DIRECTOR TAX DECLARATION

Company Details

• Company Name: [FULL LEGAL COMPANY NAME]
• ACN / ABN: [ACN OR ABN NUMBER]
• Trading Name (if applicable): [TRADING NAME]
• Address: [STREET ADDRESS]
• Suburb: [SUBURB]
• State: [STATE]
• Postcode: [POSTCODE]
• Contact Person: [NAME OF PAYROLL CONTACT]
• Phone: [PHONE NUMBER]
• Email: [EMAIL ADDRESS]

---

Director Details

• Full Legal Name: [DIRECTOR'S FIRST NAME] [DIRECTOR'S MIDDLE NAME(S)] [DIRECTOR'S SURNAME]
• Date of Birth: [DD/MM/YYYY]
• Residential Address: [RESIDENTIAL STREET ADDRESS]
• Suburb: [SUBURB]
• State: [STATE]
• Postcode: [POSTCODE]
• Tax File Number (TFN): [TAX FILE NUMBER]
• Email Address: [DIRECTOR PERSONAL EMAIL]
• Phone Number: [DIRECTOR PHONE NUMBER]

---

Tax Residency Status

Please tick the box that applies to you:

• I am an Australian resident for tax purposes.
• I am a foreign resident for tax purposes.
• I am a working holiday maker.

---

Declaration of Income and Payments

I, [DIRECTOR FULL NAME], declare that I am a Director of the Company named above. I authorise the Company to make payments to me as follows:

1. Director Fees

• Amount: $[0.00] per [Week/Month/Year/Meeting]
• GST Inclusive: [YES / NO]

2. Salary or Wages

• Amount: $[0.00] per [Year]
• Payment Frequency: [Weekly/Fortnightly/Monthly]

3. Allowances

• Motor Vehicle Allowance: $[0.00] per [Period] (Please specify cents per km if applicable: [amount])
• Travel Allowance: $[0.00] per [Period]
• Other Allowances: [DETAILS]

4. Fringe Benefits

• I agree that the Company may provide me with the following non-cash benefits:
• Motor Vehicle
• Health Insurance
• Entertainment
• Other: [DETAILS]

---

Superannuation

• Superannuation Fund Name: [NAME OF FUND]
• Fund ABN: [FUND ABN]
• Product Identification Number (SPIN) or USI: [USI NUMBER]
• Member Account Number: [MEMBER NUMBER]

---

Authorisation and Declaration

I declare that the information provided on this form is true and correct. I authorise the Company to use this information to:

1. Determine the amount of tax to be withheld from payments made to me.
2. Provide details of my payments to the Australian Taxation Office (ATO) via Single Touch Payroll.
3. Calculate and pay Superannuation Guarantee contributions on my behalf.

I understand that:

• I must notify the Company within 14 days if any of the information on this form changes.
• If I do not provide my Tax File Number, the Company must withhold tax at the highest marginal rate including the Medicare Levy.
• Giving false or misleading information is a serious offence under Australian law.

Director Signature: __________________________

Date: ___ / ___ / _______

---

For Office Use Only

• Processed By: [NAME]
• Date Entered: [DATE]
• Software ID: [ID]