ilumin Annual Individual Questionnaire

SECTIONS TO COMPLETE BASED ON ANSWERS FROM QUESTIONS ABOVE
SECTION A

NZ Dividend Income
please provide the following - all dividend statements (The payment date is the relevant date to determine whether the dividend statement should be included in the financial period

to be providedN/A

SECTION B

NZ Interest Income
Please provide the following: - all interest certificates (Please note that banks will only issue certificates for interest received over $50. However, you are required to account for all your interest income and therefore you should request certificates from your bank, or download these from your internet banking site, irrespective of how much interest is earned). - a current Certificate of Exemption (if you have one)

to be providedN/A

SECTION C

Overseas Income
Please provide the following: - Full details and schedules including dividends, interest, rental income, and/or any other income received from an overseas country

to be providedN/A

SECTION D

Overseas Investments, Bank Accounts or Superannuation
Where overseas investments are not held within a managed portfolio please provide the following: (grouped by investment company/trust): -Details and numbers of shares/units owned at the beginning of the financial year, the market value at the date, share/units purchased and sold during the 12 month period, details and number of shares/units owned at the end of the financial year and their market value at year end (if available) -Do you have any foreign bank accounts, credit cards, loans etc. in your personal name (irrespective of whether it is business related)? -if yes please provide: Bank statements for the full year

Yes -if yes please provide: Bank statements for the full yearNo
Do you have an overseas Superannuation Pension or Fund If yes please provide: -Details of the provider, amount and income received -Statements received from the provider

to be providedN/A

E. Portfolio Investments Entities (PIE's)
Please provide the following: - Investment summary schedules received for the year, including details of the perscribed investor rate (PIR) this includes KiwiSaver

to be providedN/A

F. Portfolio Managed Scheme
Please provide the following: - The portfolio Manager's year-end tax reports

to be providedN/A

G. Rental Income from Boarders

Please provide the following details:
How many boarders do you have? Type a label

	$
How much do they pay a week??
How much did they pay you this financial year?

H Beneficiary Income (from a Trust ilumin does not act for)

Please provide the following details:
- Details of all Trusts for which you are a beneficiary

to be providedN/A
- Details of all income allocated and tax credits allocated

to be providedN/A

I Shareholding in a Company (that ilumin does not act for)

Please provide the following details:
- Details of shareholder/director remuneration for which PAYE/Withholding Tax was not deducted

to be providedN/A

J Shareholding in a Look Through Company LTC (that ilumin does not act for)

Please provide the following details:
- Details of all profit and loss allocations received

to be providedN/A

K Partnership Income (from a Partnership that ilumin does not act for)

Please provide the following details:
- Details of your share of income, share of losses

to be providedN/A

L Other income

Please provide the following details:
- Full details of any other income received

to be providedN/A

M Employees Share or Option Scheme

Please provide the following details:
Name of Employer
Number of Shareholders
Date Obtained

MonthDayYear
Date
$

- Market value at the date required

	$
- Market value at the date required

N Did you Buy or sell Cryptocurrency

If yes, please provide the following details:
- Details of all purchase transaction during the year

to be providedN/A
- Details of all sales transaction during the year

to be providedN/A
- Did you receive any cryptocurrency as payment for a business transaction

to be providedNo
- if yes please advise the amount received and the date of transaction/s

to be providedN/A

O Student Loan

(Please note: we will have to identify your total income to determine if there is any obligation to calculate repayments)
- Do you have an outstanding student loan

YesNo

P absent from New Zealand for more than 325 days

(we will contact you to discuss your circumstances and whether there is any impact on your tax residency status)
Please advise the date you left or arrived back in New Zealand

MonthDayYear
Date

Q Tax resident or Citizen of another Country

please provide the following
please advise which country
- A copy of the tax return filed in that country for the relevant tax year

to be providedN/A

R Purchase or sale of property

(includes for Brightline and interest limitation rules) -If this was your main home we do not need any details
If you purchased a property, advise the year built
- A copy of the Sale or Purchase agreement

to be providedN/A
- Solicitor settlement statements (including copy of legal fee invoice) for both transactions

to be providedN/A

S Working for Families Tax Credit

If yes please provide the following details
- Do you think you may be entitled to WFFTC?

YesNo
Name of principal caregiver

Children for whom you were the 'Principal caregiver': -Name

	Date of birth	IRD number	Were you the principal caregiver for the whole year
1.
2.
3.
4.

- Have you registered with inland revenue for WFFTC?

YesNo
- Are you eligible for an in-work tax credit?

YesNo
If yes, please advise the number of weeks where you worked more than 20 hours per week for a solo parent or more than a combined 30 hours per week for a couple.

T Donations and Childcare Rebate

Please provide the following
- Receipts for donations

to be providedN/A
- Receipts for childcare fees paid

to be providedN/A

U Income Protection Insurance Premiums

Please provide the following
- Letter from your insurance provider that notes the tax-deductible premiums paid for the year

to be providedN/A

V Tax refund instructions

Please provide your bank account details for any IRD tax refunds
Bank account name:
Bank account number:

W Any other information

Please add anything else you would like to make us aware of
Additional information

Should be Empty:

ilumin - Annual Individual Questionnaire

SECTIONS TO COMPLETE BASED ON ANSWERS FROM QUESTIONS ABOVE

SECTION A

SECTION B

SECTION C

SECTION D

E. Portfolio Investments Entities (PIE's)

F. Portfolio Managed Scheme

G. Rental Income from Boarders

H Beneficiary Income (from a Trust ilumin does not act for)

I Shareholding in a Company (that ilumin does not act for)

J Shareholding in a Look Through Company LTC (that ilumin does not act for)

K Partnership Income (from a Partnership that ilumin does not act for)

L Other income

M Employees Share or Option Scheme

N Did you Buy or sell Cryptocurrency

O Student Loan

P absent from New Zealand for more than 325 days

Q Tax resident or Citizen of another Country

R Purchase or sale of property

S Working for Families Tax Credit

T Donations and Childcare Rebate

U Income Protection Insurance Premiums

V Tax refund instructions

W Any other information