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Payee's Name
(optional):
Has the payee provided a Tax File Number (TFN)?
Yes
No
If the payee has not provided a TFN, is the payee exempt from needing a TFN?
Yes
No
Is the payee an Australian Resident?
Yes
No
Has the payee claimed the Tax Free Threshold?
Yes
No
Amount the payee claimed for Tax offsets
$
Medicare levy variation
Payee claiming exemption from the levy?
No
Half
Full
Payee claiming reduced amount of levy?
Yes
No
Does the payee have a spouse?
Yes
No
Is the combined weekly income of payee and payee's spouse, or the payee's income as a sole parent, less than the relevant amount in table A?
Yes
No
Number of dependent children claimed?
Miscellaneous
Does the payee have an accumulated Higher Education Loan Programme (HELP) debt?
Yes
No
Does the payee have an accumulated Financial Supplement debt?
Yes
No
Payee receives payments:
Weekly
Fortnightly
Monthly
Quarterly
Gross earnings (for the period selected above)?
Disregard any cents in the total amount, unless a monthly amount. (Please do not use commas)
$
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