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Fringe Benefits Tax (FBT) - Motor Vehicle Exemption and Residual Benefits Declaration

Due Friday 25 March 2022

Name:

Department:

Position:

Records indicate you have driven one of Prime’s VW Caddy vans during the period 1 April 2021 and
31 March 2022.

The FBT on VW Caddy Vans is determined differently to other vehicles in Prime’s fleet, therefore we
need you to complete the following:

1. Has your use of the VW Caddy Van included any private trips? Yes / No

2. If answered ‘yes’ to question 1, were these private trips limited to: Yes / No
 Travel between home and work;
 Travel that is incidental to travel in the course of your duties of employment?

3. If answered ‘no’ to question 2, please provide details of each trip in the table below:

Date Private trip details Distance


(e.g. trip to tip to dispose of domestic rubbish) (Kilometres)

Signed: Date:

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