Provide details of any previous names, if applicable. You
need to provide certified evidence of their name change – for
example, a marriage certificate, deed poll or change of name
certificate from the Births, Deaths and Marriages registration
office in your country. These documents must be certified
copies. If there is insufficient space, write the details on a
separate page and include it with this form.
Date of birth
Provide your date of birth.
Current residential address
Provide your current residential address.
Current postal address
Provide your current postal address.
If this is the same as the residential address, write ‘AS ABOVE’.
Phone and mobile number
Provide your current phone number including your
Provide your current email address.
Last address in Australia
Provide your last Australian postal address.
Section C: Details of your visa and passport
Passport and visa class
Provide the passport details that you used to enter Australia
as a temporary visa holder. Include the passport number, the
name of the issuing country on the passport and the visa
class number (do not include the visa class description) that
the account holder previously used to enter Australia as a
temporary visa holder.
Date of arrival
Enter the date that you entered Australia.
Date of departure
Enter the date that you departed Australia.
Section D: Departing Australia super payment
Have you received a DASP
To receive a refund or to be assessed for release from current
or future liabilities under Division 293 of the Income Tax
Assessment Act 1997, you must have received a DASP.
If you have not received a DASP then do not complete
Who did you receive your DASP from
A DASP can be received from either a super provider or from
money held with us. This information will help us verify the
information you are providing to support your application.
Ifyou have received a payment from both a super provider
andtheATO, select both options.
If you received your DASP from a super fund, provide the name
of the super fund that sent you the DASP, their ABN (found on
the DASP statement) and your member account number that
your DASP was made from.
Section E: Supporting documentation
You must provide a payment advice from your super fund/s or
the ATO to show you have been paid a DASP. You also need to
provide a certification of immigration status if you received one.
Certification of personal documents
You must have all copies of your original documents certified
byan authorised person. If the original document is not written
in English, there are extra steps detailed below.
The authorised person certifying your documents must sight
the original and certify on the copies that each page is a true
copy by writing or stamping on each page ‘certified true copy’
their printed name
their qualifications (for example, ‘Justice of the Peace’)
2 Division 293 Tax – refund or debt release application for former temporary residents