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Application to register a
PAYG withholding account
WHO SHOULD COMPLETE THIS FORM
Complete this form if you do not have an ABN and you:
n employ people (for example, nannies, housekeepers or
gardeners providing domestic-type services, or carers who
provide caring services) to work directly for you – that is, not
through an agency which supplies and pays these people
n withhold an amount from a payment to a supplier who has
notquoted their ABN
n pay royalties, dividends or interest to non-residents
n report investment income paid to Australian residents.
Do not use this form if you have an ABN.
If you have an ABN, you can register for PAYG withholding:
n through the Business Portal using an AUSkey. For more
information about AUSkey, refer to Online Services.
n by phoning 13 28 66 between 8.00am and 6.00pm,
Mondayto Friday
n through a registered tax or BAS agent.
WHEN COMPLETING THIS FORM
If you are filling in this form on screen:
n download a copy of this form to your computer
n when complete, print two copies
n sign and date the declaration
n mail or fax your completed form to the address shown on
page 5
n keep the second copy for your records.
If you are filling in this form by hand:
n print clearly in BLOCK LETTERS using a black or dark
bluepen
n place X in all applicable boxes
n do not use correction fluid or covering stickers
n check you have signed and dated the declaration
n make a copy for your records
n mail or fax your completed form to the address shown on
page 5.
MORE INFORMATION
Phone us on 13 28 66 between 8.00am and 6.00pm,
Monday to Friday, if you need help completing this form.
If you phone, we need to know we are talking to the right
person before we can discuss your tax affairs. We will ask
you for details only you or someone you’ve authorised
would know. An authorised person is someone recorded
onour systems who can act on your behalf.
Refer to PAYG withholding to access further information
about:
n No ABN withholding – questions and answers
n Step-by-step guide for household employees
n PAYG withholding from interest, dividends and royalties
tonon-residents
n Reporting withholding from investment income payments.
NAT 3377-07.2014
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Section B: Address details
3 What is your main business or residential address?
This must be a street address – for example, 123 Smith Street. It cannot be a post ofce box number, roadside mail bag,
roadside delivery or other delivery point, but it can be a home address if the entity operates a home-based business.
Suburb/town/locality PostcodeState/territory
Suburb/town/locality PostcodeState/territory
4 Is your postal address different from your business or residential address?
This is the address where government departments and agencies will send notices and correspondence.
Provide your postal address below.
Yes
No Go to question 5.
Section A: Applicant information
2 What is your legal name?
Your legal name is the name that appears on all ofcial documents or legal papers –
for example, MR JOHN DAVID SMITH (Individual); or JOHN DAVID SMITH PTY LTD (Non-individual).
We are authorised by the Taxation Administration Act 1953 to request tax file numbers (TFNs). We will use your TFN to
identify you in our records. It is not an offence not to provide TFNs. However, if you do not provide your TFN, there may be a
delay in processing this form.
1 Doyouhaveataxlenumber(TFN)?
Provide your TFN hereYes
No Have you applied for a TFN? No Proof of identity will be required. See below.
Date
Yes
Day Month Year
If you are an individual and have not applied for a TFN, or choose not to disclose it, you must provide a separate sheet of
paperquoting your full name, date of birth, sex and residential address, and include with this application.
If you are not an individual and have not applied for a TFN, or choose not to disclose it, we will contact you about proof of
identity requirements when we receive your application.
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Section D: Registration information
8 When do you expect to commence withholding?
This is the day on which you are rst expected to withhold an amount from a payment – it can be up to six months in the
future. However, we will not process your application until the date you nominate.
If you backdate your PAYG withholding registration, you may be liable for general interest charge on amounts withheld.
Day Month Year
Section C: Contact details
5 What are your contact details?
Provide all details where you can. We may use these details to contact you and send notices and
correspondence about your taxation affairs.
Email address (use BLOCK LETTERS)
After hours phone number Fax number
Business hours phone number
(include area code)
Mobile number
7 Is your authorised contact person a registered tax or BAS agent?
No
Provide their registration numberYes
6 Do you want to nominate an authorised contact person?
Provide details of a person we may contact for more information. They must be authorised to make changes or
update information on your behalf – for example, a registered tax agent.
Yes
No Go to question 8.
For more information about what an authorised contact can do, refer to Primary contacts and authorised contacts.
Email address (use BLOCK LETTERS)
After hours phone number Fax number
Business hours phone number
(include area code)
Mobile number
Family name
First given name Other given names
Title: Mrs Miss Ms Other
Mr
Name
Position held
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Section E: Withholding activity details
9 How much do you expect to withhold over the next 12 months?
This is the estimated annual withholding amount – it is used to determine how often you will pay withholding amounts to us.
Where the annual withholding amount is expected to be:
n less than or equal to $25,000, you must pay quarterly
n between $25,001 and $1,000,000, you must pay monthly
n greater than $1,000,000, you must pay more frequently – we will send you more information on the frequency of payments.
.
00
$
,
,
10 How many employees or other payees do you expect to pay over the next 12 months?
We use this information to provide you with the correct number of payment summaries at the end of the nancial year.
,
11 If you employ people, what activity will they perform?
12 How do you expect to provide payment summaries to your payees and your PAYG withholding annual
report to us?
Electronically
If employing people, we will send you the
applicable payment summary forms.
Paper form supplied by us
For more information, refer to Payment summaries.
13 Are you an investment body that will pay investment income to Australian residents?
Investment income includes interest and dividends. A ‘fund payment’ is a payment generally made by managed
investmenttrusts.
No
Yes
For more information, refer to Annual investment income.
Go to question 15.
14 Will you pay royalties, dividends or interest to non-residents?
No
Yes
For more information on the payment of royalties, dividends or interest to non-residents, refer to PAYG withholding from
interest, dividend and royalty payments paid to non-residents (NAT 12564).
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Lodging this form
Make a copy of this form and any attachments for your own records before you:
n send it as an attachment using the Business, Tax Agent or BAS Agent portals (you need to be registered to deal online
– referto Online Services)
n fax it, with any attachments, to 1300 130 905 (do not include a header or cover sheet because this will delay processing)
n mail it to
Australian Taxation Ofce
PO Box 3373
PENRITH NSW 2740
We aim to process your registration within 28 days of receiving all the necessary information. If your application
isincomplete, incorrect or needs checking, it may take longer. Do not lodge another application during this time.
Section F: Declaration
Only you or a person currently on our records as having authority to act on your behalf can sign this declaration.
Formore information, refer to Primary contacts and authorised contacts.
You MUST SIGN here
Signature
Day Month Year
Date
Before you sign this form
Make sure you have answered all the relevant questions correctly and read the privacy statement below before you sign and
date this page – an incomplete form may delay processing, and we may ask you to complete a new application.
Penalties may be imposed for giving false or misleading information.
Privacy
Taxation law authorises the ATO to collect information and disclose it to other government agencies.
For information about your privacy, go to ato.gov.au/privacy
I declare that:
n I am authorised to make this application, and
n the information given on this form is true and correct.
15 Who is the authorised person signing this declaration? (Complete all fields below.)
Full name of signatory
Business hours phone number
(include area code)
Mobile phone number
Registered tax or BAS agent’s number (if applicable)
Position held (for example, director, registered tax or BAS agent, trustee or partner)
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