Dolman Bateman Tax Declaration Form

Dolman Bateman Staff Tax File Number Declaration Form

Information you provide in this declaration will allow your payer to work out how much tax to withhold from payments made to you.

You need to provide all information requested on this form. Providing the wrong information may lead to incorrect amounts of tax being withheld from payments made to you.

Employer Name *
Job Title *
Start Date *

Month Day Year
Gross Salary *
Personal Details
Full Name *

First Name Middle Name Last Name
Birth Date *

Day Month Year
Gender *

Male Female
Tax File Number *
Mobile Number *
Phone Number

Area Code Phone Number
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Personal E-mail *
Bank Details
Account Name
BSB *
Account Number *
Superannuation Details
Fund Name *
Member Number *

Emergency Contact
Full Name *
Relationship *
Phone Number *
Email Address

On what basis are you paid? *
Are you an Australian resident for tax purposes? *

Yes No
Do you want to claim the tax-free threshold from this payer? *

Yes No
Do you have a HECS or HELP Debt? *

Yes No
Identification Check

Upload a File
Please upload your drivers licence or passport Cancel of
Declaration by payee: I declare that the information I have given is true and correct on the submission of this form.
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