Enrolment Form

Enrolment Form
Name*

First NameMiddle NameLast Name
Date of Birth*

DayMonthYear
Date
Tax File Number*
Occupation
Australian Business Number (if applicable)
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Bank Details
Account Name
BSB
Account Number
Would you like an electronic or hard copy of your return?*
By signing below, you authorise Cruzy Accounting and Taxation to act on your behalf as your registered tax agent (TAN: 26303835) and communicate with the Australian Taxation Office on your behalf (view prefill information, lodge returns, check assessment ect)
Signature*

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Date Signed*

DayMonthYear
Date
Office Use Only
Added To The Portal:

YesNo
Added To Tax:

YesNo
What ID Was Sighted?
Client Number
Completed By
Date Completed

MonthDayYear
Date
Notes
Signature

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Should be Empty: