2010 Individual Income Tax Return Checklist
(Print out and bring the completed checklist with you)
Tax File Number:___________________________
ABN:_____________________________ (if applicable)
Are you an Australian resident for Tax Purposes? YES/NO/UNSURE
Name: ....................................................................................
Mr/Mrs/Ms/Miss:..........................................
Name changed since last return? YES/NO
If YES, previous name:...................................................
Postal Address: .............................................................
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Postal address changed from last tax return? YES/NO
Residential Address:............................................................
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Date of birth: / /
Telephone: (Home)................................
(Work)..................................
(Mobile)...............................
Email Address: ......................................@.........................................
Occupation: .......................................................................................
Spouse details (if applicable):
Spouse's Name:...........................................
Date of Birth:................................................
Tax File Number:..........................................
Taxable Income: $......................................
Reportable Fringe Benefits: $.......................
Do you want to use Electronic Funds Transfer?....YES/NO
If YES, provide bank details;
BSB: ...................................
Account Number: ...................................
Account name: ......................................................................
Please circle YES or NO for each of the items listed below:
INCOME – Please provide evidence
1. Salary or wage?....YES/NO
2. Allowances, earnings, tips, director’s fees etc....YES/NO
3. Employer lump sum payments....YES/NO
4. Employment termination payments....YES/NO
5. Australian Government allowances and payments like newstart, youth allowance and Austudy payment....YES/NO
6. Australian Government pensions and allowances....YES/NO
7. Australian annuities and superannuation income streams....YES/NO
8. Australian superannuation lump sum payments....YES/NO
9. Attributed personal services income....YES/NO
10. Reportable fringe benefits amounts....YES/NO
11. Interest....YES/NO
12. Dividends....YES/NO
13. Distributions from partnerships and/or trusts....YES/NO
14. Personal services income (PSI)....YES/NO
15. Net income or loss from business....YES/NO
16. Deferred non-commercial business losses....YES/NO
17. Net farm management deposits or withdrawals....YES/NO
18. Net capital gains....YES/NO
19. Direct or indirect interests in controlled foreign entities....YES/NO
20. Transfer of property or services to a foreign resident trust....YES/NO
21. Interests in a foreign investment fund (FIF) or a foreign life assurance policy (FLP)....YES/NO
22. Foreign source income (including foreign pensions) and foreign assets or property....YES/NO
23. Rent....YES/NO
24. Bonuses from a life insurance company or friendly society policy....YES/NO
25. Forestry managed investment scheme income....YES/NO
26. Other income (please specify)....YES/NO
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DEDUCTIONS – Please provide evidence
D1. Work related car expenses
- cents per kilometre method (up to a maximum of 5,000 kms) . YES/NO
- log book method....YES/NO
- one-third of actual expenses method....YES/NO
- 12% of actual cost method....YES/NO
D2. Work related travel expenses
Employee domestic travel with reasonable allowance....YES/NO
- If the claim is more than the reasonable allowance rate, do you have receipts for your
expenses?....YES/NO
Overseas travel with reasonable allowance....YES/NO
- Do you have receipts for accommodation expenses?....YES/NO
- If travel is for 6 or more nights in a row, do you have travel records? (e.g. a travel diary)....YES/NO
Employee without a reasonable travel allowance....YES/NO
- Did you incur and have receipts for airfares?....YES/NO
- Did you incur and have receipts for accommodation?....YES/NO
- Do you have receipts for hire cars (if applicable)?....YES/NO
- Did you incur and have receipts for meals and incidental expenses?....YES/NO
- Do you have any other travel expenses?....YES/NO
Other work-related travel expenses (e.g., a borrowed car)....YES/NO
(please specify)
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D3. Work related uniform and other clothing expenses
Protective clothing....YES/NO
Occupation specific clothing....YES/NO
Non-compulsory uniform....YES/NO
Compulsory uniform....YES/NO
Conventional clothing....YES/NO
Laundry expenses (up to $150 without receipts)....YES/NO
Dry cleaning expenses....YES/NO
Other claims such as mending/repairs, etc (please specify)....YES/NO
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D4. Work related self-education expenses
Course taken at educational institution:
- union fees....YES/NO
- course fees....YES/NO
- books, stationery....YES/NO
- depreciation....YES/NO
- seminars....YES/NO
- travel....YES/NO
- other (please specify)....YES/NO
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D5. Other work related expenses
Home office expenses....YES/NO
Computer and software....YES/NO
Telephone/mobile phone....YES/NO
Tools and equipment....YES/NO
Subscriptions and union fees....YES/NO
Journals/periodicals....YES/NO
Depreciation....YES/NO
Sun protection products (i.e., sunscreen and sunglasses)....YES/NO
Seminars and courses not at an educational institution:
- course fees....YES/NO
- travel....YES/NO
- other (please specify)....YES/NO
Any other work related deductions (please specify)....YES/NO
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Other types of deductions
D6. Low value pool deduction....YES/NO
D7. Interest and dividend deductions....YES/NO
D8. Gifts or donations....YES/NO
D9. Cost of managing tax affairs....YES/NO
D10. Australian film industry incentives....YES/NO
D11. Deductible amount of undeducted purchase price of a foreign pension or annuity....YES/NO
Other types of deductions (continued)
D12. Personal superannuation contributions....YES/NO
Full name of fund:...........................................................
Account no: .......................
Fund ABN: .........................
Fund TFN: ..........................
D13. Deduction for project pool....YES/NO
D14. Forestry managed investment scheme deduction....YES/NO
D15. Other deductions (please specify)....YES/NO
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L1. Tax losses of earlier income years....YES/NO
Tax offsets/rebates
T1. Do you have a dependent spouse (without dependent child or student), a housekeeper
or a child-housekeeper?....YES/NO
T2. Are you a senior Australian?....YES/NO
T3. Are you a pensioner?....YES/NO
T4. Did you receive a superannuation income stream?....YES/NO
T5. Did you have private health insurance in 2009?....YES/NO
T6. Have you incurred expenses for your child’s education?....YES/NO
T7. Do you have a child that was born or adopted between 1 July 2001 and 30 June 2004?....YES/NO
T8. Did you make superannuation contributions on behalf of your spouse?....YES/NO
T9. Did you live in a remote area of Australia or serve overseas with the Australian defence
force or the UN armed forces in 2009?....YES/NO
T10. Did you have net medical expenses over $1,500?....YES/NO
T11. Did you maintain a parent, spouse’s parent or invalid relative?....YES/NO
T12. Are you entitled to claim the landcare and water facility tax offset?....YES/NO
T13. Are you a mature age worker with ‘net income from working’ of less than $63,000?....YES/NO
T14. Are you a ‘small business entity’ with an annual turnover of $75,000 or less?....YES/NO
T15. Other tax offsets (please specify)....YES/NO
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These tax offsets may not be available where the taxpayer is eligible to claim FTB Part B.
Other relevant information
A. Are you entitled to the Medicare levy exemption or reduction in 2009?....YES/NO
(If yes, please specify):
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B. Were you under the age of 18 on 30 June 2009....YES/NO
C. Did you become an Australian tax resident at any time during the 2009 income year?....YES/NO
D. Did you cease to be an Australian tax resident at any time during the 2009 income year?....YES/NO
E. Did you have a spouse at any time during the 2009 income tax year....YES/NO
F. Do you have a HECS/HELP liability or a student supplement loan debt?....YES/NO
G. Did you pay any tax within 14 days before the due date of the liability (e.g., HECS/HELP)?....YES/NO
H. Did a trust or company distribute income to you in respect of which family trust distribution
tax was paid by the trust or company?....YES/NO
I. Do you have a loan with a private company or have such a loan amount forgiven?....YES/NO
(If yes, please specify) – (reviewer consider if deemed dividend in year under Division 7A):
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J. Did you receive any benefit from an employee share acquisition scheme?....YES/NO
(If yes, please specify) – (reviewer consider if assessable in year):
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K. Family Tax Benefit (‘FTB’):
– Did you have care of a dependent child in 2009?....YES/NO
– Did you or your spouse receive FTB through the Family Assistance Office in 2009?....YES/NO
Dated the …………..... day of ……………………………………………20….....
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Signature of taxpayer
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Name (print)
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