Request for information | Repair tax return

Form to request prepration of individual tax return

Instruction:- Please complete and submit this form to request prepration of your individual tax return.

Fields marked * are compulsary.

Please complete the form in capital letters.

Existing Client

New Client

If new please input how you heard about us (Eg. Advertisements, Google, referred by a friend (Please provide name))

For which year do you want your tax return to be prepared [eg. 2019-2020]

Title (Please tick)*:

Mr Mrs Ms Miss

First Name*:

Middle Name:

Last Name*:

Address - (Street No & Name)*:

(Suburb)*:

Post Code*:

Tax file no*:

ABN (if applicable):

Telephone no. (Mobile)*:

Home no:

Email address*:

What is your occupation?*:

Date of birth*:

Did You have a spouse in the financial year

Yes No

Please Provide Your Bank Details: BSB*:

Account No *:

Account Name *:

Are you entitled to the Medicare Levy Exemption or reduction for the year you are requesting tax return to be prepared if yes, please ensure you apply for Medicare Levy Exemption*:

Yes

How many Dependent Children do you have?*:

Do you have private Health Insurance with hospital cover?*:

Yes No

if yes please provide private health insurance statement as on attatchment to this form.

Did you earn income from salary and wages*:

Yes No

How many employers did you work for*:

Did you earn any interest income:

Yes No

If yes complete below

Details of work-related expenses
D1. Work related Car Expenses (Please note you cannot claim travel for commuting to and from your work place)

Make of Car	Registration number (Rego)	Purchase Date	Purchase Price $	Odometer reading year Start
If you want to use cents per km method, please input number of kms travelled in the financial year (Maximum 5,000 kms) (kms)
Please put any other details in the text box below	Registration $	Insurance $	Repair & Maintenance $	Fuel $

	Service $	Cleaning $	Interest $	Other $

D2. Work related Travel Expenses (Air Travel, Taxis, Parking, interstate/overseas travel/accommodation, etc)

Details	Amount $

D3. Work related Uniform/Laundry/Safety shoes

	Details	Amount$
Protective Clothing
Occupation specific clothing
Compulsory Uniform
Dry cleaning
Laundry
Other

D4. Work related Self education expenses directly releted to your work

Name of Course and Institution	Date Paid	Amount$

D5. Other Work related Expense

	Nature Of Expense	Amount$	Use for work
Home office expenses			(%)
Computer and software			(%)
Telephone/mobile phone			(%)
Internet			(%)
Tools and equipment			(%)
Subscriptions and union fees			(%)
Journals/periodicals			(%)
Sun protection items			(%)
Seminars and courses			(%)
Other (please specify)			(%)
Depreciable items eg, laptop, desktop, assets costing more than $300			(%)
Date of purchase	Description of Assets Purchased	Amount	Work related use
			(%)
			(%)
			(%)

D9. Donations Given to tax deductible recipients

Name	Amount $

Name	Amount $

Name	Amount $

Name	Amount $

Name	Amount $

Name	Amount $

D10. Tax Agent Fees (paid during the financial year for which tax return is being prepared) $

D12. Personal Super Contributions for which tax deductions can be claimed

D15. Income protection, sickness and accident protection insurance. Premium paid

Foreign exchange losses/Derivative losses

Do you have a HECS/HELP liability or a student financial supplement loan debt?

Yes

Details of any other Income and Expenses not covered above

Detail	Amount $

Please specify any other details relevant to your tax return not included above:

Attachment:

I confirm that I have reviewed the above information and confirm it to be true and correct. I also authorise you to act as my tax agent and add my profile to your tax agent portal to prepare and lodge my tax return.