MOD. Business details. Purpose of this form. Definition of a partner. For more information. If you have a hearing or speech impairment

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1 Business details MOD F Return this form online or to one of our Service Centres by Your Centrelink Reference Number Purpose of this form Definition of a partner For more information If you have a hearing or speech impairment Interpreters and translations You (and/or your partner) must complete this form if: you (and/or your partner) are self-employed or involved in a sole trader business or partnership (in Australia or outside Australia), or you (and/or your partner) were involved in a business prior to claiming Newstart Allowance or Youth Allowance. If you (and/or your partner) have ceased involvement in a business and are not claiming Newstart Allowance or Youth Allowance, any residual assets from the business should be declared as personally owned by you (or your partner). For the Australian Government Department of Human Services purposes a person is considered to be your partner if you and the person are living together, or usually live together, and are: married, or in a registered relationship (opposite-sex or same-sex), or in a de facto relationship (opposite-sex or same-sex). We consider a person to be in a de facto relationship from the time they commence living with another person as a member of a couple. We recognise all couples, opposite-sex and same-sex. If you need help to fill in this form or you need more information about the questions, go to our website or visit one of our Service Centres or call us on: ABSTUDY Disability and Carers Employment Services Parenting Payment International Services Seniors Youth and Students To speak to us in languages other than English, call te: Call charges apply calls from mobile phones may be charged at a higher rate. TTY service Freecall A TTY phone is required to use this service. If you need an interpreter or translation of any documents for our business, we can arrange this for you free of charge. 1 of 8

2 What else you will need to provide Filling in this form Returning your form(s) This form tells you which other documents you need to provide. Depending on your circumstances, you may have to fill in other forms. If you and your partner have both completed a form Mod F, only one copy of documents per couple is required. If you need your accountant to provide documents and/or information, we will not reimburse fees charged by the accountant. Please use black or blue pen. Print in BLOCK LETTERS. Mark boxes like this with a or. Where you see a box like this Go to 5 skip to the question number shown. You do not need to answer the questions in between. Check that you have answered all the questions you need to answer and that you have signed and dated this form. If you return required documents (and this form): online you can submit your documents online if you are registered for Online Services. by post we will sight and record your documents, which may include copying, and return the originals to you by registered post. in person we will sight and record your documents, which may include copying, and return the originals to you. Return this form, all additional documents and any other forms you are required to complete to one of our Service Centres or online within 14 days to make sure you are paid from the earliest date possible. If you cannot return all the forms or documents within 14 days, contact us for extra time. For more information on how to access Online Services or how to lodge documents online, go to 2 of 8

3 1 2 Your name Mr Mrs Miss Family name First given name Second given name Your date of birth Ms Other 8 Do you have an interest in any business run through a private trust? Do NOT use this form to provide details for any business run through a private trust. Instead you will need to complete a Private Trust form (Mod PT) for each private trust you have an interest in. If you do not have this form, go to our website te: If you have another business that is not part of a private trust 9 Do you have an interest in any business run through a private company? 3 4 Do you have a partner? Go to 8 Your partner s name Mr Mrs Miss Family name Ms Other Do NOT use this form to provide details for any business run through a private company. Instead you will need to complete a Private Company form (Mod PC) for each private company you have an interest in. If you do not have this form, go to our website te: If you have another business that is not part of a private company First given name 10 Do you have an interest in any type of business not run through a private trust or private company? 5 6 Second given name Your partner s date of birth Who is self-employed or involved in a sole trader business or partnership? You Go to 8 Your partner Your partner will need to complete and sign this form. Go to 8 Do NOT continue with this form. Contact us on the appropriate number listed on the front of this form. 11 Are you involved in more than one business as a sole trader and/or partnership? You will need to complete a separate Mod F form for each business you are involved in. How many copies of Mod F do you need? You and your partner 7 Are you and your partner only involved in the same partnership? If you and your partner are both self-employed and/or sole traders or involved in separate partnerships your partner will need to complete a separate Mod F for their business. If you do not have this form, go to our website CLK0Mod(F) of 8

4 Self-employed/sole trader details 12 Are you self-employed or a sole trader? Go to What is the name and address of the business? Name of business 19 Can you provide the latest profit and loss statement? I will provide it by te: If a profit and loss statement has never been completed for the business and you are unable to obtain one from your accountant, you can complete an interim Profit and loss statement form (SU580), if you do not have this form, go to our website Address of business Attach the latest profit and loss statement to this form. Postcode 20 Can you provide the latest balance sheet? I will provide it by 14 On what date did you commence operating this business? te: If you are unable to provide a balance sheet, provide a list of the type and amount of each liability and asset of the business. 15 What type of business or self employment are you involved in (e.g. dairy farm, milk bar, newsagency)? 16 Does the business hold any real estate? You will need to complete and attach a Real estate details form (Mod R). A separate form must be completed for each property. If you do not have this form, go to our website 21 Attach the latest balance sheet to this form. Is the value of the current business assets and liabilities different to that shown on the latest balance sheet? Attach a separate sheet with the following details: the current market value of the business assets and any liabilities reasons why the business asset value is different, and any documents that support your business estimate. 17 Please read this before answering questions 18 to Can you provide the latest depreciation schedule? You need to provide documents for your claim to be assessed. If you cannot attach the requested documents to this form, you must advise the date you will be providing them. We may not be able to pay you until you provide the requested documents. I will provide it by Attach the latest depreciation schedule to this form. 18 Can you provide your latest personal income tax return? I will provide it by Attach your latest personal income tax return to this form. 23 Is your current income from your business different to that shown on the latest profit and loss statement or tax returns? It would be in your interest to provide the following: your estimate of the type (e.g. wages, distributions, dividends etc.) and gross amount of the income for this financial year, reasons why the income is different to the latest income tax returns, and documents which support your estimate (e.g. interim profit and loss statement). 4 of 8

5 Business partnership details 24 Are you involved in a business partnership? Go to Please read this before answering questions 32 to 41. You need to provide documents for your claim to be assessed. If you cannot attach the requested documents to this form, you must advise the date you will be providing them. We may not be able to pay you until you provide the requested documents. 25 Do you have a partnership agreement? Attach a copy of the partnership agreement to this form. 32 Can you provide your latest personal income tax return? I will provide it by 26 What is the name and address of this partnership? Attach your latest personal income tax return to this form. Name of partnership 33 Is any business partner listed in question 28, your partner? Address of partnership Go to Can you provide your partner s latest personal income tax return? Postcode I will provide it by 27 When did the partnership commence? Attach your partner s latest personal income tax return to this form. 28 Who are the partners of this partnership? 35 Can you provide the latest partnership income tax return? Give details below of each partner s share of profit/loss. I will provide it by Partner name Share of profit/loss Attach the latest partnership income tax return to this form. 36 Can you provide the latest profit and loss statement? I will provide it by 29 What type of business is the partnership involved in (e.g. property development)? te: If a profit and loss statement has never been completed for the partnership and you are unable to obtain one from your accountant, you can complete an interim Profit and loss statement form (SU580), if you do not have this form, go to our website 30 Does the partnership hold any real estate? You will need to complete and attach a Real estate details form (Mod R). A separate form must be completed for each property. If you do not have this form, go to our website 37 Attach the latest profit and loss statement to this form. Can you provide the latest balance sheet? I will provide it by te: If you are unable to provide a balance sheet, provide a list of the type and amount of each debt and asset of the partnership. Attach the latest balance sheet to this form. 5 of 8

6 38 Is the value of the current partnership assets and liabilities different to that shown on the latest balance sheet? Attach a separate sheet with the following details: the current value of the partnership assets and any liabilities reasons why the partnership asset value is different, and any documents that support your partnership estimate. Recent changes to your business Is your business still operating? Go to 47 Why is your business no longer operating (e.g. sold, lease expired, in liquidation)? 39 Can you provide the latest depreciation schedule? I will provide it by Attach the latest depreciation schedule to this form. 45 When did your business stop operating? 40 Can you provide the current and capital account details for each business partner? I will provide it by 46 Do you intend to resume trading in your business? Go to 52 Attach your business partner s current and capital account details to this form. 47 Is your business generating any income? 41 Can you provide separate schedules showing balances, income and expenses for each investment, loan and bank account itemised on tax returns? I will provide it by 48 Have you stopped working in your business? Go to 50 Attach separate schedules showing balances, income and expenses for each investment, loan and bank account itemised on tax returns to this form. 49 Provide details of the type of duties you perform and the number of hours you spend each week on these duties. Type of duties performed (e.g. maintenance of equipment, obtaining contracts, book keeping). of hours per week 42 Is your current income from the partnership different to that shown on the latest profit and loss statement or tax returns? It would be in your interest to provide the following: your estimate of the type (e.g. wages, distributions, dividends etc.) and gross amount of the income for this financial year reasons why the income is different to the latest income tax returns, and documents which support your estimate (e.g. interim profit and loss statement). 50 Go to 51 Do you intend to resume work in the business? 6 of 8

7 51 Is anyone else helping you with running the business? Tick applicable box(es) and provide details Type of help Substitute Business partner. of hours per week Accountant details 54 Your accountant s details Name of accountant Address Contractor Partner or de facto Other (give details below) Phone number ( ) Postcode Checklist Newstart Allowance and Youth Allowance 52 Are you claiming or receiving Newstart Allowance or Youth Allowance? Go to Which of the following forms, documents and other attachments are you providing with this form? If you are not sure, check the question to see if you should attach the documents. Where you are asked to supply documents, please attach original documents. 53 Are you looking for full-time work? Explain why you are not looking for full-time work? Go to 54 Give details below Real estate details form (Mod R) (If you answered at question 16 or question 30) Latest personal income tax return (If you answered at question 18 or question 32) Latest profit and loss statement (If you answered at question 19 or question 36) Latest balance sheet (If you answered at question 20 or question 37) Business/Partnership details (If you answered at question 21 or question 38) Latest depreciation schedule (If you answered at question 22 or question 39) Your estimates, reasons income is different to the latest tax returns, and documents which support your estimate (If you answered at question 23 or question 42) Partnership agreement (If you answered at question 25) Partner's latest personal income tax return (If you answered at question 34) Latest partnership income tax return (If you answered at question 35) Business partner s current and capital account details (If you answered at question 40) Separate schedules showing balances, income, expenses for each investment, loan & bank account itemised on tax returns (If you answered at question 41) 7 of 8

8 56 IMPORTANT INFORMATION Privacy and your personal information Your personal information is protected by law, including the Privacy Act 1988, and is collected by the Australian Government Department of Human Services for the assessment and administration of payments and services. This information is required to process your application or claim. Your information may be used by the department or given to other parties for the purposes of research, investigation or where you have agreed or it is required or authorised by law. You can get more information about the way in which the Department of Human Services will manage your personal information, including our privacy policy at www. humanservices.gov.au/privacy or by requesting a copy from the department. Statement 57 Statement I declare that: the information provided in this form is complete and correct. I give permission to contact my accountant for any relevant information necessary to assess my claim. I understand that: giving false or misleading information is a serious offence. the Australian Government Department of Human Services can make relevant enquiries to make sure I receive the correct entitlement. Your signature Date 8 of 8