Empdupe Version 5.0 Produced by Data-Tech Software Phone (03) 9222 9777 Fax (03) 9222 9888
Signature:
Date Received:
Process Number:
FOR OFFICE USE
Australian Taxation Office
Magnetic Information Processing Services
REPLY PAID NO. 57
P.O.BOX 900
CANBERRA ACT 2608
(for floppy disk)
Delivery Address:
Other Comments:
Method of dispatch:
Date sent to Tax Office:
Does this media contain TEST data? (Y/N):
Media Identifier:
Please write an identifier on the outside of your floppy disk and show this below
Media Type:
Fax Number:
Telephone:
Contact Name:
Postcode:
State:
Postal Address
Suburb or Town:
Number/Street:
Business Address
Supplier Name:
SUPPLIER NUMBER:
Financial Year Ending:
EA
GROUP CERTIFICATE REPORT
This media contains
INFORMATION LINE number 1800 642 933
This form must be enclosed with Test or Production Data
MAGNETIC MEDIA INFORMATION
Floppy Disk
The amount at D represents a tax-free bona fide redundancy payment or approved early-retirement scheme payment. The amount is not to be included on your income tax return.
The amount at C is an Eligible Termination Payment. Full details of this amount are contained in the Statement of Termination Payment issued to you when the payment was made.
The amount at B was paid to you for unused long service leave which accrued before 16th August 1978. Only 5% of this amount is taxable.
The amount is assessable in full, however the marginal rate of tax will not exceed 31.5%.
unsued long service leave or unused annual leave and leave loading that accrued after 17th August 1993 are shown in the Gross Salary and Wages box.
August 1993, if you did not leave your job because of bona fide redundancy or invalidity or under an approved Early Retirement Scheme. Amounts paid to you in respect of
* for unused long service leave that accrued after 15th August 1978 and before 18th August 1993 or for unused annual leave and leave loading that accrued before 18th
under an approved Early Retirement Scheme; or
* for unused long service leave accrued after 15th August 1978 or for unused annual leave and leave loading, if you left your job because of bona fide redundancy or invalidity or
The amount at A was paid to you:
LUMP SUM PAYMENTS ON TERMINATION OF EMPLOYMENT
Where no tax has been deducted and the employee is required to lodge an income tax return, this certificate should be included in the return.
(ii) If the value of this certificate is more than the assessment, a refund cheque will be posted.
(i) If the value of this certificate is less than the assessment, the balance must then be paid by the date due shown on the notice of assessment, or
(b) If tax is payable, a notice of assessment will issue and credit will be allowed thereon for the value of this certificate.
(a) If tax instalments have been deducted and no tax is payable, an advice will be issued and a refund cheque will be posted.
you. Where this certificate is to be enclosed with an income tax return, the certificate and the return will be dealt with as follows:
Eligible Termination Payment shown in the lump sum payment block, in which case you should refer to the notes attached to the Statement of Termination Payment issued to
instalments have been deducted. This certificate must be enclosed with the return unless you intend to apply for full or part refund of the tax instalment component of an
