INCOME NAME. Occupation and Employer. Current Residential Address. Current Postal Address. Address. Phone Number

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1 NAME Occupatin and Emplyer Gvernment emplyees please include level. Current Residential Address Current Pstal Address Address Phne Number Hw Wuld Yu Like Us t Cntact Yu Phne Bank Accunt Infrmatin Accunt BSB Accunt Number The ATO is n lnger issuing cheques fr refunds. Refunds will nly be paid directly int yur nminated bank accunt. Please tick-ff and cmplete each item that is applicable t yu. INCOME PAYG Payment Summary Previusly called Grup Certificate. Please attach all PAYG Payment Summaries. Allwances These include allwances frm emplyer. Please prvide amunt and descriptin. Emplyer Lump Sum and Eligible Terminatin Payments Please include all PAYG Payment Summaries and statements. 1

2 INCOME Cntinued Pensins, Super Lump Sums and Gvernment Allwances These include CmSuper, allcated pensins and gvernment payments. Interest Received Theses include amunts frm bank accunts and investments. Please prvide summary. Als include accunts held n behalf n children. Dividends Received Prvide summary and statements. Please nte, dividends are cnsidered as incme n the date f payment, nt the recrd date. Emplyee Share Shemes Please prvide annual tax statements. Partnership and Trust Distributins Please prvide annual tax statements. Business Incme Please prvide yur MYOB file r details f any business incme and expenses fr the 2015 financial year. Capital Gain r Lss Sale f shares r real estate are sme cmmn examples f events resulting in a capital gain r lss. Please prvide bth purchase and sale details. Freign Surce Incme Please prvide statements and details. Rental Incme Please see page six. Other Incme Please prvide details f any ther incme including Farm Management Depsit withdrawals (FMD's). 2

3 DEDUCTIONS Wrk-related Car Expenses Car Mdel and Year Registratin Number Engine Capacity Ttal Number f Kms Travelled Ttal Wrk-related Kms Travelled Year f Lg Bk Expenses Petrl Registratin Insurance Repairs Lease Payments Other Other Wrk-related Travel Please prvide details and receipts (e.g. airfares and accmmdatin). Wrk-related Clthing & Laundry Please prvide details. Wrk-related Self-educatin Expenses Include any educatin expenses relating t yur wrk. Other Wrk-related Expenses Assciatins and Memberships Cnferences and Seminars Unin Fees Bks and Jurnals Statinery Cmputer Cnsumables Prtective Items Hme Office (hurs per week) Internet Telephne Other Fr expenses that are nt slely wrk-related, please include wrk-related percentage. Interest and Dividend Deductins These include any expenses against interest and dividend incme. Please prvide details f interest paid n any investment brrwing. 3

4 DEDUCTIONS Cntinued Dnatins Include amunts dnated t lcal r verseas charities, r schl building funds. Prvide receipts. Tax Agent Fees Please als include details f kms travelled and ther csts (e.g. parking) incurred in seeing us. Persnal Super Cntributins Please prvide details, amunt and date f cntributin. Other Deductins This may include cst f incme prtectin insurance. Please als include details f Farm Management Depsits made during the 2015 financial year. Please prvide details. DETAILS OF SPOUSE AND DEPENDANTS Spuse Date f Birth If Halletts nt preparing Return we require the fllwing: Taxable Incme Reprtable Fringe Benefits Reprtable Emplyer Super Cntributins Net Investment Lss Net Rental Lss Tax Free Gvernment Pensin Dependant 1 Date f Birth Dependant 2 Date f Birth Dependant 3 Date f Birth Dependant 4 Date f Birth Please prvide full names and dates f birth f all dependant children. 4

5 OFFSETS Superannuatin Cntributins Made n Behalf f Yur Spuse Please prvide details. Medical Expenses Over $2,218 (Where family incme <$180,000) Medical Expenses Over $5,233 (Where family incme >$180,000) The Gvernment has intrduced legislatin changing the eligibility fr the net medical expenses tax ffset. T be eligible yu must have:- Received this ffset in yur 2012/2013 & 2013/2014 incme tax assessment; r paid fr medical expenses relating t disability aids, attendant care r aged care. If yu are eligible, please prvide statements frm yur health insurance, medicare and ther receipts as necessary. Medicare Levy Surcharge f Insurer Date Jined Family Members cvered Premiums Eligible fr Australian Gvernment Rebate Yur Australian Gvernment Rebate Received Benefit Cde Type f Private Hspital Plicy Held (Please circle) Single / Cuple / Family Individuals and families with private health cver are exempt frm Medicare Levy Surcharge. Please prvide a cpy f the annual advice/summary frm yur private health fund. Als, ensure that new brn family members are cvered by the fund. Families with full-time students under 24 years f age, need t ensure that these family members remain cvered by a Private Health Insurance cver, as the ATO deems them t be dependents. HELP, HECS and SFSS Debt Please prvide a cpy f the ATO statement, if yu have any debt. PAYG Instalments If yu have paid any PAYG instalments fr this financial year, please prvide quarterly r annual activity statements. Any Other Relevant Infrmatin r Ntes fr Cmpletin f Yur Return 5

6 RENTAL PROPERTY DETAILS Prperty 1 n Title Deed Percentage Held Address f Prperty Date Purchased Date First Rented Prperty 2 n Title Deed Percentage Held Address f Prperty Date Purchased Date First Rented Please prvide a cpy f the settlement statement fr new prperties purchased during the year. Als, cntact Halletts fr any additinal infrmatin that may be required (e.g. Quantity Surveyr's Reprt) in relatin t the new prperties. Incme Grss Rental Incme Other Prperty 1 Prperty 2 Expenses Advertising Agent's Fees and Cmmissin Bank Charges Bdy Crprate Fees Cleaning Cuncil Rates Gardening Insurance Interest n Lans Land Tax Legal Fees Pest Cntrl Repairs and Maintenance Statinery, Phne and Pstage Stamp Duty (ACT prperties nly) Travel Expenses Water Rates Other (incl. any additins t prperty) Please attach a cpy f the agent's summary, if applicable. 6