PAYG Withholding Summary for [Financial Year Ending 30 June YYYY]

1. Payer Details

Business Name: [Insert Legal Business Name] Trading Name (if different): [Insert Trading Name] ABN: [Insert Australian Business Number] Business Address: [Insert Street Address, Suburb, State, Postcode] Contact Phone: [Insert Phone Number] Lodgement Reference Number: [Insert if applicable]

2. Payee Details

Full Name: [Insert Employee Full Name] Residential Address: [Insert Street Address, Suburb, State, Postcode] Tax File Number (TFN): [Insert TFN or provide reason for non-quotation] Date of Birth: [Insert DD/MM/YYYY] Employment Basis: [Full-time / Part-time / Casual / Contractor]

3. Payment Details (Financial Year Totals)

Description	Amount ($)
Gross Payments (Salary, Wages, Commissions, Allowances)	[0.00]
Total Tax Withheld	[0.00]
Reportable Fringe Benefits Amount	[0.00]
Reportable Employer Superannuation Contributions	[0.00]
Allowances (Detailed below)	[0.00]
Lump Sum Payments (Type A, B, D, E)	[0.00]
Other Income	[0.00]

4. Allowance Breakdown

If any allowances paid are not shown on the Gross Payments total separately, list them here.

5. Certification

I declare that the information provided in this summary is true and correct.

Signature: __________________________ Date: __________________________ Authorised Signatory: [Print Name]

6. Instructions for Recipient

1. Keep this for your records. You need this information to complete your income tax return.
2. Check the details. Ensure your name, address, and TFN are correct. If there are errors contact your employer immediately.
3. Lodge your return. Include these figures in your tax return by 31 October (or later if using a registered tax agent).
4. Reportable amounts. Note that Reportable Fringe Benefits and Reportable Employer Super Contributions are not included in your taxable income but are used for income tests.