Tax File Number Declaration Form
1. What is your Full Name?
*
First Name (Required)
Middle Name (Optional)
Last Name (Required)
2. What is your Date of Birth?
*
/
Day
/
Month
Year
Date
3. What is your Primary Email Address?
*
example@example.com
4. What is your Home Address?
*
Street Address
Street Address Line 2
City
State
Postcode
5. Do you have a Tax File Number?
*
Yes
No
Other
6. What is your Tax File Number?
*
6. You have chosen 'No/Other'. Please provide why:
*
I have made a separate application/enquiry to the ATO for a new or existing TFN
I am claiming an exemption because I am under 18 years of age and do not earn enough to pay tax
I am claiming an exemption because I am in receipt of a pension, benefit or allowance
7. On what basis are you paid?
*
Full-time employment
Part-time employment
Casual employment
Labour hire
Superannuation or annuity income stream
8. Are you:
*
An Australian resident for tax purposes
A foreign resident for tax purposes
A working holiday maker
9. Do you want to claim the tax-free theshold from this payer?
*
Yes
No (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 repayment that may be raised on your notice of assessment)
No
Signature
*
Declaration by payee: I declare that the information I have given is true and correct
Date
*
-
Day
-
Month
Year
Date
Submit
Should be Empty: