I have no overseas interests.

Signed

Overseas Life Insurance

Do you have a right to any overseas life insurance?

Overseas Rental Properties

Do you own any overseas rental properties?

If yes please provide copies of the overseas financial statements and tax returns.

Loans / Mortgages

Do you have an overseas mortgage?

Superannuation

Are you receiving any overseas superannuation? Or do you have an entitlement to one in the future?

Pension

Do you receive an overseas pension? Or do you have an entitlement to one in the future?

Shares in Private Companies

Do you hold shares in any overseas private companies, such as shares in family overseas company?

Investments in Australia

Do you hold any investment in Australia?

If yes, please list below or refer to list.

Investments in other countries

Do you hold investments in any overseas countries other than Australia?

If yes, please list below or refer to list.

Overseas Bank Accounts

Do you hold money in any overseas bank accounts?

Overseas Inheritance

Have you received an inheritance from overseas during this financial year?

Overseas Income

Have you received any overseas income during this financial year?

Are you a trustee in a foreign trust?

Have you received any distributions from offshore trusts?

Authorisation

Please enter your full name below as authorisation.

Income

If yes, the IRD will send us your Summary of Earnings automatically.

Rebate Information

Other Income

If yes, please provide details of this.

Interest / Dividend Income

If yes, please provide interest and dividend advice notices.

Overseas Income/ Investments

If yes, please provide advice notices.

Rental Property owned in your personal name

If so please provide details of income and expenses.

Have you obtained a chattels valuation for this property?

Yes / No. If yes, please forward a copy to us.

Income Protection Insurance

If yes, please attach a copy of the invoice and policy.

Donations

If yes, please provide receipts and or details of how much was paid, when and whom.

Working For Families Tax Credits

Did you receive Family or Child Support during the year? Yes/No

If yes, please supply the following details:
• Names of children (complete fields below).
• Did you pay for childcare assistance either at a crèche, day nursery, playcentre or kindergarten while working?
• Please provide receipts where applicable.

Names of Children (who were cared for and financially dependent on you) | IRD Number | Date of Birth

Required Documents Uploader

Authorisation

Please enter your full name below as authorisation and acceptance of the terms below.

I / We hereby instruct Coombe Smith to prepare my / our Financial Statements and Taxation Returns for the year / period ending 31 March 2020. I / We undertake to supply all information necessary to carry out such services, and will be responsible for the accuracy and completeness of such information. Your services are not intended to, and accordingly will not result in the expression by you of an opinion on the Financial Statements in so far as third parties are concerned, or in the fulfilling of any statutory audit requirements.

I/We also authorise Coombe Smith to act as our agent for ACC levy purposes. This authorisation allows you to query and change information on my/our ACC levy account(s) through ACC staff, and through ACC Online Services – (if required).

You are hereby authorised to communicate with my / our bankers, solicitors, finance companies and all government agencies to obtain such information as you require in order carrying out the above assignments.