Mackay Bailey Ltd
Chartered Accountants
109 Blenheim Road
PO Box 13311
Christchurch 8141
New Zealand
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+ 64 3 341 0930
+ 64 3 343 9843
office@mackaybailey.co.nz
www.mackaybailey.co.nz
INFORMATION QUESTIONNAIRE
FOR
SALARY AND WAGE EARNERS
TAX RETURN (PTS)
FOR THE 2015 FINANCIAL YEAR
NAME:
Please update your contact details below if there have been any changes:
Phone:
Fax:
Mobile:
E-mail:
Postal address:
Please take the time to work through this questionnaire thoroughly, action each point that is applicable to you. This will
greatly assist us in the efficient calculation of your tax position.
Directors
Tania King
James Nell
Michael Woodward
Terms of Engagement
This engagement is subject to Mackay Bailey Limited’s current Terms of Engagement which are available on our
website: www.mackaybailey.co.nz/engagement
By signing this page you accept responsibility for all information provided to us and agree to our Terms of
Engagement.
Authority to Act and Obtain Information
We may use this authority to obtain additional information should we require it to complete this engagement.
I authorise Mackay Bailey to obtain any financial records necessary to complete my financial statements and tax
returns for the 2015 year. This may include, but is not limited to, bank statements, co-operative statements,
insurance invoices as well as dividend and interest certificates.
I authorise Mackay Bailey to be my Inland Revenue Tax Agent for all tax types and communicate with Inland
Revenue on my behalf, including communicating via electronic methods.
I authorise Mackay Bailey to communicate with financiers, banks, solicitors and other advisors as they deem
appropriate to obtain information necessary to carry out this engagement.
Signature:
Full Name:
Date Completed:
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Do you require a Personal Tax Summary (PTS)?
Did you receive more than
$70,000 for the year?
YES
Did you receive more than $200 of
interest taxed at less than 33%?
NO
Did you receive more than
$48,000 for the year?
YES
You must request a
Personal Tax Summary.
Please complete, sign
and return the attached
questionnaire and we
will calculate your tax
position for you.
NO
YES
Did you receive more than $200 of
interest taxed at less than 30%?
YES
NO
NO
Are you liable for child
support?
YES
Did you receive more than $200 of
interest, dividends and/or Maori
authority distributions?
NO
NO
Do you think you may be entitled to a tax refund?
This may be because you:
• Worked only part of the year, but lived in NZ for the
whole year
• Have an annual income under $48,000 and also
have dividend income automatically taxed at 33%
• Had income fluctuations during the year
• Had more than one employer during the year
• Want to claim expenses such as income protection
insurance
• You used a secondary tax code but your income
was under $48,000
NO
You don’t need to do anything further.
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YES
YES
You must request a
Personal Tax Summary.
Please complete, sign
and return the attached
questionnaire and we will
calculate your tax
position for you.
You may want to request a Personal Tax
Summary. Please complete, sign and return
the attached questionnaire and we will
calculate your tax position for you to see if
you have a refund due.
INCOME
The following income information will be supplied directly to our office by Inland Revenue:
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Wages
Salary
NZ Superannuation
Veterans Pension
Taxable New Zealand Income Support Benefits
Accident Compensation Payments
Family Support
Workplace Insurance
NEW ZEALAND INTEREST AND DIVIDENDS
Please supply us with all dividend and interest certificates, including joint investments
Please provide full details of source and amount received. Dividend, interest and bonus issue certificates are required
to show interest withholding tax paid on your behalf and imputation tax credits available to you.
EXPENSES
The only expenses you can claim are:
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A fee to someone completing your tax return.
Commission on interest or dividend income (but not bank fees – they are a private expense).
Interest on money you borrowed to buy shares or to invest – as long as the investment is expected to produce
some taxable income
Premiums on loss of earnings insurance provided any payouts from the insurance policy are taxable income.
•
Are you able to claim for any expenses paid during the year?
Yes / No
If yes, attach details.
WORKING FOR FAMILIES TAX CREDITS
If you believe you are entitles to Working for Families Tax Credits (WFFTC), please download and complete the
supplementary questionnaire from our website or contact us to request a copy.
STUDENT LOANS
Do you have a student loan
Yes / No
TAX CREDITS FOR DONATIONS
§
Total amount of your Donations to Charities
(Please staple your donation receipts to the back of this form)
§
Enter the bank account number you would like your rebate and any tax refund to be direct credited to
:
(The Inland Revenue may also transfer the rebate credit against any tax arrears you have.)
Bank
Branch
Account Number
$_________________
Suffix
Thank you for completing this questionnaire. Please sign where indicated on page 2.
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