Refund of Franking Credits

Your Name*

First Last

Date of Birth*

Email*

Enter Email Confirm Email

Telephone*

Address

Address (line1)*

Address (line2)

City/Suburb

State/Territory*

Post Code*

Your Spouse's Name

First Last

Bank Account Details

This is the bank account where you want the refund of your franked dividends to be paid

BSB*

Account Number*

Do you have any investments in a managed fund?*

As you have selected Yes what is the name of the Fund?

Cost of Refund for each year requested is

Price:

Enter Number of Years you wish to claim*

Please enter a number from 1 to 10.

If you want to claim for years prior to 2006-2007 you will need to have the dividend statements yourself as the ATO will not have a record. You will need to mail copies of these statements to us at PO Box 82, Mackay 4740 along with a printed copy of this form. We will ring you and discuss what is involved and organise payment.

Total

$ 0.00

Please Enter financial years here that you are claiming for:*

For example, if you wish to claim for 2006-2007 and 2007-2008 please enter: 2006-2007, 2007-2008.

I declare that all the information provided above is true and correct in every detail. I authorise BAN TACS Accountants Pty Ltd to apply for a refund of my franking credits on my behalf and to act as my tax agent. I declare that my taxable income is below the taxable threshold for the relevant year. I confirm that I am a resident of Australia for tax purposes. Further, I declare that I have not lodged a tax return for the relevant year. I understand that there may be extra charges if I want to claim franking credits for shares in companies that have not reported my dividend to the ATO but I will be contacted before further costs are incurred.

Signature*

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Name

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