n Print clearly, using a BLACK pen only. n Print X in ALL applicable boxes.



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Self-managed superannuation fund annual return 2011 Who should complete this annual return? Only self-managed superannuation funds (SMSFs) can complete this annual return All other funds must complete the Fund income tax return 2011 (NAT 71287) The Self-managed superannuation fund annual return instructions 2011 (NAT 71606) (the instructions) can assist you to complete this annual return Section A: Fund information 2 Name of self-managed superannuation fund (SMSF) TO COMPLETE THIS ANNUAL RETURN n Print clearly, using a BLACK pen only n Use BLOCK LETTERS and print one character per box S M I T H S T n Print X in ALL applicable boxes 1 Tax file number (TFN) To assist processing, write the fund s TFN at the top of pages 3, 5 and 7 The Tax Office is authorised by law to request your TFN You are not obliged to quote your TFN but not quoting it could increase the chance of delay or error in processing your annual return 712260611 3 Australian business number (ABN) (if applicable) 4 Current postal address Suburb/town State/territory Postcode 5 Annual return status Is this an amendment to the SMSF s 2011 annual return? 6 Fund auditor Auditor s name Professional body Postal address Membership number Auditor s phone number Suburb/town State/territory Postcode A Date audit was completed Was the audit report qualified? 7 Electronic funds transfer (EFT) Provide your financial institution details to have your refund paid directly to you It s faster and simpler to have your refund paid in this way Write the BSB number, account number and account name below We do not issue refunds to a trustee s personal bank account See Self-managed superannuation fund annual return instructions 2011 B BSB number (must be six digits) Account name (for example, JQ Citizen) Account number NAT 71226 62011 IN-CONFIDENCE when completed Page 1

8 Status of SMSF Australian superannuation fund A Section B: Income 10 Income Does the fund trust deed allow acceptance of the Government s Super Co-contributions? 9 Was the fund wound up during the income year? If yes, provide the date on which the fund was wound up Did you have a capital gains tax (CGT) event during the year? Did the CGT event relate to a forestry managed investment scheme interest that you held other than as an initial participant? G Z C Net capital gain A If the total capital loss or total capital gain is greater than $10,000 complete and attach a Capital gains tax (CGT) schedule 2011 You must complete and attach a Capital gains tax (CGT) schedule 2011 Fund benefit structure Have all tax lodgment and payment obligations been met? 00 B Gross rent and other leasing and hiring income B Gross interest C 00 00 Forestry managed investment scheme income X 00 D1 Gross foreign income 00 Net foreign income D 00 R1 R2 R3 less R6 Australian franking credits from a New Zealand company Calculation of assessable contributions Assessable employer contributions Assessable personal contributions *-TFN quoted contributions Transfer of liability to life insurance company or PST 00 00 00 00 Gross payments where ABN not quoted H *Unfranked dividend amount *Franked dividend amount *Dividend franking credit *Gross trust distributions E Transfers from foreign funds F Gross distribution from partnerships I Assessable contributions (R1 R2 R3 less R6) J K L M R 00 00 00 00 00 00 00 00 00 Number Calculation of non-arm s length income *Net non-arm s length private company dividends U1 U2 00 *Net non-arm s length trust distributions 00 *Other income S *Assessable income due to changed tax status of fund T 00 00 U3 *Net other non-arm s length income 00 Net non-arm s length income (subject to 45% tax rate) (U1 U2 U3) U 00 TOTAL ASSESSABLE INCOME V 00 Page 2 *If an amount is entered at this label, check the instructions to ensure the correct tax treatment has been applied IN-CONFIDENCE when completed

Place your attachments here Section C: Deductions 11 Deductions Interest expenses within Australia A Fund s tax file number (TFN) Exempt current pension income K 00 00 Interest expenses overseas B 00 Capital works deductions Deduction for decline in value of depreciating assets E Small business and general business tax break P D 00 00 00 712260711 Death or disability premiums F 00 Death benefit increase G 00 Approved auditor fee H 00 Investment expenses I 00 Management and administration expenses J 00 Forestry managed investment scheme deduction U Other deductions L 00 00 Tax losses deducted M 00 TOTAL DEDUCTIONS N TAXABLE INCOME OR LOSS (TOTAL ASSESSABLE INCOME less TOTAL DEDUCTIONS) O 00 00 IN-CONFIDENCE when completed Page 3

Section D: Income tax calculation statement 12 Income tax calculation statement Taxable income A $, C1 Credit: foreign income tax offset Credit: rebates and tax offsets C2 -TFN quoted contributions tax J Gross tax B Rebates and offsets (C1 C2) C F1 F2 F3 F4 F5 F6 F7 F8 Credit: interest on early payments Credit: foreign resident withholding Credit: ABN/TFN not quoted (non-individual) Credit: refundable franking credits Credit: no-tfn tax offset Credit: interest on no-tfn tax offset Credit: refundable National rental affordability scheme tax offset Credit: TFN amounts withheld from payments from closely held trusts SUBTOTAL (B less C) Section 102AAM interest charge E Eligible credits (F1 F2 F3 F4 F5 F6 F7 F8) D (Cannot be less than zero) F PAYG instalments raised G Supervisory levy H 1 8 0 0 0 TOTAL AMOUNT DUE OR REFUNDABLE (D E less F less G H) I Section E: es 13 es If total loss is greater than $100,000, or there is a foreign loss, complete and attach a es schedule 2011 to later income years U 00 V 00 Tax losses carried forward Net capital losses carried forward to later income years Page 4 IN-CONFIDENCE when completed

Fund s tax file number (TFN) Section F: Member information Report current members at 30 June 2011 and former members who were paid a benefit (lump sum or income stream, but not a rollover) during the financial year Include members for whom no contributions were received Report deceased members in Section G MEMBER 1 Member s TFN Date of birth Contributions Include contributions reported to you on a Rollover benefits statement (RBS) (NAT 70944) OPENING ACCOUNT BALANCE ABN of principal employer Employer contributions A A1 Personal contributions CGT small business retirement exemption CGT small business 15-year exemption amount Personal injury election Spouse and child contributions Other family and friend contributions Directed termination (taxable component) payments Assessable foreign superannuation fund amount n-assessable foreign superannuation fund amount Transfer from reserve: assessable amount Transfer from reserve: non-assessable amount Any other contributions (including Super Co-contributions) B C D E F G H I J K L M 712260811 TOTAL CONTRIBUTIONS N Other transactions Exclude any rollover components reported at N from amounts reported at P If P is negative, transfer the loss to O Allocated earnings or losses Inward rollover amounts Outward rollover amounts Benefit payments and code O P Q R CLOSING ACCOUNT BALANCE S IN-CONFIDENCE when completed Page 5

Report current members at 30 June 2011 and former members who were paid a benefit (lump sum or income stream, but not a rollover) during the financial year Include members for whom no contributions were received Report deceased members in Section G MEMBER 2 Member s TFN Date of birth Contributions Include contributions reported to you on a Rollover benefits statement (RBS) (NAT 70944) OPENING ACCOUNT BALANCE ABN of principal employer Employer contributions A A1 Personal contributions CGT small business retirement exemption CGT small business 15-year exemption amount Personal injury election Spouse and child contributions Other family and friend contributions Directed termination (taxable component) payments Assessable foreign superannuation fund amount n-assessable foreign superannuation fund amount Transfer from reserve: assessable amount Transfer from reserve: non-assessable amount Any other contributions (including Super Co-contributions) B C D E F G H I J K L M TOTAL CONTRIBUTIONS N Other transactions Exclude any rollover components reported at N from amounts reported at P If P is negative, transfer the loss to O Allocated earnings or losses Inward rollover amounts Outward rollover amounts Benefit payments and code O P Q R CLOSING ACCOUNT BALANCE S Page 6 IN-CONFIDENCE when completed

Fund s tax file number (TFN) Report current members at 30 June 2011 and former members who were paid a benefit (lump sum or income stream, but not a rollover) during the financial year Include members for whom no contributions were received Report deceased members in Section G MEMBER 3 Member s TFN Date of birth Contributions Include contributions reported to you on a Rollover benefits statement (RBS) (NAT 70944) OPENING ACCOUNT BALANCE ABN of principal employer Employer contributions A A1 Personal contributions CGT small business retirement exemption CGT small business 15-year exemption amount Personal injury election Spouse and child contributions Other family and friend contributions Directed termination (taxable component) payments Assessable foreign superannuation fund amount n-assessable foreign superannuation fund amount Transfer from reserve: assessable amount Transfer from reserve: non-assessable amount Any other contributions (including Super Co-contributions) B C D E F G H I J K L M 712260911 TOTAL CONTRIBUTIONS N Other transactions Exclude any rollover components reported at N from amounts reported at P If P is negative, transfer the loss to O Allocated earnings or losses Inward rollover amounts Outward rollover amounts Benefit payments and code O P Q R CLOSING ACCOUNT BALANCE S IN-CONFIDENCE when completed Page 7

Report current members at 30 June 2011 and former members who were paid a benefit (lump sum or income stream, but not a rollover) during the financial year Include members for whom no contributions were received Report deceased members in Section G MEMBER 4 Member s TFN Date of birth Contributions Include contributions reported to you on a Rollover benefits statement (RBS) (NAT 70944) OPENING ACCOUNT BALANCE ABN of principal employer Employer contributions A A1 Personal contributions CGT small business retirement exemption CGT small business 15-year exemption amount Personal injury election Spouse and child contributions Other family and friend contributions Directed termination (taxable component) payments Assessable foreign superannuation fund amount n-assessable foreign superannuation fund amount Transfer from reserve: assessable amount Transfer from reserve: non-assessable amount Any other contributions (including Super Co-contributions) B C D E F G H I J K L M TOTAL CONTRIBUTIONS N Other transactions Exclude any rollover components reported at N from amounts reported at P If P is negative, transfer the loss to O Allocated earnings or losses Inward rollover amounts Outward rollover amounts Benefit payments and code O P Q R CLOSING ACCOUNT BALANCE S Page 8 IN-CONFIDENCE when completed

Section G: Supplementary member information Use this section for: n deceased members n any other members who cannot be included at pages 5 to 8 MEMBER 5 Member s TFN Date of birth If deceased, date of death Contributions Include contributions reported to you on a Rollover benefits statement (RBS) (NAT 70944) OPENING ACCOUNT BALANCE ABN of principal employer Employer contributions A A1 Personal contributions CGT small business retirement exemption CGT small business 15-year exemption amount Personal injury election Spouse and child contributions Other family and friend contributions Directed termination (taxable component) payments Assessable foreign superannuation fund amount n-assessable foreign superannuation fund amount Transfer from reserve: assessable amount Transfer from reserve: non-assessable amount Any other contributions (including Super Co-contributions) B C D E F G H I J K L M TOTAL CONTRIBUTIONS N Other transactions Exclude any rollover components reported at N from amounts reported at P If P is negative, transfer the loss to O Allocated earnings or losses Inward rollover amounts Outward rollover amounts Benefit payments and code O P Q R CLOSING ACCOUNT BALANCE S IN-CONFIDENCE when completed Page 9

Use this section for: n deceased members n any other members who cannot be included at pages 5 to 8 MEMBER 6 Member s TFN Date of birth If deceased, date of death Contributions Include contributions reported to you on a Rollover benefits statement (RBS) (NAT 70944) OPENING ACCOUNT BALANCE ABN of principal employer Employer contributions A A1 Personal contributions CGT small business retirement exemption CGT small business 15-year exemption amount Personal injury election Spouse and child contributions Other family and friend contributions Directed termination (taxable component) payments Assessable foreign superannuation fund amount n-assessable foreign superannuation fund amount Transfer from reserve: assessable amount Transfer from reserve: non-assessable amount Any other contributions (including Super Co-contributions) B C D E F G H I J K L M TOTAL CONTRIBUTIONS N Other transactions Exclude any rollover components reported at N from amounts reported at P If P is negative, transfer the loss to O Allocated earnings or losses Inward rollover amounts Outward rollover amounts Benefit payments and code O P Q R Page 10 CLOSING ACCOUNT BALANCE S If additional members need to be reported in Section G: Supplementary member information copy this page and attach to the annual return DO NOT USE STAPLES IN-CONFIDENCE when completed

Section H: Assets and liabilities 14 ASSETS 14a Australian managed investments Listed trusts A $ Unlisted trusts B $ Insurance policy C $ Other managed investments D $ 14b Australian direct investments Cash and term deposits E $ Debt securities F $ Loans G $ Listed shares H $ Unlisted shares I $ Derivatives and instalment warrants J $ n-residential real property K $ Residential real property L $ Artwork, collectibles, metal or jewels M $ Other assets O $ 14c Overseas direct investments Overseas shares P $ Overseas non-residential real property Q $ TOTAL AUSTRALIAN AND OVERSEAS ASSETS U $ 15 LIABILITIES Borrowings V $ Total member closing account balances (total of all CLOSING ACCOUNT BALANCEs from Sections F and G) Section I: Taxation of financial arrangements 16 Taxation of financial arrangements (TOFA) Did you make a gain, loss or transitional balancing adjustment G from a financial arrangement subject to the TOFA rules? Overseas residential real property R $ Overseas managed investments S $ Other overseas assets T $ W TOFA transitional balancing adjustment J $, IN-CONFIDENCE when completed Page 11 00 Reserve accounts X $ Other liabilities Y $ TOTAL LIABILITIES Z $ Total TOFA gains H, 00 Total TOFA losses I, 00

Section J: Regulatory information The following questions indicate the operational status of the SMSF Penalties will apply for false or misleading information You must answer either or for all questions listed and provide dollar amounts if applicable In-house and related party assets Did the SMSF loan, lease to or invest in related parties (known as in-house assets)? A 00 Did the SMSF hold in-house assets at any time during the year that exceeded 5% of total assets? B Did the SMSF hold an investment in a related party at any time during the year (excluding in-house assets)? C $ Did the SMSF acquire any assets (other than exempt assets) from related parties? D $ Other regulatory questions Did the SMSF lend money or provide financial assistance to a member or relative of a member of the fund? E Did the SMSF receive in specie contributions during the year? F 00 Did the SMSF make and maintain all investments on an arm s length basis? G Did the SMSF borrow for purposes that are not permissible? H Did members have the personal use of the Did the SMSF provide money to members without a condition of release being met? J SMSF s assets before retirement? I Did trustees of the fund receive any remuneration for their services as a trustee? K Are any trustees or directors currently disqualified persons as defined by SISA? L Are all SMSF assets appropriately documented as owned by the fund? M Did the SMSF carry on a business of selling goods or services? N Does the auditor provide services to the SMSF as either a tax agent, accountant or financial advisor or administrator? O Section K: Other information Forestry managed investment schemes Product or private ruling information Year Number G H I Family trust election status If the trust or fund has made, or is making, a family trust election, write the four-digit income year specified of the election (for example, for the 2010 11 income year, write 2011) A If revoking or varying a family trust election, print R for revoke or print V for variation, and complete and attach the Family trust election, revocation or variation 2011 B Interposed entity election status If the trust or fund has an existing election, write the earliest income year specified If the trust or fund is making one or more elections this year, write the earliest income year being specified and complete an Interposed entity election or revocation 2011 for each election If revoking an interposed entity election, print R, and complete and attach the Interposed entity election or revocation 2011 D C Page 12 IN-CONFIDENCE when completed

Section L: Declarations Penalties may be imposed for false or misleading information in addition to penalties relating to any tax shortfalls Important Before making this declaration check to ensure that all income has been disclosed and the annual return, all attached schedules and any additional documents are true and correct in every detail If you are in doubt about any aspect of the annual return, place all the facts before the ATO TRUSTEE S OR DIRECTOR S DECLARATION: I declare that current trustees and directors have authorised this annual return and it is documented as such in the SMSF s records I have received the audit report and I am aware of any matters raised I declare that the information on this annual return, including any attached schedules and additional documentation is true and correct I also authorise the ATO to make any tax refunds to the nominated bank account (if applicable) Authorised trustee s, director s or public officer s signature Preferred trustee or director contact details: Date Phone number Email address n-individual trustee name (if applicable) ABN of non-individual trustee Time taken to prepare and complete this annual return Hrs The Commissioner of Taxation, as Registrar of the Australian Business Register, may use the ABN and business details which you provide on this annual return to maintain the integrity of the register For further information, refer to the instructions TAX AGENT S DECLARATION: I declare that the Self-managed superannuation fund annual return 2011 has been prepared in accordance with information provided by the trustees, that the trustees have given me a declaration stating that the information provided to me is true and correct, and that the trustees have authorised me to lodge this annual return Tax agent s signature Tax agent s contact details Date Tax agent s practice Tax agent s phone number Reference number Tax agent number Postal address for annual returns: Australian Taxation Office, GPO Box 9845, IN YOUR CAPITAL CITY IN-CONFIDENCE when completed Page 13

Page 14 IN-CONFIDENCE when completed

IN-CONFIDENCE when completed Page 15

Page 16 IN-CONFIDENCE when completed