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Online Tax return request form.

Name:
Tax File Number:
Date of Birth:
Occupation:
Group Certificate (s) attached	Number ⁯
Address:
Home Phone:
Work Phone:
Mobile:
Email Address:
Bank Account Details (Deposit of your Tax Refund):
BSB
ACCOUNT Name:
ACCOUNT Number:

If more than one tax year then please use one information sheet per year

I, (Insert Name) hereby declare that the information given to MTS Adelaide is true, complete and correct and I authorise them to prepare and lodge my Tax Return electronically from this information. (allow up to 2 weeks for your tax return to be processed by the tax office )

Signed: Date:

INCOME

INCOME (Please complete the following, add extra lines if necessary)

1. PAYG PAYMENT SUMMARIES (Group Certificates) (including pensions, Annuities)

Attach Certificates

2. INTEREST (money received on all bank accounts - ATO reconciles with the accounts) Yes ⁯ No ⁯

Name of Bank	Account No	Total Interest Received	TFN Withholding	Is this a Joint Account
		$	$
		$	$
		$	$

3. DIVIDENDS (Dividends received from shares during the year)

Shares	Un-franked Amount	Franked Amount	Imputation Amount
	$	$	$
	$	$	$

4. ANY OTHER INCOME. (Please provide details of any other income you received in the financial year which does not fit into any of the above categories.)

$ $

Please attach particulars of income

DEDUCTIONS
(Please complete the following, add extra lines if necessary)
Please ensure you are able to substantiate all claims, even if less than $300.
1. WORK RELATED DEDUCTIONS

Details Amount
	a	$
	b	$
	c	$
	d	$

2. Other Deductions
please attach particulars of other deductions

PRIVATE HEALTH INSURANCE

1. DO YOU HAVE PRIVATE HEALTH INSURANCE.
Name of Fund:	Type of Cover: Comprehensive
2. Marital Status (Married)
Do you Have Dependants
Details of Dependant
Full Name	Date of Birth
Net Income $

an electronic copy of the return will be returned to you by email for filing
we will contact you should we have further queries
contact our office should you have further queries ⁯

3 HECS/ SFSL DEBT If Yes $

Payment required with delivery of this document to MTS for preparation of your Income Tax Return A copy of your completed Income Tax Return and receipt for payment will be emailed to you.

If our fee is greater than the basic fee of $110 (or $150 Fee deducted from your Refund) our office will contact you seeking your authority for the extra fee.
OTHERWISE You authorise our firm to receive the aforementioned payments.

Method of Payment
Straightforward uncomplicated returns the below methods of payment are available .
Should the return be more complicated attach a brief description of particulars and we will contact you with a brief estimated quotation.

Other Attachments Please attach as much detail and particulars for quotation.

Payment Method

Direct EFT to MTS Adelaide BSB: 085 005 Acc No: 47 082 9534

Credit Card: (circle) M/Card or Visa

Name on Card Expiry Date

$ Signature

Cash: ⁯ $ Cheque: ⁯ $

Fee From Refund Authority: ⁯
If yes, please complete Fee From Refund Authority fom and send to us..

Other alternatives to provide information
If you prefer you may complete the attached MTS Flyer and return to our office together with supporting documentation with a method that suits you.

Please do not hesitate to contact the writer should you have any further queries.

FEES

Basic Tax Return: (Includes 2 PAYGS & 3 Deductions**) $110.00
**Additional fees apply for any extra PAYGS & Deductions. (per Additional items) $10.00

Fee Deducted From Refund: (Administration Charge applies of) $40.00

Ask for our Price for Rental Properties, Sub Contractors, and accounting for businesses. An appointment with one of our accountants will be required to prepare your return.

Our firm is also able to assist you with Financial planning and Lending advice through our authorised associates. Please contact us directly if you require our assistance.

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