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College of Arts, Society & Education
Pay Claim Guide
Instructions
At the end of the professional experience, please complete the Pay Claim Form and Tax File Number Declaration
form.
1. Personal Details
All fields are mandatory. The date of birth (DOB) field is required to correctly identify people with the same name.
Please note; JCU’s default superfund is Uni Super however we will process into QSuper. If QSuper is selected
please complete the QSuper form below.
2. Claim Details
Enter the Pre-Service Teachers full name, Pre-service Teacher Year Level, Placement Dates
SBTE (School Based Teacher Educator)
Enter the hours of Supervision; note the maximum allowance is five hrs per day.
Site Coordinator
Enter the number of Coordination Days. Then the number of group talks held in hours.
3. Total
Enter a total in each section.
4. Banking Details
All fields are mandatory.
5. Certification
Both SBTE (School Based Teacher Educator) and Site Coordinator/Centre Director to sign.
6. Submit Form
The completed claim form and Tax File Number Declaration Form should be forward to the College Placement Team,
James Cook University via email to eduprofex@jcu.edu.au
Pay Rate
Supervision Payment Rate: $6.00 per hour (max $30 per day) from 1st Jan 2020.
Coordination Days Rate: $1.44 per PST per day
Group Talks Payment Rate: $12.28 per hour
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College of Arts, Society and Education
Pay Claim Form
Personal Details
Home Address
Title Phone Number
Claimant’s Surname Email
Claimant’s First Name Name of School
Previous Surname
Tax File Number Declaration Submitted
Date of Birth Uni Super QSuper (please complete
the QSuper Form)
Banking Details
Name of Bank BSB
Account Name Account Number
JCU CASE Education USE ONLY
FUNDING ACCOUNT:
2221.11102.0001.7050
Certified by (Signature): Date
HR OFFICE USE ONLY
Personal Record Processed Timesheet Processed: Timesheet Checked: Employee No.: Job No.:
Claim Details
Name of Pre-Service Teacher
Pre-Service
Teacher
Year Level
Placement Dates
SBTE
SITE COORDINATOR
Hours of
Supervision
(Max 5 hrs
per day)
Number of
Coordination
Days
of Group
Talks
TOTAL
Certification
SBTE:
I certify that the above details are correct.
Signature Date
Site Coordinator/Centre Director:
I certify that the above details are correct.
Name
Signature
Date
Please Select
0
0
0
Please Select
Please Select
Please Select
Please Select
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit
5 What is your primary e-mail address?
4 What is your business address?
Suburb/town/locality
State/territory Postcode
There are penalties for deliberately making a false or misleading statement.
Signature of payer
DECLARATION by payer: I declare that the information I have given is true and correct.
Month
Year
Day
Date
2 If you don’t have an ABN or withholding
payer number, have you applied for one?
Yes
No
Section B: To be completed by the PAYER (if you are not lodging online)
Branch number
(if applicable)
1 What is your Australian business number (ABN) or
withholding payer number?
6 Who is your contact person?
Business phone number
7 If you no longer make payments to this payee, print X in this box.
Return the completed original ATO copy to:
Australian Taxation Office
PO Box 9004
PENRITH NSW 2740
IMPORTANT
See next page for:
 payer obligations
 lodging online.
ato.gov.au
This declaration is NOT an application for a tax file number.
 Use a black or blue pen and print clearly in BLOCK LETTERS.
 Print X in the appropriate boxes.
 Read all the instructions including the privacy statement before youcomplete this declaration.
Tax le number declaration
Once section A is completed and signed, give it to your payer to complete sectionB.
NAT 3092-06.2019 [DE-6078]
Section A: To be completed by the PAYEE
7 On what basis are you paid? (select only one)
Full‑time
employment
Part‑time
employment
Casual
employment
Superannuation
or annuity
income stream
Labour
hire
9 Do you want to claim the tax-free threshold from this payer?
Answer no here if you are a foreign resident or working holiday
maker, except if you are a foreign resident in receipt of an
Australian Government pension or allowance.
No
Yes
Only claim the tax‑free threshold from one payer at a time, unless your total income from
all sources for the financial year will be less than the tax‑free threshold.
There are penalties for deliberately making a false or misleading statement.
You MUST SIGN here
Signature
Month YearDay
Date
DECLARATION by payee: I declare that the information I have given is true and correct.
10 Do you have a Higher Education Loan Program (HELP), VET Student
Loan (VSL), Financial Supplement (FS), Student Start-up Loan (SSL) or
TradeSupportLoan (TSL) debt?
Your payer will withhold additional amounts to cover any compulsory
repayment that may be raised on your notice of assessment.
Yes
No
OR I have made a separate application/enquiry to
the ATO for a new or existing TFN.
For more
information, see
question 1 on page 2
of the instructions.
OR I am claiming an exemption because I am under
18 years of age and do not earn enough to pay tax.
OR I am claiming an exemption because I am in
receipt of a pension, benefit or allowance.
1 What is your tax
le number (TFN)?
2 What is your name?
Title: Mr Mrs Miss Ms
Surname or family name
First given name
Other given names
4 If you have changed your name since you last dealt with the ATO,
provideyour previous family name.
6 What is your date of birth?
Month YearDay
3 What is your home address in Australia?
Suburb/town/locality
State/territory Postcode
Sensitive (when completed)
3 What is your legal name or registered business name
(or your individual name if not in business)?
An Australian resident
for tax purposes
A foreign resident
for tax purposes
A working
holiday maker
8 Are you: (select only one)
30920619
5 What is your primary e-mail address?
OR
Print form
Save form
Reset form
Personal details
Client number
You can find your client number on your annual Super
Statement orbylogging in to Member Online.
Title Given names
Surname
Payroll/employee ID (if this is applicable)
Date of birth (dd/mm/yyyy) Tax file number
3
I am the person named on this form and would like my future
employer contributions to be paid to QSuper.
Signature
Date (dd/mm/yyyy)
Please give this signed form to your employer – you do not need
toforward it to QSuper.
Employer use only
Date accepted (dd/mm/yyyy) Date processed (dd/mm/yyyy)
Paying into QSuper is easy
Clearing houses: QSuper accepts payments through a number of
clearing houses. If you already use a clearing house, contact your
provider to see if you can use them to pay QSuper. If you are unsure
whether a clearing house is right for you, call QSuper’s Employer
Solutions team on 1300 472 282.
Please note: Please note: QSuper does not accept cheques, direct
deposits or BPAY® contributions.
QSuper’s details
Product issued by the QSuper Board (ABN 32 125 059 006,
AFSL489650) as trustee for QSuper (ABN 60 905 115 063)
USI 60905115063001
MySuper Authorisation Number 60905115063329
Postal Address: GPO Box 200 Brisbane Qld 4001
Telephone: 1300 360 750 (+617 3239 1004 if overseas)
Monday to Thursday 8.30am – 5.00pm AEST
Friday 9.00am – 5.00pm AEST
W
ebsite: qsuper.qld.gov.au
QSuper’s statement of compliance
QSuper is a complying resident regulated superannuation fund as
defined in theSuperannuation Industry (Supervision) Act 1993 and
hasnot receivedeither of the following:
A notice of non-compliance from the Australian Prudential
Regulation Authority (APRA)
A notice from APRA advising QSuper not to accept contributions
made by an employer.
QSuper can accept contributions from other superannuation and
rollover funds and from employers on behalf of their employees who
are eligible QSuper members. You can find more information about
this atqsuper.qld.gov.au
A B
Choose QSuper as Your Super Fund
When should I use this form?
You can use this form to ask your employer to pay your super contributions to QSuper if:
You have applied to join QSuper directly
You are already a QSuper member and want to stay with QSuper when you move to a new job even if it is not with the Queensland Government.
By choosing QSuper, you can be part of SuperRatings Choice Super of the Year 2018
1
and enjoy outstanding results andaward-winning service
2
.
Please complete Part A of this form and give it to your employer. They will take care of the rest.
1 Past performance is not a reliable indicator of future performance. Choice Super of the Year 2018 SuperRatings Awards. SuperRatings does not issue, sell, guarantee
or underwrite this product. Go to www.superratings.com.au for details of its ratings criteria. Ratings, awards or investment returns are only one factor that you should
consider when deciding how to invest your super. 2 Chant West Best Fund: Investments 2017 and Best Fund: Member Services 2016. Chant West does not issue, sell,
guarantee or underwrite this product. Go to www.chantwest.com.au for details of its ratings criteria. Past performance is not a reliable indicator of future performance.
3An employer is authorised to collect an employee’s TFN under the Superannuation Industry (Supervision) Act 1993. It is not an offence for an employee not to quote
their TFN. However, quoting a TFN reduces the risk of administrative errors and if the employee does not quote their TFN their contributions may be taxed at a higher
rate. An employee can get more details regarding their privacy rights by contacting their superannuation fund.
© QSuper Board 2018.
ABN 60 905 115 063
SFN 261041941
DTMC-871 01/18 FO99
Member Centres 70 Eagle Street Brisbane, 63 George Street Brisbane
andSunshine Coast University Hospital, 6Doherty Street Birtinya
Telephone 1300 360 750 (+617 3239 1004 if overseas)
Monday to Thursday 8.30am – 5.00pm AEST, Friday 9.00am – 5.00pm AEST
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