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Tax File Number Declaration Form

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antjohnston98
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174 views1 page

Tax File Number Declaration Form

Uploaded by

antjohnston98
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Tax file number declaration

This declaration is NOT an application for a tax file number.


■ Use a black or blue pen and print clearly in BLOCK LETTERS.
■ Print X in the appropriate boxes.
ato.gov.au ■ Read all the instructions including the privacy statement before you complete this declaration.

Section A: To be completed by the PAYEE 5 What is your primary e-mail address?


1 What is your tax
file number (TFN)? 984204855 antjohnston98@gmail.com
OR I have made a separate application/enquiry to
For more the ATO for a new or existing TFN.
information, see
question 1 on page 2 OR I am claiming an exemption because I am under Day Month Year
of the instructions. 18 years of age and do not earn enough to pay tax.
6 What is your date of birth? 05/09/1998
OR I am claiming an exemption because I am in
receipt of a pension, benefit or allowance. 7 On what basis are you paid? (select only one)
Full‑time Part‑time Labour Superannuation Casual
2 What is your name? Title: Mr
✘ Mrs Miss Ms employment employment ✘ hire or annuity
income stream
employment
Surname or family name
8 Are you: (select only one)
J o h n s t o n An Australian resident A foreign resident A working
First given name for tax purposes ✘ for tax purposes OR holiday maker

An t h o n y 9 Do you want to claim the tax‑free threshold from this payer?


Other given names Only claim the tax‑free threshold from one payer at a time, unless your total income from
Wa r r e n all sources for the financial year will be less than the tax‑free threshold.
Answer no here if you are a foreign resident or working holiday
3 What is your home address in Australia? Yes ✘ No maker, except if you are a foreign resident in receipt of an
Australian Government pension or allowance.
28 Eaton Avenue
10 Do you have a Higher Education Loan Program (HELP), VET Student
Loan (VSL), Financial Supplement (FS), Student Start‑up Loan (SSL) or
Trade Support Loan (TSL) debt?
Your payer will withhold additional amounts to cover any compulsory
Suburb/town/locality
NORMA NHUR S T
Yes ✘ repayment that may be raised on your notice of assessment. No

State/territory Postcode DECLARATION by payee: I declare that the information I have given is true and correct.
Signature
N SW 2 0 7 6 Date
Waiting to be accepted Day Month Year
4 If you have changed your name since you last dealt with the ATO,
provide your previous family name. You MUST SIGN here Waiting to be accepted
There are penalties for deliberately making a false or misleading statement.

Once section A is completed and signed, give it to your payer to complete section B.

Section B: To be completed by the PAYER (if you are not lodging online)
1 What is your Australian business number (ABN) or Branch number 5 What is your primary e-mail address?
withholding payer number? (if applicable)

2 3 0 9 2 5 4 5 6 8 9
2 If you don’t have an ABN or withholding
payer number, have you applied for one? Yes No
6 Who is your contact person?
3 What is your legal name or registered business name
(or your individual name if not in business)? S o p h i e G e r a s
NOVA 96.9 Pty Ltd Business phone number

7 If you no longer make payments to this payee, print X in this box.

DECLARATION by payer: I declare that the information I have given is true and correct.
Signature of payer
4 What is your business address? Executed online by Date
Day Month Year
Level 5, 33 Saunders St
Soph i e Ge r as Waiting to be accepted
There are penalties for deliberately making a false or misleading statement.
Suburb/town/locality
P y r mo n t Return
 the completed original ATO copy to: IMPORTANT
State/territory Postcode Australian Taxation Office See next page for:
PO Box 9004 ■ payer obligations
N SW 2 0 0 9 PENRITH NSW 2740 ■ lodging online.

Sensitive (when completed)


30920619
NAT 3092-06.2019 [DE-6078]

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