Individual Authority Form

Important - Privacy of your information

Your personal information is being collected by Professional Network Pty Ltd as authorized by the Law and will only be used for the administration of your tax matters

First Name

Last Name

Gender

Phone

Date of Birth

Address

Address Line 1

Address Line 2

City/Suburb

State

Post Code

Country

TFN

ABN- If Applicable

Occupation

Enter Your Bank Details

BSB

Account Number

Account Title

Your Residency Status in Australia

Number of Dependent Kids under 21years of age (if any)

Do you have Medicare card?

Yes

Do you have Private Health Insurance

Yes

Are you married / or Do you have a spouse or partner?

Yes

Spouse First Name

Spouse Last Name

Spouse Date of Birth

Spouse Income

Did you live in Australia for the whole financial year?

Yes

Date of entry to Australia

Date of exit from Australia

Further information, If any:

I authorize “Professional Network Pty Ltd” to represent me as Tax agents and Accountants. I declare that the information provided is true and correct as of my knowledge. I also understand my responsibility to substantiate data provided to Professional Network for lodgement of my tax returns.

Please Attach Your Photo ID for Identification purpose

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Signature

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