd Locked Bag 18 Collins Street East MELBOURNE VIC 8003 Or Fax Or info@maxxia.com.au DISCLAIMER Maxxia provides administration and referral services on behalf of employers. It does not provide any form of financial, taxation or financial product advice to employees on the relative merits of package programs or on any other basis. Some information on taxation matters may be provided to illustrate possible advantages, but is of a general nature only. You should seek your own independent professional advice on how packaging programs may impact your particular financial, taxation and welfare benefit circumstances. Maxxia may receive commissions or rebates in connection with some services it provides or arranges to be provided by third parties. By appointing and utilising Maxxia services, you consent to its receipt of such commissions and rebates. Tax laws regarding the treatment of salary benefits may change, which could adversely impact your financial, taxation or welfare benefit decisions. PRIVACY Maxxia is committed to protecting the privacy and rights of its customers. Our Privacy Policy contains important information about how we collect, hold, use and disclose personal information. It explains what happens if we cannot collect your personal information, as well as how you can access and correct the personal information we hold about you, or make a complaint. If you do not wish to receive promotional material from us, or would like a copy of our Privacy Policy, please contact us on Our Privacy Policy is also available at maxxia.com.au Maxxia Pty Ltd ABN Authorised Representative (No ) of McMillan Shakespeare Limited (AFSL No ) Full FBT Salary Packaging Application Form Page 4

5 Optional - Authority for the Disclosure of Salary Packaging Information Maxxia takes the utmost care to ensure that all information provided by you in relation to your salary packaging arrangements remain private and confidential at all times. You can authorise other individuals (eg. your Financial Consultant) to obtain information directly from Maxxia on your behalf, with respect to your salary packaging arrangements. In order to maintain the confidentiality on your account it is requested that you complete the details below authorising Maxxia to disclose salary packaging information if you require this facility. You may at any time cancel this authorisation by forwarding written confirmation directly to Maxxia. Personal Details Surname: Date of Birth: / / Payroll Identification Number: Address : Your contact details: Work Mobile Home Employer Name: Details of Authorised Person Surname: Organisation/Relationship: Authorised contact details: Work Mobile Fax Employee Declaration I authorise the person named in this authority to obtain information with respect to my salary packaging arrangements from Maxxia. Employee Name (print): Employee Signature: Date: / / Send your completed Authority Form to: Maxxia Pty Ltd Locked Bag 18 Collins Street East MELBOURNE VIC 8003 Or Fax Or info@maxxia.com.au Full FBT Salary Packaging Application Form Page 5