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RAHTA Declaration Form (RTIO)

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Iron Ore – Remote Area Holiday Travel Assistance (RAHTA) Declaration
This declaration form is to be completed and submitted with supporting documentation to Payroll within 28 calendar
days of your last day of leave, as determined by your leave record / RAHTA Claim.
Employee Information
Employee Name:
Employee Number:
Dependant Name/s:
Total RAHTA Paid: $
Departure Location:
Travel Start Date
Holiday Destination1:
Travel Finish Date
The holiday destination stated above MUST be the destination that you travel to by the most direct route.
Air Travel
Payroll Use
I travelled by air and I have attached :
Mandatory
Tax invoice stating itemised flight costs and passenger details (bank statements
and credit card receipts are not acceptable); OR
Exceptional
A Statutory Declaration
Optional
Tax invoices for meals, accommodation or taxi costs for the on-route trip only
$__________
$__________
$__________
Car Travel
Payroll Use
I travelled by car and I have attached
Mandatory
Fuel receipts; and
Mandatory
$__________
Mandatory
A receipt from my destination as
evidence of my arrival
My car’s engine capacity is:
Optional
Tax invoices for meals, accommodation
or taxi costs for the on-route trip only
1600cc (1.6 litres) or less
1601 to 2600cc (1.601 – 2.6 litres) $__________
2601cc (2.601 litres) and over
Did you travel by the most direct route to your holiday destination?
km ________
Yes
Rate ______
No – Please attach statement explaining why (eg road inaccessible), and detail the route that was taken $ _________
Note: The kilometres will be calculated from your departure point to your destination, and return. Please note that
the most direct route from whereis.com is used unless a justifiable reason is provided that meets the principles of
the RAHTA Policy and Fringe Benefit Tax Legislation.
$__________
Declaration
I have attached documentation and receipts to the value of $ ________________ to substantiate my claim.
I declare that the above information is true and correct and complies with the RAHTA policy. I understand that if the total amount
spent and substantiated on holiday travel, is less than the total advanced, then PAYG tax will be calculated on the shortfall, and I
authorise the difference to be deducted from my following pay. I understand that no reversals will be made after this declaration
has been processed.
Employee Signature:
Date :
Return completed declaration forms and substantiation to Payroll via:
RTTMS Form>Declare RAHTA Expenses (preferred method) or
email [email protected]
PAYROLL USE ONLY
Please always keep a copy of your receipts - originals are not required
Company Code ____________________
Total Claimed _____________________
Shortfall __________________________
Form continues over page
1
If you travel to a destination that is not considered a major population centre, as defined by the Census data, the RAHTA value
may be treated as a reportable benefit and be reported on your Payment summary.
RTIO-HR-0044542
Page 1 of 2
Iron Ore – Remote Area Holiday Travel Assistance (RAHTA) Declaration
It is important to ensure that you complete and return your declaration form to Payroll within 28 calendar
days of returning from your leave.
Please note the following;
 Failure to submit your RAHTA declaration;
 Late submission of your RAHTA declaration;
 Incomplete Declarations (ie; insufficient / incorrect receipts, no boarding passes, etc…);
will result in part or all of the assistance being paid as an allowance and PAYG tax being deducted.
Once processed this will not be reversed
You can obtain a copy of the current RAHTA policy from the Iron Ore Intranet in the Human Resources
section or via MyRiotinto.com to ensure you are aware of the correct documentation to submit.
If for any reason the travel did not occur, you are obligated to advise the Company in writing. The Company
will then treat the assistance paid as assessable income and PAYG will be deducted.
If you do require further assistance please contact the Payroll Helpdesk on 1300 66 77 03, or alternatively
please submit a general payroll request via RTTMS.
RTIO-HR-0044542
Page 2 of 2
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