Tax File Number Declaration

Tax File Number Declaration
This short form will populate your tax form and send a copy to you post your submission. If there are any changes that you need to make this can be fascilitated for you at any time
Section A: To be completed by the PAYEE
1. What is your tax file number (TFN)?
OR I have made a separate application/enquiry to the ATO for a new or existing TFN.OR I am claiming an exemption because I am under 18 years of age and do not earn enough to pay tax.OR I am claiming an exemption because I am in receipt of a pension, benefit or allowance.
Title:

Mr.MrsMissMs
2. What is your name?

Surname or family nameFirst given nameOther given name
3. What is your home address in Australia?

Street Address

Suburb/town/locality

CityState / territory

Poscode
4. If you have changed your name since you last dealt with the ATO, provide your previous family name.
5. What is your primary e-mail address?
example@example.com
6. What is your date of birth?

DayMonthYear
Date
7. On what basis are you paid? (select only one)

Full-time employmentPart-time employmentLabour hireSuperannuation or annuity income streamCasual employment
8. Are you: (select only one)

An Australian resident for tax purposesA foreign resident for tax purposesOR A working holiday make
9. Do you want to claim the tax-free threshold from this payer? Only claim the tax-free threshold from one payer at a time, unless your total income from all sources for the financial year will be less than the tax-free threshold.

YesNo Answer no here if you are a foreign resident or working holiday maker, except if you are a foreign resident in receipt of an Australian Government pension or allowance.
10. Do you have a Higher Education Loan Program (HELP), VET Student Loan (VSL), Financial Supplement (FS), Student Start-up Loan (SSL) or Trade Support Loan (TSL) debt?

Yes Your payer will withhold additional amounts to cover any compulsory No repayment that may be raised on your notice of assessment.No
Declaration by Payee: I declare that the information I have given is true and correct.
Signature

Clear
Date

DayMonthYear
Date
There are penalties for deliberately making a false or misleading statement.
Section B: To be completed by the PAYER

(if you are not lodging online)
1. What is your Australian business number (ABN) or withholding payer number?
2. If you don’t have an ABN or withholding payer number, have you applied for one?

YesNo
3. What is your legal name or registered business name (or your individual name if not in business)?
4. What is your business Address?
Street Address
Suburb/town/locality
City
State/ territory
Postcode
5. What is your primary e-mail address?
example@example.com
6. Who is your contact person?
Business phone number
7. If you no longer make payments to this payee, print X in this box.
Signature of payer

Clear
Date

DayMonthYear
Date
Please verify that you are human*
More information:

By; phone 13 28 61 between 8.00am and 6.00pm, Monday to Friday. If you want to vary your rate of withholding, phone 1300 360 221 between 8.00am and 6.00pm, Monday to Friday. Payer – for more information, phone 13 28 66 between 8.00am and 6.00pm, Monday to Friday. If you phone, we need to know we’re talking to the right person before we can discuss your tax affairs. We’ll ask for details only you, or someone you’ve authorised, would know. An authorised contact is someone you’ve previously told us can act on your behalf. If you do not speak English well and need help from the ATO, phone the Translating and Interpreting Service on 13 14 50. If you are deaf, or have a hearing or speech impairment, phone the ATO through the National Relay Service (NRS) on the numbers listed below: TTY users – phone 13 36 77 and ask for the ATO number you need (if you are calling from overseas, phone +61 7 3815 7799) Speak and Listen (speech-to-speech relay) users – phone 1300 555 727 and ask for the ATO number you need (if you are calling from overseas, phone +61 7 3815 8000) Internet relay users – connect to the NRS on relayservice.gov.au and ask for the ATO number you need. If you would like further information about the National Relay Service, phone 1800 555 660 or email helpdesk@relayservice.com.au
Should be Empty:

Tax File Number Declaration

Section A: To be completed by the PAYEE

Section B: To be completed by the PAYER