TAX FILE NUMBER
Date of of Birth
Suburb and Postcode
Address changes since last return
If Yes Spouse Full Name
Spouse Date of Birth
Spouse Tax File Number
Spouse Taxable Income
YOUR INCOME DETAILS
payment summary 1 Employer Name and ABN
payment summary 1 Gross Income and Tax withheld
payment summary 2 Employer Name and ABN
payment summary 2 Gross Income and Tax withheld
payment summary 3 Employer Name and ABN
payment summary 3 Gross Income and Tax withheld
Allowances, tips, director'sfees ...
Govt Allowances: Amounts and tax withheld
Govt pensions : Amount and tax withheld
Income from dividends
Any CGT event to report?
Describe any other Income if any:
Personal info Part 2 :Deductions
If you are unsure, leave it blank and we will contact you
Work related deductions, Donations, Accounting feees etc.
Did you use your car for any work purposes?
if yes : Reasons & number kms travelled per month or year
WORK RELATED TRAVEL EXPENSES
If applicable: Purpose and travel costs:
Do you have a logo on your purchased uniform?
Do you have wear any protective uniforms?
Did you make any donations this year?
Total donations made:
Other notes about my deductions:
PRIVATE HEALTH INSURANCE
Were you and your dependants covered by private health insurance?
If Yes: Name of Fund, Member number and type of cover
Did you have any out of pocket expenses over $2120 for you or familly members?
Did you have any HELP/ HECS debt ?
If Yes amount owed (estimate)
I authorise Gerard Marino to represent me and lodge my tax return
The information provided for the preparation of this tax return is true and correct
How will you be paying your tax return fee?
Direct deposit Paypal
Account number and name