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Your Given Name(s) * Your Family Name * E-mail Address: * Your Birth Date dd/mm/yyyy * Your Street Address * Your Suburb * Your State * Choose NSW VIC QLD WA SA TAS ACT NT Your Post Code * Did You Use ITP-The Income Tax Professionals For Your Last Tax Return ? * Yes No Your preferred contact phone number * Your Gender Male Female Your Marital Status Choose Married De-Facto Not married Has Any Part of Your Name Changed? Yes No If Yes, What WasYour Former Name? If Married or De-Facto, Does Your Partner Have Any Taxable Income? Yes No Home Phone Number (include area code) Work Phone Number Mobile Phone Number Facsimile Number (include area code) Your Occupation Did You Receive any PAYG Salary/Wages ? Yes No Did You Receive Any Allowances, Earnings or Fees ? Yes No Any Lump Sum Payments Received ? Yes No Any Interest Received ? Yes No Any Dividends Received ? Choose None From one share / investment From two shares / investments From three Shares / investments From more than three shares / investments Any Investment property / Rental Income ? Choose None From one property From two properties From three properties From more than three properties Any Reportable Fringe Benefits ? Yes No Any Newstart / Abstudy / Youth Allowance ? Yes No Any Other Australian Pensions ? Yes No Any Foreign Income, Including Pensions ? Yes No Any Work Related Deductions ? Yes No Any Donations to Approved Charities ? Yes No Do You Use Your Motor Vehicle for Work Related purposes? Yes No Do You Have Private Health Cover? Yes No Are You Entitled to Medicare Benefits? Yes No If No, Have you Applied for a Medicare Levy Exemption? Yes No Do You Have HECS Debt or Student Loans? Yes No Any Dependent Children? Yes No Any Child Support or Maintenance Arrears? Yes No Are You Receiving Family Assistance? Yes No Do You Have Children in Day Care? Yes No Do You Have Out of Pocket Medical Bills Over $1,500? Yes No Have You Sold Any Investment Property Yes No Have You Sold Any Shares? Yes No Do You Have Any Partnership or Trust Distributions?: Yes No Any Superannuation Contributions if Self Employed or Unsupported? Yes No Do You Have Any Business Income? Yes No Are You a Primary Producer? Yes No Did You Work in a Remote Area During The Year? Yes No What Year Was Your Last Tax Return How Many Years Tax Returns Do You Wish to Prepare? Choose One year Two years Three Years Four Years Five Years Six Years Seven years Eight Years Nine years More than nine years How Would You Like to Pay For Your Tax Return? Choose Take the fee from my refund Credit Card (Amex, Visa, Mcard) PAYPAL Bank transfer Has Your Address Changed Since Your Last Tax Return?: Yes No How Did You Find Out About Our Assisted Online Service?: A Google search Using another search engine Through the ITP national website Newspaper advertising Television advertising Radio advertising From a friend, family member or colleague Other Your Tax File Number (TFN) * In submitting this form I confirm that the information I will provide is / will be a true representation of my tax situation and I appoint ITP as my Tax Agents to confirm the validity of the information provided. * I Agree I Dont Agree Verification Code: Enter Verification Code: * * Required