ABN Verification and Contractor Declaration Form

Principal Business Details

Business Name: [INSERT PRINCIPAL BUSINESS NAME] ABN: [INSERT PRINCIPAL ABN] ACN (if applicable): [INSERT PRINCIPAL ACN] Address: [INSERT PRINCIPAL ADDRESS]

Contractor Details

Legal Name: [INSERT CONTRACTOR LEGAL NAME] Trading Name (if different): [INSERT TRADING NAME] ABN: [INSERT CONTRACTOR ABN] ACN (if applicable): [INSERT CONTRACTOR ACN] Address: [INSERT CONTRACTOR ADDRESS] Email: [INSERT EMAIL ADDRESS] Phone: [INSERT PHONE NUMBER]

ABN Verification

I, the representative of the Principal Business, declare that I have verified the ABN provided above against the Australian Business Register on [INSERT VERIFICATION DATE].

• ABN is Active
• ABN is Cancelled (Do not proceed with payment without tax withholding)

Contractor Declaration

I, [INSERT CONTRACTOR NAME], declare that:

1. Tax Status: The information provided is true and correct. I am registered for GST (if applicable). My GST status is [REGISTERED / NOT REGISTERED].
2. Nature of Relationship: I am engaged as an independent contractor. I am not an employee of the Principal Business. I accept responsibility for my own income tax liabilities and taxation obligations.
3. Insurance: I confirm that I hold the following insurances relevant to the work I am performing:

• Public Liability Insurance ($10 million minimum): [YES / NO]
• Workers Compensation Insurance (if required by law): [YES / NO / EXEMPT]
• [INSERT OTHER INSURANCE]: [YES / NO]
• Policy numbers are available upon request.

4. Superannuation: I acknowledge that the Principal Business may be required to pay superannuation contributions into a nominated superannuation fund if the contract is wholly or principally for my labour. [ ] I provide my Superannuation Fund Details (see below) OR [ ] I declare that I am not required to provide these details as I am not principally engaged for my labour (note: the Principal may be liable to pay regardless of this declaration).
5. Work Health and Safety: I agree to comply with all relevant Work Health and Safety (WHS) legislation and codes of practice. I will maintain a safe work environment and provide any necessary safety data sheets or equipment.
6. Licences: I hold all valid licences, permits, and registrations required to perform the stated work in [INSERT STATE/TERRITORY].

Superannuation Details (Complete if applicable)

Fund Name: [INSERT FUND NAME] Fund ABN: [INSERT FUND ABN] Member Number: [INSERT MEMBER NUMBER] Account Name: [INSERT ACCOUNT NAME]

Payment Details

Bank Name: [INSERT BANK NAME] BSB: [INSERT BSB] Account Number: [INSERT ACCOUNT NUMBER] Account Name: [INSERT ACCOUNT NAME]

Signatures

Contractor Declaration:

Signature: __________________________ Date: ____ / ____ / ________ Print Name: __________________________

Principal Business Verification:

Signature: __________________________ Date: ____ / ____ / ________ Print Name: __________________________ Position: __________________________

For office use only

• Tax File Number Declaration Received
• Insurance Certificates Sighted
• Licences Verified