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Please fill out the form below .

PERSONAL DETAILS PART 1 If unsure leave blank and we will contact you

TAX FILE NUMBER

Title

Name

Surname

Date of of Birth

Address

Suburb and Postcode

State

Address changes since last return

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Phone number

Email

Spouse

Select an option

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

Gross Interest

Income from dividends

Franking Credits

Any CGT event to report?

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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 fees etc.

Motor Vehicle Did you use your car for any work purposes?

Select an option

if yes : Reasons & number kms travelled per month or year

WORK RELATED TRAVEL EXPENSES If applicable: Purpose and travel costs:

Uniform Do you have a logo on your purchased uniform?

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Do you have wear any protective uniforms?

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Donations Did you make any donations this year?

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Total donations made:

Other notes about my deductions:

PRIVATE HEALTH INSURANCE Were you and your dependants vovered by private health insurance?

If Yes: Name of Fund, Member number and type of cover

Medical expenses Did you have any out of pocket expenses over $2120 for you or familly members?

Select an option

HELP/HECS repayments Did you have any HELP/ HECS debt ?

Select an option

If Yes amount owed (estimate)

DECLARATION I authorise Gerard Marino to represent me and lodge my tax return

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The information provided for the preparation of this tax return is true and correct

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How will you be paying your tax return fee?

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BANK DETAILS BSB

Account number and name

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