Individual Tax Questionnaire & Checklist (IR3)

Individual Tax Questionnaire & Checklist (IR3)
Full Name*

First NameLast Name
Tax Year*
For year ended
IRD Number:*
E-mail*
example@example.com
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

City

Postal Code
Date of Birth*

DayMonthYear
1) Tax Residency
Were you in NZ for the full year?

YesNo
Please state the dates arrived and departed*
2) Working for Families Tax Credits and Parental Tax Credit
Did you or your partner receive family tax credits from Work and Income?

YesNo
3) Wages/Salary/benefits with tax deducted
Did you receive any income with tax deducted from wages, salaries, ACC payments, any benefits or prison?

YesNo
Please state sources of income with tax deducted*
Please upload any relevant files

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4) Income from schedular payments
Did you receive income from schedular payments?

YesNo
Please state the sources of income with tax deducted*
Please list any expenses related to the schedular payments and amounts*
Please upload any relevant files

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5) NZ Interest
Have you received any NZ interest income?

YesNo
Please provide tax certificates from all sources

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6) NZ Dividends
Did you receive an electricity dividend from ENTRUST?

YesNo
Have you received any other NZ dividend income?

YesNo
Please provide dividend advice notices & company dividend statements for cash dividends and dividends re-invested in the company*

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7) Income from Portfolio Investment Fund
Do you have income from a Portfolio investment fund?

YesNo
Please upload a copy of the year end tax report from your fund manager*

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8) Overseas Income
Have you received any income from overseas?

YesNo
Please provide details

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9) Shareholder-employee salary with no tax deducted
Did you recieve a shareholder-employee salary with no tax deducted?

YesNo
Please list company or companies, and amounts received*
Please upload any relevant files

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10A) Residential Rental Income
Did you receive any income or incur any expenses from residential property?

YesNo
In addition to this questionaire you will need to complete our rental questionaire - one for each property.
10B) Other Rental Income
Did you receive any income or incur any expenses from other rentals?

YesNo
Please provide details

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11) Income from self-employment
Did you receive any income from self-employment?

YesNo
Please complete the sole trader questionaire, in addition to this questionnaire
12) Other income
A) Did you receive any taxable Maori authority distributions?

YesNo
Please provide details

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B) Did you receive any NZ estate or trust income?

YesNo
Please provide details

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C) Did you receive any partnership income?

YesNo
Please provide details

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D) Did you receive any look-through company (LTC) income?

YesNo
Please provide details

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E) Did you receive any other income?

YesNo
Please provide details

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13) Expenses
Can you claim any expenses?

YesNo
Please provide details

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14) Bank account (for any refund)
Name of account
Account Number
15) Signature
By signing and dating this checklist and confirmation of engagement you confirm:

1) You have completed all the questions above;

2) We are authorised to proceed with the work.
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Individual Tax Questionnaire & Checklist (IR3)

1) Tax Residency

2) Working for Families Tax Credits and Parental Tax Credit

3) Wages/Salary/benefits with tax deducted

4) Income from schedular payments

5) NZ Interest

6) NZ Dividends

7) Income from Portfolio Investment Fund

8) Overseas Income

9) Shareholder-employee salary with no tax deducted

10A) Residential Rental Income

10B) Other Rental Income

11) Income from self-employment

12) Other income

13) Expenses

14) Bank account (for any refund)

15) Signature