Tax Form PrefixMr.Mrs.Ms.Mx.MissDr.Prof.First NameMiddle NameLast NameStreet AddressApartment, suite, etcSuburbState/ProvincePost codeCountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre & MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabweTax File Number0 / 9Date of BirthPhoneEmail AddressChoose your document for ID VerificationChoose your document for ID VerificationAustralian Driving LicencePassportLicence NumberState of IssueState of IssueNSWQLDACTSANTTASVICDate of IssueDate of ExpiryUpload Driving LicenceChoose FileNo file chosenDelete uploaded filePassport NumberCountry of IssueDate of IssueDate of ExpiryUpload PassportChoose FileNo file chosenDelete uploaded fileAccount Holder NameBSBAccount NumberAre you an Australian Citizen?Are you an Australian Citizen?YesNoAre you a Permanent Resident?Are you a Permanent Resident?YesNoDid you apply PR during the year?Did you apply PR during the year?YesNoDate of PR applicationVISA TypeDo you have a Medicare Levy Exemption Certificate?Please select Yes or NoYesNoYou may be entitled to Medicare Levy Exemption.Please downloand and complete the medicare levy exemption form using the below link and email it to MES@servicesaustralia.gov.au along with your copy of passport. https://www.servicesaustralia.gov.au/sites/default/files/ms015-2205en-v2-f.pdfDate of Arrival- If you came to Australia first time during the financial year.Date of Departure- If you left Australia permanently during the financial year.Did you have a Spouse or De-Facto Partner during the financial year?Select Yes/ NoYesNoName of SpouseDate of BirthTaxable Income of SpouseDo you have a dependent Children?Select Yes/ NoYesNoNo. of Dependent Children?Click the types of income you received during the financial year, then enter your details down below.Salary / WagesInterest IncomeDividend IncomeGovernment PaymentsRental IncomeCapital Gain or LossForeign IncomeOther IncomeBusiness IncomeSalary and WagesOccupationIn how many places did you worked?Information from ATOWe will obtain the salary information directly from the ATO through our Tax Agent Portal.Interest IncomeInterest Received FromGross InterestTax Deducted, if anyInformation from ATOWe will obtain the bank interest details directly from the ATO through our Tax Agent Portal. Please provide details if you've earned interest from sources other than banks.Dividend IncomeCompany NameNo. of Account HolderFranked DividendFranking CreditUnfranked DividendTFN WithholdingGovernment PaymentPayment TypeGross Amount ReceivedTax Deducted, if anyRental Proprerty DetailsRental Proprerty DetailsStreet AddressSuburbStatePost codeCountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre & MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabweYour ownership percentageNo. of weeks property was rented this yearDate property first earned rental incomeIncome DetailsGross Rental IncomeOther rental related IncomeExpenses DetailsAdvertising for RentBody Corporate Fee/StrataCleaning ExpensesCouncil RatesGardening/Lawn mowingInsuranceInterest on LoanLand TaxLegal FeesPest ControlProperty Agent CommissionRepairs & MaintenanceWater ChargesBank FeesSundry Rental Exps 1Sundry Rental Exps 2RemarksCapital Gain or LossASX Code / Company NameAmountSelect Profit or LossProfitLossDid you hold for more than 12 Months?YesNoOptional- Upload Capital Gain or Loss ReportChoose FileNo file chosenDelete uploaded fileForeign IncomeCountry of IncomeType of IncomeAmountRemarksOther IncomeType of IncomeAmountRemarksNature of BusinessSales/ Total IncomeBusiness ExpensesClick the types of deductions applicable to you, then enter your details down below.Car Related ExpensesTravel ExpenseUniform, Laundry & Protective GearsSelf EducationOther Work Related ExpensesMobile and InternetWork From HomePurchase of EquipmentsGift/DonationsLast Year Tax Agent FeePersonal Super ContributionOthersCar Related ExpensesTravel from home to work and vise versa not allowed.Car Make & ModelCar RegoWork KM travelled during the yearReason for car useTravel ExpensesNature of ExpenseAmountNature of ExpenseAmountUniform and Clothing ExpensesWork Unifrom with employer LogoLaundryProtective Gears/ Steel Capped ShoesOccupation Specific Clothing such as ApronsSelf Education ExpensesNature of ExpensesNature of ExpensesCourse FeeBookTravelAmountOther Work Related ExpensesNature of ExpensesNature of ExpensesUnion FeesSeminarsBooks and JournalsComputer AccessoriesTools and EquipmentSubscriptions and Membership FeePrinting & StationeryAmountMobile and Internet ExpensesMobile and Internet Expenses can be claimed if it is required for work purpose. If there is minimal usage such as for rostering, checking email, it cannot be claimed.Nature of ExpensesNature of ExpensesMobileInternetPercentage of Work UsageTotal Amount PaidWork From HomeFor every 1 hour worked from home, 67 cents can be claimed as deductions. However, Mobile Phone, Internet Bills, Computer Accessories cannot be claimed. No. of hours worked from homePurchase of EquipmentsPurchase DetailsEquipment Type (Specify)Date of PurchasePercentage of Work UsageAmountDonationsName of charitable organisationAmountTax Agent Fee Paid Last YearPersonal Super Contribution DetailsName of SuperfundABN of SuperfundMembership NumberAmount ContributedDo you have Acknowledgement of notice of Intent to ClaimSelect Yes/NoYesNoOthersOthers (Please Specify)AmountDeclarationI hereby appoint and authorise The Tax Adviser Pty Ltd, trading as The Tax Adviser ("the agent"), to act as my tax agent, and to lodge my tax return electronically or otherwise. I further authorise tax agent to deal with ATO on my behalf. I declare that: I have disclosed, all of the income including net capital gains which I have earned/received during the financial year. I have all receipts or documentation necessary to substantiate the above claims and I will make them available if required by the Tax Office Signature *Start signing your signature hereYour browser does not support e-Signature field.Submit
