i, Australian Government — Tax file number declaration <* Australian Taxation Office THs declaration Is NOT an aplication fora axe number. Use a beck or bie pon an print larly in BLOCK LETTERS, Birt Xn the approato bows. PF ao.sova 1 Boad al to nsevctons reluang he pracy staeent bee you compat hs decaaton qd Section A: To be completed by the PAYEE 6 On what basis are you paid? (Select only one) 1 What is your tx on Faltime -—)_Parime -—) Lao) Serarmuton casual {ile number (TFN)? LIL emplomens|_Jemployment|_] tie |_| cenit |] erioymat O: ‘OR rave mate a separate appcatonlenaary a Oren ‘eA fora ew orexstrg 74 |_| | 7 Are you.an Australian resident or tax purposes? veg] yo fueston Yon page | OR Iam cloming an exemption because am noe {ist at goxawresideney 1 ces tthe ncn, "yer of age rd ater noo 9px L_| | Do you want to claim tho taxcreo treshod from this payer? (OR Lam clang n exemption because Iam in nyt te tax-tee thes rm on payer ta ira, unless your real oa peso teat or alone, {ol zone froma overran er wees an he J ——rrrt | etoetee o cetos totes tone 2 Whatisyourname? rie: tr[_ J tis[_] Ms[_] ms vee[_] wo[ stesso estentncattar Atala Sumame ot amily same Government pension or alowance ‘Do you want to claim the seniors and pensioners tax offset by Fat grentane ATH AT | reacing the amount withheld from payments made to you? FAN mn Complete a Wittotingaetretion NAT 2083), ut oH you ves[_ sreclaming tre toxtoetvestld tom tis gaye: ryeunave No Tae Tor than ane payer, page fhe Instructors, 40 Do you want to claim a zone, overseas forces or invalid and invalid care KILI LILI ‘ax offset by reducing the amount withheld fram payments made to you 3 ifyou have changed your name since you last deat with the ATO, poder presen tty nome ves | comstets a wanting decaratin AT 3098, No 111 (@) Do you have a Higher Education Loan Program (HELP), Student Start-up Loan (SS1) or Trade Support Loan (TSL) debt? ‘ous payer wil wha aedonalerounts o cover any compulsory repaymart that may be ral on you rates of assessment (©) Do you have a Financial Supplement debt? ‘You ayer wil wha aetonlanaunts o cover ny compulsory repayment hal may be aed on your rate of assessment Yes No swmateyrceorm COVED 5 What is your home address in Australia? oe ves — = DECLARATION by payee: docaro atte nformation have gen tue and canct Sonate ayes — — a aby wn vy LIL ‘You MUST SIGN here OL / Sora (© Fer are poate cetera mak a ae or miseadig satenent @ once section Ais completed and signed, give it to your payer to complete section B. oH Section B: To be completed by the PAYER fi you are not lodging online) 1 What is your Australian business number (ABN) or ‘yanchunber | 4 What s your business address? withhotging payer number? (aplea fol Ie ale[si Ton OO Sa ofa] vel ENE oO oO OO erty — — Pasade NT of si 3jo E]G]e] | | & Whois your contact person? OO od oo sanapenae [alaa[e[5|[7 6 Ifyou no longer make payments print Xin this box. DECLARATION by payer: doce tat te infarmaton have givens tue and caret Sara ope oe Oar secorondenmainoomre | [ montane Sn fntln atone Sexo pge or fobor sls pment LOO PENRITH NSW 2740 1 lodging one. © There are penalties for dliverately making a false o misleaing statement L Sensitive _— tt 30920716