Resource Centre

Income Tax Return Form

Please complete this questionnaire in full, prior to meeting with an MDB accountant. The questionnaire is to be completed and submitted using the secure online form below, with any relevant requested documents to be attached electronically (as you would attach to an email).

If you have documents that you are unable to attach electronically, it is preferred that you use the link here to print off the questionnaire, manually complete it and fax or post all documents together to MDB:

MDB Accountants
566 Elizabeth Street
Melbourne, VIC 3000
Ph: 61 3 9349 1488
Fax: 61 3 9349 1186

Please also have any supporting documentation such as receipts, diaries and log books in order.

For any queries regarding this questionnaire, please contact MDB’s Administration Assistant on 61 3 9349 1488 or entity@mdbco.com.au

Data Protection

We take every measure to protect your data. All data collected via this form is protected by Shared SSL, which ensures complete data encryption and authentication between the web browser and the provided data.

Title
First Name
Last Name
Mobile No.
Business No.
Home Address
Postcode
Contact Email
Date of Birth
Occupation
Bank Account Details

Bank Account Name
Bank Account Number
BSB


Please note that the following questions are not in numerological order in accordance with ATO guidelines.

Please select relevant box: -


1a. Are you a resident for tax purposes?

A2. Have you been in Australia for the full financial year?
Date Entered
Date Left

2. Are you in Australia on a Visa?
Type of Visa
Date Obtained


3. Are you entitled to use the Medicare system?
Please attach your Medicare Levy exemption certificate, NB if you would like to be exempt from Medicare you will need this certificate in the event of an audit and must contact Medicare on 1300 300 271 to obtain it.

 Add File

4. Do you have a HECS debt? (higher education contributions scheme) (NB: If you have a PELS liability it will be included on your HECS statement.)
Balance as at 30/06/11

5. Have you completed quarterly or Annual PAYG instalment activity statements (IAS)?
Date Amount

T1. Did you have a spouse at 30 June 2011?
Name
D.O.B.
2011 Taxable Income

T1B. Do you have dependent children? (NB: This only applies to residents of Australia for social security purposes).
Child 1 Child 2 Child 3 Child 4 Child 5
Name
D.O.B.
Days cared for (eg: 365)
(IT7) Child Support paid if applicable $

T5. Do you have Australian approved Private Health Insurance cover? If so, please attach "end of year financial year" statement.
Name
Membership No.
Type of cover
Days covered
30% Reduction Rebate

T6. Education Tax Refund (only eligible for FBT Part A recipients) (Note: Complete T1B if claiming Education Rebate)

Number of primary school children

(50% refundable tax offset. Max $375)
Number of secondary school children

(50% refundable tax offset. Max $750)
Expenses allowed – purchase, lease or hire of computers, computer equipment & software, internet, school books, stationary, uniforms & course tools of trade.

T7. Have you made Super contribution for your spouse? (Max $3,000 contribution)
Total

T9. Have you paid combined Family medical expenses less reimbursement from Medicare or Private Health Insurance greater than $2,000?
Total


INCOME

1. Have you received a payment summary (Group Certificate) from your Employer?


Please attach "Payment Summary Copy"
 Add File

5 & 6. Have you received a payment summary from Centrelink or any other Government Body?

(IT3) Tax Free Pension Amount
 $ 
Please attach Tax Return copy only
 Add File

10. Have you earned any Bank interest?
Bank Amount TFN Witholding Tax Joint A/C percentage

11. Have you received any dividends?
Company Unfranked Franked Imputation credit TFN Witholding Tax

13. Have you received any income from managed funds or cash management trusts?
Please attach a copy of Annual Tax and Capital Gains Statements
 Add File

15. Do you have income from small business?
Please attach all relevant documents or a summary of all income and expenses
 Add File

18. Capital Gains - Sale of Shares, property and other investments
Please attach a copy of settlement statement/buy & sell contacts/all relevant documents
 Add File

20. Do you have an investment property?
Please attach all relevant documents or a summary of all income & expenses
 Add File

21. Have you received any Foreign Source income?
Please attach all relevant documentation
 Add File

24. Have you received any other assessable income?
Please attach all relevant documentation
 Add File

DEDUCTIONS

NB - Do not provide any expenses already reimbursed from by Entity Solutions. This is for non-reimbursed expenses only.

D1. Did you do any Motor Vehicle travel?

      Have you maintained a log book?

  • No
  • Yes
Please give a brief explanation on how travel relates to business
Esitmated Bus. Km's.
Log book %
Registration
Make & model of car
Fuel
Registration & Ins.
Interest of loan
MV lease payments
repairs & services
Date car purchased
Purchase cost
Litre in engine

Note: Other documentary evidence may be required (eg car allowance or letter from your employer)

D2. Did you undertake any other work related travel?
Airfares
Accommodation
Meals
Incidentals

      Did you maintain a travel diary?
Days travelled
Taxi
Parking
Tram
Train

Employee without a reasonable travel allowance must have receipts for all of the above travel expenses (TD 2005/32).

D3. Did you have to wear a uniform or protective clothing?
 
Amount ($)
Uniform Purchase
Protective clothing purchase
Non slip shoes
Protective shoes
Sunscreen
Dry cleaning

28b. Did you have to launder your own uniform?

D4. Did you incur cost for self education relating to your work?
 
Amount ($)
Course fees (not HECS)
Union fees
Travel
Stationary/Photocopying
Books
Institution
Course name
Please give a brief explanation on how self education relates to your current employment (TR 98/9)

D5. Did you have other work related expenses?
Amount At Business percentage** Claimable deduction Date purchased TFN Tax
Seminars
Stationary
Laptop **
Computer **
Computer software **
Home telephone
Mobile telephone
Internet charges
Tools & equipment
Subscriptions & union
Journals & periodicals

** If total expense exceeds $500 please provide substantiation of how the business percentage was derived.

      Do you ever worked from home and maintained a logbook?
Hr's Per Week
Total Weeks Worked

D6. If it is your first year with MDB are you depreciating items on your last years return?
Please attach copy of depreciation schedule
 Add File

D7/D8. Have you taken out an investment loan to purchase shares or managed funds?
Bank Interest Bank charges

D9. Have you made any gifts, charity purchases or donations of $2 or more to an eligible organisation?
Name Amount ($)

D10. Did you incur Tax Agent fees last year?
Total

      Did you incur fees for investment/business advice?
Total

D15. Did you invest in any tax effective products?
Total

      Do you have income protection insurance?
Total

      Do you have further deductions?
Details Amount ($)

Comments:



I DECLARE THAT THE INFORMATION I HAVE GIVEN IN THIS QUESTIONNAIRE INCLUDING ANY ATTACHMENTS ARE TRUE AND CORRECT. I HAVE THE NECESSARY RECEIPTS AND/OR OTHER RECORDS - OR EXPECT TO OBTAIN THE NECESSARY WRITTEN EVIDENCE WITHIN A REASONABLE TIME OF LODGING MY TAX RETURN TO SUPPORT MY CLAIMS FOR DEDUCTIONS AND REBATES.