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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 Have life partner Not married Has Any Part of Your Name Changed? Yes No If Yes, What WasYour Former Name? 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 ? Yes No Any Investment / Rental Income ? Yes No 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 Do You Have Investment Property? Yes No Have You Sold Any Investment Property Yes No Have You Sold Any Shares? Yes No Any Superannuation Contributions if Self Employed or Unsupported? Yes No Are You a Primary Producer? Yes No Did You Work in a Remote Area During The Year? Yes No 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 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