Login

Fillable Printable Statutory Declaration of Taxation - Australia

Fillable Printable Statutory Declaration of Taxation - Australia

Statutory Declaration of Taxation - Australia

Statutory Declaration of Taxation - Australia

WHEN TO COMPLETE THIS
STATUTORY DECLARATION
Have you attempted to obtain the following from your payer?
n Your payment summary.
n A copy of your payment summary.
n A letter stating details of your income and the amount
oftax withheld.
If you have not attempted to obtain this information,
youshould do so before proceeding any further. 
You should complete this statutory declaration when you
cannotobtain orlocate the following payment summaries: 
n PAYG payment summary – individual non‑business
(NAT 0046)
n PAYG payment summary – employment termination payment
(NAT 70868)
n PAYG payment summary – superannuation lump sum
(NAT 70947)
n PAYG payment summary – superannuation income stream
(NAT 70987).
Payment summary information may
beavailableinpre‑lling service
Payment summary information is generally available through the
pre-filling service in e‑tax or by contacting your tax agent. If your 
information is not available in the pre-filling service, and you do
not have your payment summary, you should complete this
statutory declaration.
For more information on the pre-filling service, visit our
website at www.ato.gov.au/etaxprefilling
MAKING A STATUTORY DECLARATION
You can make a declaration if you are an individual person
and the declaration relates to your own income tax return.
n Use a separate declaration for each income year
(1 July to 30 June).
n Use a separate declaration for each payment summary.
n Complete all the relevant sections. Ensure all details
about your payments and the amounts withheld are included.
If you do not complete all the details, you may not be allowed
a credit for the amount that was withheld from your payments
when your tax return is processed. If you do not know the 
required details, print ‘UNKNOWN’.
WHAT TO DO WITH YOUR
COMPLETED DECLARATION
Use the information in this declaration to complete your
tax return or amendment request. If you do not have to lodge 
this declaration, you must keep it with your records.
If you have any documents showing amounts were
withheld from payments you received (for example, payslips, 
pay envelopes or time sheets), keep those documents with
this declaration.
You do not have to lodge this declaration with your tax return 
or amendment request unless you have completed it in place
of the ETP payment summary (NAT 2605) for 2007 and prior
financial years.
PRIVACY
We are authorised by the Income Tax Assessment Act 1936 to
ask for the information on this form. We need this information to
help us correctly identify your records. Where authorised by law,
we may give this information to other government agencies that
administer laws relevant to your particular situation. It is not an
offence not to quote your tax file number (TFN).
If at any time you find your payment summary, and the
amounts shown on it are the same as the amounts you are
claiming on this declaration, keep the payment summary
with your records. However, if any of the amounts shown on
your payment summary are different to the amounts you are
claiming on this declaration, you must use the payment
summary amounts on your tax return.
If you have already lodged your tax return, you must 
request an amendment. To do this, write to us and ask us
to replace the amount you have already claimed with the
amount shown on the payment summary.
Write to us at:
Australian Taxation Office
PO Box 3004
PENRITH NSW 2740
Statutory declaration
NAT 4135–11.2012
MAKING AND SIGNING THE DECLARATION
Under the Statutory Declarations Act 1959, you can make
a declaration before:
n a person who is currently licensed or registered under a
law to practise in one of the following occupations
– chiropractor
– dentist
legal practitioner
medical practitioner
– nurse
– optometrist
patent attorney
– pharmacist
– physiotherapist
– psychologist
trade marks attorney, or
veterinary surgeon
n a person who is enrolled on the Supreme Court roll of a
State or Territory or the High Court of Australia as a legal
practitioner (however described), or
n one of the following people
an agent of the Australian Postal Corporation who is in
charge of an office supplying postal services to the public
an Australian Consular Officer or Australian Diplomatic
Officer (within the meaning of the Consular Fees Act 1955)
a bailiff
a bank officer with five or more continuous years of service
a building society officer with five or more years of
continuous service
–  a chief executive officer of a Commonwealth court 
a clerk of a court
a Commissioner for Affidavits
a Commissioner for Declarations
a credit union officer with five or more years of
continuous service
an employee of the Australian Trade Commission who is
- in a country or place outside Australia
- authorised under paragraph 3(d) of the Consular Fees
Act 1955, and
-  exercising his or her function in that place 
an employee of the Commonwealth who is
- in a country or place outside Australia
- authorised under paragraph 3(c) of the Consular Fees
Act 1955, and
-  exercising his or her function in that place 
–  a fellow of the National Tax Accountants’ Association 
a finance company officer with five or more years of
continuous service
a holder of a statutory office not specified in another item
in this list
a judge of a court
a Justice of the Peace
a magistrate
a marriage celebrant registered under Subdivision C of
Division 1 of Part IV of the Marriage Act 1961
a master of a court
a member of Chartered Secretaries Australia
a member of Engineers Australia, other than at the
grade of student
–  a member of the Association of Taxation and 
Management Accountants
a member of the Australasian Institute of Mining
and Metallurgy
a member of the Australian Defence Force who is
- an officer
- a non-commissioned officer within the meaning of
the Defence Force Discipline Act 1982 with 5 or
more years of continuous service, or
- a warrant officer within the meaning of that Act
a member of the Institute of Chartered Accountants in
Australia, the Australian Society of Certified Practising
Accountants or the National Institute of Accountants
a member of
- the Parliament of the Commonwealth
- the Parliament of a State
- a Territory legislature, or
- a local government authority of a state or territory
a minister of religion registered under Subdivision A
of Division 1 of Part IV of the Marriage Act 1961
notary public
a permanent employee of the Australian Postal Corporation
with five or more years of continuous service who is
employed in an office supplying postal services to the public
a permanent employee of one of the following with five or
more years of continuous service who is not specified in
another item in this list
- the Commonwealth or a Commonwealth authority
- a state or territory or a state or territory authority, or
- a local government authority
a person before whom a statutory declaration may be
made under the law of the state or territory in which the
declaration is made
a police officer
a registrar or deputy registrar of a court
–  a senior executive service employee of
- the Commonwealth or a Commonwealth authority, or
- a state or territory or a state or territory authority
a sheriff
a sheriffs officer, or
a teacher employed on a full-time basis at a school or
tertiary education institution.
Page 1
Sensitive (when completed)
NAT 4135–11.2012
Statutory declaration
Statutory Declarations Act 1959
Your full name
Occupation
Suburb/town/locality State/territory Postcode
Address
I,
of
make the following declaration under the Statutory Declarations Act 1959:
1 I am not in possession of the payment summary for the period:
Day Month Year
From
Day Month Year
to
2 Payer details
Australian business number
Full name
Trading name (if applicable)
Full business address
Name of person who made the payments (ie payer)
Business hours phone number
Nature of business
Suburb/town/locality State/territory Postcode
3 Payment details
Name under which I was paid
My tax file number (TFN)
Location where work was performed
If the payment was made by your employer, what was the basis of your employment?
CasualPart-time Full-time
Personnel or payroll number (if applicable)
Suburb/town/locality State/territory Postcode
Page 2
Sensitive (when completed)
Remember, you must only complete one of the three sections on pages 2–3.
If you do not know the exact amounts, provide estimates.
Complete this section if the payment should be on a PAYG payment summary – individual non‑business
Weekly Total (1 July–30 June)
$
,
.
$
,
.
Amount of gross payments
(before any amounts were withheld)
$
,
.
$
,
.
Amount of net payments (after any amounts were withheld)
$
,
.
$
,
.
Amount of any allowances received
$
,
.
Reportable fringe benefits amount
$
,
.
Reportable employer superannuation contributions
$
,
.
Exempt foreign employment income
$
,
.
Amount of lump sum payments (other than eligible or employment
termination payments, or superannuation lump sum payments)
$
,
.
Total tax withheld from the above payments
Complete this section if the payments should be on a PAYG payment summary – employment
termination payment
$
,
.
Employment termination payment – taxable component
$
,
.
Employment termination payment – tax-free component
$
,
.
Total tax withheld from the above payments
For 2011–12 and prior financial years:
No Yes
Is this a transitional termination payment?
No Yes
Is this payment part of a payment made in an
earlier income year for the same termination?
Is this payment a death benefit? No Yes
Dependant
Indicate the type of death benefit:
Non-dependant
Trustee of deceased estate
Date of payment
Day Month Year
For 2012–13 and future financial years:
Employment termination payment (ETP) code
Read through all the codes before selecting one that describes the type of payment. If more than one code applies to the
payment, you will need to complete a separate payment summary for each code.
Life benet ETP
CODE DESCRIPTION
R
ETP made because of one of the following:
n early retirement scheme
n genuine redundancy
n invalidity
n compensation for
– personal injury
– unfair dismissal
– harassment
– discrimination
O Other ETP not described by R, for example, golden 
handshake, gratuity, payment in lieu of notice, payment for
unused sick leave, payment for unused rostered days off
Multiple payments for same termination
CODE DESCRIPTION
S You made a code R payment to your employee in a
previousincome year for the same termination
P You made a code O payment to your employee in a
previousincome year for the same termination
Death benet ETP
CODE DESCRIPTION
D
Death benet ETP paid to a dependant of the deceased
B Death benet ETP paid to a non-dependant of the deceased 
and you made a termination payment tothenon-dependant 
in a previous income year forthesame termination
N
Death benet ETP paid to a non-dependant of the deceased
T Death benet ETP paid to a trustee of the deceased estate
For more information, refer to How to complete the PAYG payment summary – employment termination payment
(NAT70996-07.2012) on our website at www.ato.gov.au
Page 3
Sensitive (when completed)
Complete this section if the payments should be on a PAYG payment summary – superannuation lump
sum or PAYG payment summary – superannuation income stream
$
,
.
Taxable component – taxed element of a superannuation lump sum payment
$
,
.
Taxable component – untaxed element of a superannuation lump sum payment
$
,
.
Taxable component – taxed element of a superannuation income stream
$
,
.
Taxable component – untaxed element of a superannuation income stream
$
,
.
Taxable component – taxed element of a superannuation income stream lump sum 
in arrears payment
$
,
.
Taxable component – untaxed element of a superannuation income stream lump sum 
in arrears payment
$
,
.
Tax-free component
$
,
.
Total tax withheld from the above payments
Is this superannuation lump sum payment a death benefit? No Yes Indicate the type of death benefit:
Non-dependant
Trustee of deceased estate
I understand that a person who intentionally makes a false statement in a statutory declaration is guilty of an offence under
section 11 of the Statutory Declarations Act 1959, and I believe that the statements in this declaration are true in every particular.
Signature of person making the declaration
Declared at
on day
of
YearMonth
Before me
Signature of person before whom the declaration is made
Full name of person before whom the declaration is made
Qualification of person before whom the declaration is made
(see page 2 ‘Making and signing the declaration’)
Address of person before whom the declaration is made
Note 1 A person who intentionally makes a false statement in a statutory declaration is guilty of an offence, the
punishment for which is imprisonment for a term of 4 years – see section 11 of the Statutory Declarations Act 1959.
Note 2 Chapter 2 of the Criminal Code applies to all offences against the Statutory Declarations Act 1959
see section 5A of the Statutory Declarations Act 1959.
Page 4
Sensitive (when completed)
Login to HandyPDF
Tips: Editig or filling the file you need via PC is much more easier!
By logging in, you indicate that you have read and agree our Terms and Privacy Policy.