kendons CLIENT INFORMATION QUESTIONNAIRE - INDIVIDUAL

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1 Balance Date: 31 March 2018 kendons BUSINESS CLIENT INFORMATION QUESTIONNAIRE - INDIVIDUAL ADVISORS CHARTERED ACCOUNTANTS We are conscious of the need to provide an efficient and cost effective service and as our fees are charged on a time basis providing us with all of the records and information requested in the attached questionnaire will enable us to complete your financial accounts with the minimum of delay and cost. Signature of Client: Date: *Please Complete *Full Name: IRD Number: *Address: POSTAL CODE * Address *Telephone Number Fax Number *Bank account for any Tax Refunds Account Name: Account number: _ - Please tick to confirm that you accept our Terms of Engagement available at TERMS OF ENGAGEMENT I/We authorise Kendons Scott Macdonald Limited to prepare financial statements from the information and records I/We have supplied to you and to act as my/our agent at Inland Revenue Department and Accident Compensation Corporation on all tax and ACC related matters. I/We advise you not to complete an audit or review. I/We accept responsibility for the accuracy and completeness of all records and information supplied to you. AUTHORISATION TO COLLECT INFORMATION FOR ALL FINANCIAL YEARS From time to time it is more cost efficient for us to contact other parties to obtain information for and on your behalf, subject to the provisions of the Privacy Act Examples are copies of bank statements, details of cheques presented, deposits made, copies of term loan agreements and details of hire purchase agreements, settlement statements, interest and dividend advice notices and information held by Inland Revenue Department. Costs may be charged direct to you by the agency concerned. I/We authorise Kendons Scott Macdonald Limited to request information, which is required for a timely and orderly completion of my/our financial statements, direct from the individual agents concerned. I/We acknowledge that we are aware of the purpose for which this information is being collected and disseminated. I/We authorise Kendons Scott Macdonald Limited to obtain all necessary information required from Inland Revenue Department about all tax types. This includes obtaining information through all Inland Revenue media and communication channels for the ensuing year. I/We authorise any refunds to be paid to Kendons Trust account if required. Accident Compensation Corporation You authorise our organisation to act as your agent for ACC levy purposes for all associated entities. This authorisation allows our organisation to query and change information on your ACC levy account(s) through ACC staff, and through ACC Online Services. The authority will also allow our organisations main representative discretion to delegate access to your ACC information to other members of our organisation. Other delegated members of our organisation will also be able to query and change information on your ACC levy account. 119 Blenheim Road, P.O. Box 8621, Riccarton, Christchurch 8440 P (03) F (03) E kendons@accounting.co.nz W 1

2 Name: CHECKLIST RECORDS REQUIRED 1. Employee information, please list Employers and we will obtain income details direct from Inland Revenue Department Enclosed (Tick One) Not Applicable 2. Family Support: Please tick if you have received regular family support payments: 3. Interest Advice Slips/RWT Certificates (please see schedule page 3) Number attached: 4. Dividend Advices (please see schedule page 3). Number attached: Note: It is essential that ALL advice slips are included. 5. Entertainment; under the entertainment tax regime 50% of qualifying entertainment expenses are deductible. Receipts for entertainment need to specify who was entertained and why. 6. Income Protection Insurance; these may be claimed either personally or as a business expense. Please provide details including amount paid for year. 7. Charitable Donation (Housekeeper/Childcare) Receipts to be claimed on the rebate claim form IR526 forwarded to you at your home address by the Inland Revenue Department This does not form part of your Tax Return. If you wish us to complete the IR526 form please provide us with all receipts. INFORMATION REQUIRED 1. Wages Salary and National Superannuation: We will receive an advice from the Inland Revenue Department of your source deducted earnings. Amount received from any other pension or superannuation scheme (including overseas pension). Name of Scheme: 2. Date of Birth (required by I.R.D): / / 3. Family Assistance Children (Full Names) Date of Birth IRD No (if available) Date left school (if applicable) Is child financially independent? Yes/No 2

3 Please provide details: Child support / private maintenance received from the other parent / guardian. Shared custody. How many days per week do you have custody. In work payment entitlement. On average how many hours worked per week. Any money received from friends & family.. Are you a beneficiary of any family trust (if so have you received any money from this trust, please provide details). SCHEDULE OF INTEREST-BEARING INVESTMENTS AND DIVIDENDS RECEIVED Please include all investments held at any time during year. Identify any overseas income. SOURCE OF INTEREST GROSS INTEREST TO 31/3/2018 TAX DEDUCTED RWT CERTIFICATE ATTACHED? YES/NO SOURCE OF INTEREST GROSS INTEREST TO 31/3/2018 TAX DEDUCTED RWT CERTIFICATE ATTACHED? YES/NO 3

4 SOURCES OF DIVIDEND Please include all details of shares taken in lieu of dividend. GROSS DIVIDENDS TO 31/03/2018 WITHHOLDING TAX IMPUTATION CREDITS NUMBER OF DIVIDEND ADVICES ATTACHED $ $ $ $ $ $ $ $ $ Please ensure that you enclose all documentation regarding dividends received. New Zealand and overseas investments (e.g. shares, term deposits, superannuation etc) IF YES, please provide the following; for both New Zealand overseas investments: 1. Statement showing term deposits and interest rates at 31 March Details of shares held at 1 April 2015 and 31 March 2018, including the following details: Company Name Number of Shares Original Cost Market Value Portfolio Report from Broker Including your statement from Link Market and Computer Share for New Zealand shares. 3. Detail of any sale and purchases of shares for the year ended 31 March Details of any overseas superannuation investments held or life insurance policies where you are a beneficiary for the year ended 31 March

5 RENTAL DETAILS Rent Received - (If insufficient room please detail on a separate schedule.) $ If the above figure includes Bonds received deduct here $ Net Rents $ Expenses relating to Rents: Rates $ Insurance $ Repairs and Maintenance $ Interest $ Telephone $ Other (specify) PLEASE PROVIDE SUPPORTING DETAILS (E.G. RATE NOTICE ETC) Have you bought or sold a rental property during the year? If so attach solicitor's statement. If totals are given above please supply working papers or adding machine tapes to verify the amounts. Are you holding the bonds or have they been paid to Tenancy Services? If the rentals are banked please supply bank statements. Please supply details of any assets purchased or sold (e.g. fridge) and date of sale or purchase. Asset Cost / Sale Price Date Purchased / Sold HAVE YOU SIGNED THE DECLARATION ON PAGE 1? 5