COURTESY OF SCOTT ASSOCIATES CHARTERED ACCOUNTANT
SIMPLE TAX CHECKLIST FOR 2013
Name: ________________________________________________________
Daytime contact number (in case we need to call you) _________________
 Email address: _______________________________________________
Our preference is to email you your tax return – quicker and you have a permanent copy.
Please send me my completed tax return by post 
If this box is not ticked it will be emailed to you.
Tick this box to receive a free monthly practice tax update via email
WORK FLOW MANAGEMENT – Typically your returns are not due until March or May 2014.
Please advise:
I am in a rush – please do this as quickly as possible (subject to workload)
I would like this back within 6 – 12 weeks
I would like this back within 13 – 24 weeks
I am in no rush please have this back to me before the due date
During the year 1/7/2012 to 30/6/2013:
Did you receive income from employment? (If you
1.
received foreign employment income please contact
this office.)
If YES, please attach PAYG Summary.
2.
3.
4.
5.
6.
7.
Occupation for 2013
____________________________
(Please be as specific as possible)
Did you receive any payment from termination of a job,
or from retirement?
If YES, please attach: ETP (Employment Termination
Payments) form.
Did you receive a pension, benefits from Centrelink
such as old age pension and or AUSTUDY?
If YES, please attach statement.
Do you have a HECS / HELP/ PELS debt?
If YES please provide amount owing.
Did you have any interest income?
If YES, please attach relevant statements.
Did you have any dividend or investment income?
If YES, PLEASE ATTACH RELEVANT
STATEMENTS - MOST IMPORTANT
Did you sell any assets which might result in a capital
gain/loss? (e.g. shares, rental property etc.)
If YES, please attach relevant buy and sell
statements, contracts etc.
Did you receive any rental income?
If YES, please attach relevant statements or your
annual rental summary (refer to our checklist or call
our office to obtain one if you answered yes & it is not
attached)
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YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
COURTESY OF SCOTT ASSOCIATES CHARTERED ACCOUNTANT
Did you have any other income?
If YES, please describe (e.g. partnership or trust
distributions, foreign income)
8.
Do you wish to claim any deductions for
- Work related expenses
- Donations to charities
- Tax agent fees
- Self-education expenses
- Interest, dividend or investment deductions
- Income Protection Insurance
If YES, please complete Page 3 & 4.
9.
10.
11.
12.
Did you personally make any contributions to your own
superannuation, OR to your spouse’s superannuation?
If YES, please provide details.
Did you have a spouse or any dependent(s) during the
2013 financial year?
If YES, please complete Page 4.
Did you (and your family combined) spend more than
$2,120 out of pocket on medical, dental, hospital,
pharmaceutical, optical expenses etc?
If YES, please complete below and Page 4
Medicare
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
_ _____/________________________
ID No.
Medicare Number
Please include all ID numbers on your card
13.
Did you have private health insurance covering
you and your dependents?
If YES, please obtain and attach “Private Health
Insurance Statement” from your fund.
(Please contact your Fund ASAP if you don’t have this
Statement, as it is critical. No processing will be done until
you provide this statement.)
14.
15.
***Please also complete Page 5***
Was there any period that you (or your spouse) were
NOT covered by private HOSPITAL insurance?
If YES write the number of days not covered:_______
If you have paid any child support, please contact this office.
RETURN OF ORIGINAL SOURCE DOCUMENTS (please tick preferred option)
On completion, I will pick up documents from office
On completion, please return documents to me at my expense
BANK ACCOUNT DETAILS
IF DUE A REFUND - NO BANK DETAILS – NO REFUND (ATO POLICY)
BSB___________________ Account Number___________________________________
Account Name_____________________________________________________________
Done! The information given by me in the Simple Tax Checklist is complete and accurate.
_______________________________
Signed
_________________
Date
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COURTESY OF SCOTT ASSOCIATES CHARTERED ACCOUNTANT
Thank you for contributing to our efforts to make tax easier for you. Please
make sure you have attached any relevant documents before faxing/emailing
or posting back to us in the reply paid envelope.
SIMPLE TAX CHECKLIST FOR 2013
Complete only where you have answered “YES” in the Checklist.
INTEREST
Bank
Account Number
Total Interest
Received $
% of this owned
by you
DEDUCTIONS: Please ensure you are able to substantiate all claims, even if
less than $300.
1. MOTOR VEHICLE: Did you use your own car for business / work purposes through the
year: YES 
NO 
If YES, then please provide one of the following:
Log Book Method – Business % Use
(please ensure you keep a log book for a continuous period of 12 weeks)
Business Use _____% - as per my log book
Please provide details of all expenses you incurred over the financial year including fuel, repairs
and maintenance, registration, insurance etc.
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
If you have a loan for the vehicle, please provide details of the interest you paid over the year and
the cost of the car. If you have a hire purchase, please provide a copy of the loan agreement.
Cost of Vehicle $ ______________________ Interest Paid $ ____________________
Attached is my hire purchase agreement: 
If you had a lease for your vehicle please provide figures of your lease payments.
Lease Payments per month $ _______________ x Number of Payments _________
Kilometres Method: You use your car for work, but have not kept a logbook. Let us know how
many kilometers you would have travelled for work. The maximum the tax office allows you to
claim is 5000 kilometers.
Kilometres: ____________________ Registration Number: ____________________
Car Engine Size: (in litres e.g. 1.6 litres): ___________________________________
2. WORK UNIFORM: Did you have to wear a logo uniform or protective clothing?
YES 
NO 
If YES, were you out of pocket through the year for purchasing any new items? (If so,
please provide details).
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COURTESY OF SCOTT ASSOCIATES CHARTERED ACCOUNTANT
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
3. OTHER WORK RELATED DEDUCTIONS (please circle):
Diary / stationery / work materials: ___________________________________________
Union fees / professional bodies: ____________________________________________
Seminar costs or self-education fees: _________________________________________
4. OTHER: (Any costs you incurred that were directly related to your job). Please provide
details:
_______________________________________________________________________
_______________________________________________________________________
______________________________________________________________________
Note: If you have attended University, now or in the past and are paying off your fees through
HECS OR HELP, please provide us with your HECS or HELP statement to include in your return .
5. OTHER DEDUCTIONS:
Sickness & accident insurance / income protection insurance $ _______________
Donations / school building fund $ _______________
Tax Agent Fees $ _______________
Investment Deductions: $ _______________ Please provide documents such as growers
statements, prepaid or margin loan interest details, etc.
Note: The law requires that you must have receipts to claim work-related expenses (WRE), unless total WRE
is less than $300. If you are unsure about the deductibility of an expense please note it down and we
will contact you to discuss.
6. EDUCATION TAX REFUND and FAMILY TAX BENEFIT
Handled directly through Centrelink / Family Assistance Office.
SPOUSE and/or DEPENDANTS
Please list Spouse & Children
D.O.B
Their Income $
MEDICAL EXPENSES Do not complete unless total out-of- pocket expenses exceed $2,120*
- what you spent less any refund from Medicare and your Health Fund
- you can obtain a schedule from your Health Fund and/ or Medicare and attach these schedules.
Details
Amounts Not Reimbursed
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COURTESY OF SCOTT ASSOCIATES CHARTERED ACCOUNTANT
PRIVATE HEALTH INSURANCE
Private Health Fund _______________________________________________________
Membership Number ________________________________________________________
**Please attach Private Health Insurance Statement 1 July 2012 to 30 June 2013**
 If you claimed your Australian Government Rebate through reduced premiums, only the
Private Health Insurance Statement is required.
 If you paid the full cost of your policy upfront and claimed your rebate from Medicare, the
receipt from Medicare is also required.
 If you paid the full cost of your policy upfront and intend to claim your rebate through your
tax return, please read carefully and check the correct Tax Claim Code below:
Tax
Claim
Code
A
B
C
D
E
F
Best Describes Your Circumstances
Yes
You were single on 30 June 2013 and had no dependents
You are a single parent with a dependent child or children, or you have a
dependent sibling
You had a spouse on 30 June 2013, or you had a spouse who died during the
year and you did not have another spouse before the end of the year, and you
are claiming your share of the rebate entitlement in relation to the policy, or
you are claiming for a dependent child only policy
You had a spouse on 30 June 2013, or you had a spouse who died during the
year and you did not have another spouse before the end of the year, and you
were covered by the same complying private health insurance policy for the
same amount of time, and You claimed your share of the policy using Tax Claim
Code C are claiming your spouse’s share of the rebate entitlement in relation
to the policy
You had a spouse on 30 June 2013, and you were covered by the same
complying private health insurance policy, and your spouse is claiming your
share of the rebate entitlement for you in their tax return
If you are a dependent child on a family private health insurance policy or you
are covered by a dependent child only policy, you are therefore not entitled to
any private health insurance rebate
Have you nominated your Australian Government Rebate tier with your Health Fund?
Not nominating a rebate tier may mean having to repay any amounts received that are
greater than your rebate entitlement at tax time. You can quickly calculate your rebate tier,
and then register it online with your Health Fund. Adjustments will then be made to your
future premium.
FROM 1 JULY 2013
Singles
Couples/ Families
Under 65
65 – 69
70+
BASE TIER
Up to $88,000
Up to $176,000
30%
35%
40%
TIER 1
$88,001 - $102,000
$176,001 - $204,000
20%
25%
30%
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TIER 2
$102,001 - $136,000
$204,001 - $272,000
10%
15%
20%
TIER 3
$136,001 and above
$272,001 and above
0%
0%
0%