2015 General Return Preparation

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1 Client name ABN Tax File Date of Birth Mobile Telephone Spouse s name Address Occupation Change in Marital Status / Referral Source Bank Account Details for EFT BSB OR Trust Account? A/C / Account Name Action Items: Ethical Letter / Engagement Letter Given to client Signed This Year Private Health Insurance Details Benefit code Health Insurer Code Policy Number Tax claim code Share rebate claimed during year Members on policy $ Factsheet Given Y/N Days Covered 1/7/14-31/3/15 Days Covered 1/4/15-30/6/15 Fin Planning Referral? / Who? John / Rebecca Why / Why t tes: 1

2 Income 1 Salary or wages (please specify) Paid Parental Leave or Dad and Partner Pay Paid By: Employer / FAO $ Reportable Fringe Benefits Amounts (RFBA) Reportable Employer Superannuation (RESC) 2 Allowances, earnings, tips, director s fees etc 3 Employer lump sum payments 4 Employment termination payments 5 1. Australian government allowances (eg Newstart, Youth Allowance, Austudy) 6 Australian government pensions and allowances (eg age or single parent pension) 7 2. Australian Annuities and superannuation income streams Taxed $ Untaxed $ 8 3. Australian Superannuation lump sum payments Taxed $ 9 4. Attributed personal services income Interest (use schedule if > $1,000) 117. Dividends (use schedule if > 2 security held) 128. Employee share schemes 139. Income from partnership and/or trusts 10. (Please use schedule for details) Personal services income Net income or loss from business Deferred non-commercial business losses Net farm management deposits or withdrawals Net capital gains (use schedule if yes) 16. Exempt Capital Gains Exemption Code Investment in Foreign Entities Foreign income (please specify) Rental 20. Untaxed $ Bonuses from a life assurance or friendly 22. society policy Forestry managed investments scheme income Other income (please specify) 2

3 Deductions D1. Work-related car expenses (Factsheet given Y/N) (Rates will change next year. Flat rate 66 cents or logbook) cents per kilometre (max. 5,000kms) < 1.6 litre litre litre > litre 65 cents 76 cents 77 cents log book method one-third of actual expenses method 12% of actual cost method Rego # and Description of car Owner s name D2. Other work-related travel expenses Meals Tolls Airfares Taxis Parking ATO reasonable travel allowance Other (please specify) D3. Work-related uniform and other clothing expenses Protective Clothing Occupation-specific clothing n-compulsory uniform Compulsory uniform Sun protection and sun glasses Laundry (up to $150 without receipts) Dry cleaning Other (please specify) D4. Work-related self-education expenses Course - Student union fees - course fees - books, stationery, computer consumables - depreciation - internet expenses - travel & motor vehicle expenses - home office expenses - other (please specify) - $250 Reduction applied Reason Why / Why not 3

4 D5. Other work-related expenses Internet Home office (Factsheet given Y/N) 45c / hr Computer and software Telephone/mobile phone Tools and equipment < $300 Subscriptions Union Fees Journals/periodicals Seminars and courses (including travel) Stationery Other (please specify) 2015 General Return Preparation Other types of deductions D6. Low value pool deduction D7. Interest deductions D8. Dividend deductions D9. Gifts and donations D10. Cost of managing tax affairs Travel to / from tax agent D11. UPP of a foreign pension or annuity D12. Personal superannuation contributions Concessional / n-concessional Full name of fund Account number Fund ABN / TFN tice of Intent to Claim Form lodged Date Lodged with Super Fund / / Employment Test Passed (10% test) D13. Deduction for project pool D14. Forestry managed invest. scheme deduction D15. Other deductions (please specify) Income Protection Insurance Factsheet Given Other Insurances - Life insurance? - Trauma? L1. Tax Losses of earlier income years A3. Superannuation Co-Contribution 4

5 201 General Return Preparation Tax Offsets / Rebates T1. Senior Australian or pensioner T2. Superannuation income stream T3. Spouse superannuation contributions T4. Remote zone or overseas defence posting Zone Dates T5. Net medical expenses Last Year (use schedule) This Year Factsheet Given T6. Parent, spouse s parent or invalid relative offset T7. Landcare and water facility tax offset T8. Other non-refundable tax offsets T9. Other refundable tax offsets M1. Medicare Levy Reduction / Exemption M2. Days covered by Private Health insurance rebate changes Period 1 1/7/14-31/3/15 Period 2 21/4/15-30/6/15 Income Test Information T1 Any total reportable fringe benefits amounts IT2 Reportable employer super contributions IT3 Tax free government pensions IT4 Target foreign income IT5 Net financial investment loss IT6 Net rental property loss IT7 Paid child support (incl. food, school fees etc) IT8 Dependent Children in 2015 How Many? Adjustments A1 Change of tax residency during year A2 Under 18 at 30 June? A3 n-concessional Super Contributions? A4 Co-Contribution Entitlement? Trust or company distributions for which family trust distribution tax has been paid 5

6 Other Information A HECS / HELP / SFFS Debt / VET-FEE etc Fact Sheet B Division 7A Loans forgiven? C Gain/Loss from financial arrangements to elect to apply the TOFA changes to account for 2011 D Employee Share Scheme? Spouse Information (if applicable) Did you have spouse for the full year? If not full year for what period From: To: Did your spouse die during the year? DOD Spouse name DOB: Spouse s taxable income Section 98 non-taxable trust income Trust or company distributions for which family trust distribution tax has been paid Spouse reportable fringe benefits amounts Spouse Australian govt. pensions or allowances Spouse exempt pension income Spouse reportable superannuation contributions Spouse tax-free govt. military pensions Spouse target foreign income Spouse net investment loss (rental + investments) Child support your spouse paid (incl food, school fees) Superannuation lump sum (excl. death benefits) which includes a taxed element < low rate cap (age y/o) Declaration I declare all the information I have given is true and correct. Signature of Taxpayer Name (print) Date 6

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