Instant Tax Refunds
2011 Individual Income Tax Return Application
Instant Tax Refunds

1. Client Details
Full Name:
Street address:
Suburb:
State:
Post Code:
Date of Birth:
Occupation:

2. Contact Information
Home Phone Number:
Work Phone Number:
Mobile Phone Number:
Email address:
Medicare Number:
IRN (number next to your name on Medicare card):
Do you have Private Health Cover?
 Yes No
Private Health Fund Name:
Private Health Fund Number:
Type of Private Health Cover?
 Ancillary Combined Hospital
Partner/Wife/Husband Name (Living with you):
Partner/Wife/Husband Date of Birth:
No. Children you pay child support for:
No. of Dependant Children living with you:
Did you work under an ABN this year?
 Yes No
How/Where did you hear about us?

3. Additional Information - ALL QUESTIONS MUST BE ANSWERED
Do you have a Centrelink Debt?
   Yes No
Do you have a Child Support Debt in Australia or NZ?
   Yes No
Do you have an ATO Debt?
   Yes No
Do you have a HECS Debt?
   Yes No
Do YOU personally receive Family Tax Benefit Part A payments?
   Yes No

4. Income
Did you receive?
If yes please enter details in text box below
Salary/Wages/Allowances/Pensions
   Yes No     Payment Summaries from all employers and/or government agencies.    
Employment Lump Sum/Termination Payments
   Yes No     Payment Summaries and ETP Statements.    
Australian Superannuation Lump Sum Payments
   Yes No     Payment Summaries.    
Interest
   Yes No     For each account: bank/building society name, account number, amount earned.    
Dividends
   Yes No     For each share: company name, franked and unfranked amounts, and imputation credits. (Or provide dividend notices). Did you incur any costs to earn this income, such as investment loan interest?    
Business Income
   Yes No     Details of all receipts & all related expenses and copies of all BAS forms lodged and associated calculations.    
Investment Income
   Yes No     Fund name and copy of Annual Tax Advice (as provided by the Fund Manager at year-end)    
Income from sale of assets
   Yes No     Capital gains and losses occur on sale of assets such as real estate, shares etc. To calculate any gain/loss, provide the purchase and sale dates, values and associated costs.    
Rental Income
   Yes No     Property address, gross rent received, details of all expenses relating to each rental property owned including interest.    
Foreign Source Income
   Yes No     Assessable & Exempt foreign income or lump sum payments from overseas pensions, employment, annuities or investments.    

5. Deductions
Did you spend money on?
If yes please enter details in text box below
Car Expenses
   Yes No     Make, model and registration number of the car used, Log Book where this method is used, and details of expenses, and or distance travelled. Please advise how vehicle was acquired (purchased cash/hire purchase/lease/novated lease).    
Other Work Travel
   Yes No     For each trip provide details of travel destinations, purpose of trip, costs of travel & accommodation. If travel is for 6 or more continuous nights, do you have a travel diary or itinerary?    
Uniform & Protective Clothing
   Yes No     Details for all items purchased or repaired during the year.    
Laundry & Dry Cleaning Expenses
   Yes No     For professional dry cleaning & laundering, provide receipts. For home laundry, provide estimate number of work wash loads per year.    
Income Protection Insurance
   Yes No     Details of Policy type and premiums paid during the year.    
Sun Protection Items
   Yes No     If you are an outdoors worker you are entitled to claim for sun protection items such as sunscreen etc.    
All Other Work-Related Expenses
   Yes No     Details of all expenses incurred in relation to your occupation.    
Gifts/Donations
   Yes No     Details of charitable organizations and the amount of each donation.    
Self Education
   Yes No     Courses of study undertaken and details of all associated expenses.    

6. Tax Offsets
Did you spend money on?
If yes please enter details in text box below
Qualifying education expenses for your children
   Yes No     Did you spend money on education for each child at Primary School of High School for all or part of the tax year for whom you are in receipt of the Family Tax Benefit A? You can claim for certain expenditures including Computers, computer peripherals, home internet costs, computer software, computer based education courses, printer consumables, school textbooks, library and resource fees, tools required for coursework and stationery.    
Superannuation Contributions on behalf of a spouse who was not working
   Yes No     Provide details of Superannuation fund and amounts.    
Did you work in a remote Australian location for more than 182 days or work in an overseas location?
   Yes No     Did you work in a remote or isolated area, or did you serve in the Australian Military Forces in an overseas posting. Provide details?    
Did you have net Medical Expenses over $2000
   Yes No     Details of all medical expenses paid for you or your family and any refunds or reimbursements received from Health Funds.    
 
I declare that, to the best of my knowledge and belief, this information is true and correct
   Yes No