SCHEDULE OF PARTICULARS FOR 2015/2016 INCOME TAX RETURN PREPARATION
Please note you can download this form from our website www.jphgroup.com.au and email the completed form.
NAME:
Please complete items 1 – 7 for our records. If you are an existing client, please advise any changes to your details.
1.
RESIDENTIAL ADDRESS:
2.
POSTAL ADDRESS:
3.
TELEPHONE:
4.
OCCUPATION:
5.
DATE OF BIRTH:
6.
FULL NAME OF SPOUSE:
7.
EMAIL ADDRESS:
8.
BANKING DETAILS:
BUS
HOME
MOBILE
Please note, from 1 July 2013 the Australian Taxation Office will no longer issue refund cheques. Banking details to be
provided for direct payment of your refund.
NAME OF ACCOUNT:
BSB:
9.
ACCOUNT NO:
DO YOU AND ALL FAMILY MEMBERS HOLD PRIVATE HEALTH INSURANCE?
(IF YES) NAME OF FUND:
NO:
MEMBERSHIP NO:
Rebate claimable (attach a copy of Health Fund Statement)
10.
YES:
$
DETAILS OF INCOME:
Please attach PAYG Payment Summaries, including Commonwealth Government payments for pension, unemployment, etc.
11.
a)
BANK INTEREST
Please attach a detailed list of bank interest earned and withholding tax paid.
b)
INVESTMENT / OTHER INCOME
Please attach a detailed list with full details, including withholding tax – i.e. Eligible Termination Payments, Trust/Partnership
distributions, other business income, earnings, dividends (including imputation credits).
c)
RENTAL PROPERTY INCOME: Please attach a full list of income and expenses.
d)
SALE / TRANSFER OF CAPITAL GAINS ASSET: i.e. Property, shares etc. (please attach details of original purchase and sale).
DONATIONS:
Institution
12.
Amount
Institution
Amount
$
$
$
$
PRIVATE SUPERANNUATION:
SELF EMPLOYED / NON SUPPORTED PERSONS (generally claimable where no employer superannuation provided)
Institution
Policy No.
Amount
$
Policy No.
Amount
$
SPOUSE CONTRIBUTION (Non working spouse only)
Institution
(EMPLOYEES ELIGIBLE FOR THE CO-CONTRIBUTION WILL AUTOMATICALLY HAVE THE AMOUNT DEPOSITED INTO THEIR
SUPERANNUATION ACCOUNT AFTER THEIR TAX RETURN HAS BEEN PROCESSED AND THE SUPERANNUATION FUND HAS PROVIDED THE
TAX OFFICE WITH THE REQUIRED DETAILS.)
13.
NET MEDICAL EXPENSES
The net medical expenses tax offset is being phased out. From 2015-2016 until 2018-2019, claims for this offset are restricted to net
eligible expenses for disability aids, attendant care or aged care.
Net expenses are your total eligible medical expenses minus refunds from Medicare, National Disability Insurance Scheme (NDIS) and
private health insurers which you or someone else received or are entitled to receive.
This offset is income tested. If you are eligible for the offset, the percentage of net medical expenses you can claim is determined by
your adjusted taxable income (ATI) and family status.
14.
STATEMENT OF WORK RELATED EXPENSES FOR 2015/2016 INCOME TAX PREPARATION
a)
GENERAL EXPENSES (attach note detailing particular expense if not sure whether claimable)
Amount
b)
Trade Union Subscriptions (specify)
$
Professional Subscriptions (specify)
$
Conferences, Professional Development (specify)
$
Replacement of protective clothing / uniforms
$
Laundering of protective clothing / uniforms
$
Dry cleaning of protective clothing / uniforms
$
Replacement of tools / equipment (specify)
$
Stationery, Postage and Supplies
$
Reference Journals and Periodicals
$
Reference Books (Professional Library)
$
Telephone (Business only)
$
Mobile Phone (Business only
$
Internet (Business only)
$
Self Education Expenses (please attach details)
$
Disability Insurance
$
Other (please specify)
$
Other (please specify)
$
Other (please specify)
$
HOME OFFICE (POWER/HEATING COSTS ONLY)
Hours worked at home
c)
MOTOR VEHICLE EXPENSES
Make of Car
Engine size (no. of CCs)
Business Kms
Where more than 5,000 km, an attached detailed list of all motor vehicle expenses is required, together with the business
percentage from the log book for this vehicle. The log book must have been kept for a consecutive 13 week period within the last 5
years.
d)
BUSINESS
Interest - please provide details of interest deductions for funds used to purchase a business.
Business Assets - please provide a list of asset items purchased over the value of $300. Include date of purhcase and amount paid
for each asset. Items under $300 to be included under general expenses.
e)
WORK RELATED TRAVEL
Did you stay away overnight for work related purposes during the year? If yes, for how many nights?
Location
Travel Allowance Received?
$
I declare that the above information is true and correct and that this schedule and supporting documentation will form part of my
Taxation Return. Further, I confirm I have in my possession receipts / documentary evidence where required to support the above
claim.
SIGNED:
DATE: