PERSONAL TAX CHECKLIST

Financial Year : 1 APRIL 2013 to 31 MARCH 2014

Your Name: Date of Birth: / /
Phone (day):
Address: Phone(evening):
Email:

This is a checklist to assist you in supplying us with the necessary information to prepare your 2014 year personal tax
return. By signing this checklist you are disclosing all taxable income to be declared in your 2014 tax return.
Please ensure you complete and sign this form as your tax return will not be prepared
without it.

INCOME

If you received any of the following types of income for the year ended 31 March 2014, please provide details --
Interest or Dividends (please supply certificates including PIE investments) YES / NO
Taxable Income from Foreign Investments (supply gross and tax details) YES / NO
Did you receive or OWN overseas investments including foreign pensions/superannuation YES /NO
Did you make withdrawals or transfers from overseas pension or superannuation funds? YES / NO
Did you receive income from another entity such as Company shareholder salary/Partnership/Trust/Estate that we
do not prepare. If YES please supply details YES / NO

Did you receive/earn income from rents? If yes, please complete separate Rental Checklist YES / NO

If you received employment related earnings (ie wages or withholding payments), the IRD will provide us with your
income details

EXPENSES/DEDUCTIONS

Did you pay income protection premiums in your own name which has not been claimed elsewhere YES / NO
If yes please provide verification.
• If you received withholding income, did you have deductible expenses relating to that income? YES / NO
Have you been allocated a share of loss in a LTC company or in a Partnership that we don’t prepare Financial
Statements for? YES / NO

Personal Tax Checklist Page 1 of 3

 WORKING FOR FAMILIES TAX CREDITS

Please list the following details of dependent children under the age of 18 and still attending school:

Date left school or

Full Name IRD Number Age Date of Birth financially
independent

Did you receive Working for Families Tax Credits during the year? YES / NO
Are you or your spouse working for wages or self-employed? YES / NO
If YES how many hours per week do you or your spouse work? YOU ___________ SPOUSE/PARTNER ____________
• Were you or spouse working for the full year? If no, please detail periods ________________________________________
• Did you pay or receive Child Support to/from an ex-partner for the year ended 31 March 2014? YES / NO
If yes, how much did you Pay………………………. Receive…………………………………..
• Is your child 16 or over and earned $12,000 or more for the 2014 year? Please supply details YES / NO
Have you had a baby during the financial year? Date of Birth________________ YES / NO
You may be entitled to a one-off Parental Tax Credit if you haven’t received Paid Parental Leave.

REBATES

Donations – supply receipts for all donations made 1 April 2013 to 31 March 2014. Please advise if claimed by
company or yourself. _________________________________

Bank Account Number – required for direct crediting rebate ___________________________________________________

Independent Earner Tax Credit – To qualify for this entitlement, we need to know if you meet the criteria. You may
qualify for some months, but not the full year. Please complete the following if you believe your income was
between $24,000 to $48,000 (after expenses and before losses).
From 1 April 2013 to 31 March 2014 -
• Were you a New Zealand tax resident ? If not full year, please detail months in NZ YES/NO

• Did you receive an income tested benefit, NZ Super or overseas equivalent? YES/NO
If yes, but not for full year, please detail months not receiving benefits

•Were you or your partner entitled to Working for Families Tax Credits? YES/NO
If yes, but not full year, please detail months not receiving family assistance
PLEASE NOTE: Even if you received Independent Earner Tax Credit through the PAYE system (on ME tax code) you still need
to complete this section, otherwise you may have tax to pay.

Personal Tax Checklist Page 2 of 3

 TERMS OF ENGAGEMENT

Provision of Services
o All services are provided solely for the clients own use and the use of other specifically authorised parties. Unless
stated otherwise all reports prepared by Your Accountant Ltd in the provision of our services will be prepared for
the stated purpose alone and Your Accountant Ltd or their agents will not be liable for any losses, claims and/or
demands by any third party resulting from this engagement.
o The whole or any part of reports prepared by Your Accountant Ltd for you cannot be included in any document
without the written approval of Your Accountant Ltd as to how it will appear.
o All services are provided on the basis that you have provided Your Accountant Ltd with a full disclosure of all
necessary information including income from all sources. Your Accountant Ltd accepts no liability in respect of our
services where such a full disclosure has not been made. If additional information is requested from you and is
not supplied in a timely manner Your Accountant Ltd reserves the right to revoke this engagement.
o I/We accept that I/we have primary responsibility for meeting my/our tax obligations. These include keeping the
required records, ensuring tax returns are true & correct, filing my/our tax returns on time and meeting any tax
obligations.
o Considerable uncertainty can arise when applying tax law to specific situations and Your Accountant Ltd provides
no guarantee their advice will be accepted by the Inland Revenue Department.
o I/We accept responsibility for any additional tax, penalties, and/or use of money interest imposed (by way of audit
activity or otherwise) by the Inland Revenue Department resulting from information used to compile returns by
Your Accountant Ltd.

• Invoicing & Payment of Accounts

th
o All accounts are payable by the 20 of the month following invoice date, with any overdue accounts incurring a
2% interest charge per month that they are overdue.
o Your Accountant Ltd reserves the right to submit interim invoices for services where it is considered necessary to
do so.
o Your Accountant Ltd may defer filing your tax return until our account is paid.
o Should a Debt Collection Agency be required to collect an overdue account, all additional recovery costs will be
added to the outstanding amount for collection.

• Personal Information
o Any personal information collected and held by Your Accountant Ltd will be used solely for purposes related to
the services provided to you. Under the Privacy Act 1993 you have the right of access to and correction of
personal information about you that Your Accountant Ltd holds.

Client Authorisation
I/We authorise you to prepare Financial Statements from the information and records I/we have supplied to Your Accountant
Limited. I/we advise you not to complete an audit or review. I/we accept responsibility for the accuracy and completeness of all
records and information supplied to Your Accountant Limited and agree to the terms of engagement as above.

Under the terms of the Privacy Act 1993, I/We give Your Accountant Limited full authority to seek additional information, including
by electronic services, from my/our Bank, lawyer, WINZ, ACC and the Inland Revenue Department for any purpose relating to
my/our affairs to enable the proper completion of my Financial Statements and Income Tax Returns. This authority also applies for
the Client Linking System with the Inland Revenue Department and Your Accountant Limited as tax agent for all tax types.

I/we acknowledge that this authority shall remain in force and effect until revoked by me/us in writing.

Authorised Signature: __________________________________________

Name: __________________________________________

Date: __________________________

Personal Tax Checklist Page 3 of 3