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  • $3,080,000.00Taxable Income
  • $13,859.00Tax Free Part
  • $1,360,371.79Tax On Taxable Income
  • $347,250.00TOTAL OFFSETS
  • $0.00Basic offsets
  • $0.00Low Income offset
  • $0.00Mature Age Worker offset
  • $47,550.00Other offset
  • $300,000.00Lump sum
  • $300.00Private Health Insurance Liability
  • $46,200.00Medicare Levy
  • $0.00Surcharge
  • $370,320.12REPAYMENTS
  • $246,880.08HELP
  • $123,440.04SFSS
  • $9,100,000.00TAX CREDIT

Personal Information

Tax file number (TFN)
First name
Other given names
PART A    Electronic Lodgement Declaration (Individual)

This declaration is to be completed where a taxpayer elects to use the Electronic Lodgement Service. It is the responsibility of the taxpayer to retain this declaration for a period of five years after the declaration is made, penalties may apply for failure to do so.

The Tax Office is authorised by the Income Tax Assessment Act 1936, the Income Tax Assessment Act 1997 and the Taxation Administration Act 1953, the A New Tax System (Australian Business Number) Act 1999 and the Superannuation (Unclaimed Money and Lost Members) Act 1999 to ask for information in this form. We need this information to help us to administer the taxation and superannuation laws.

We may give this information to other government and non-government organisations specified in the taxation and superannuation laws to receive it-for example, benefit payment agencies such as Centrelink, the Department of Education, Employment and Workplace Relations and the Department of Families, Housing, Community Services and Indigenous Affairs; law enforcement agencies such as state and federal police: and other agencies such as the Child Support Agency, the Australian Bureau of Statistics and the Reserve Bank of Australia and superannuation funds. The Commissioner of Taxation, as Registrar of the Australian Business Register, may use the ABN and business details which you provide on this tax return to maintain the integrity of the register.

Your tax file number
You do not have to quote your TFN. However, you cannot lodge your income tax form electronically if you do not quote your TFN.

Electronic funds transfer - direct debit
Where you have requested an EFT direct debit some of your details will be provided to your financial institution and the Tax Office's sponsor bank to facilitate the payment of your taxation liability from your nominated account.

Tax file number   421017401   Name   ALI BAHMAD   Year   2013

I declare that:

  • the information provided to my registered tax agent for the preparation of this tax return, including any applicable schedules is true and correct, and
  • the agent is authorised to lodge this tax return.


Important: The tax law imposes heavy penalties for giving false or misleading information.



Day   Month     Year

This declaration is to be completed when an electronic funds transfer (EFT) of a refund is requested and the tax return is being lodged through the electronic lodgment service (ELS).

The declaration must be signed by the taxpayer prior to the EFT details being transmitted to the Tax Office. If you elect for an EFT, all details below must be completed.


Important: Care should be taken when completing EFT details as the payment of any refund, including any family tax benefit, will be made to the account specified.

Agent's reference number  69399005    Account holder name             

I authorise the refund to be deposited directly to the specified account as above.



Day   Month     Year
ALI BAHMAD [Ref. : 113303218]

IN-CONFIDENCE-when completed

Family name











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