How to complete this form

On this page

• Avoiding common errors
• Section A: Payee details
• Section B: Payment details
• Section C: Payer details

To complete this form you must:

• write each letter in a separate box
• use a black pen
• use BLOCK LETTERS.

You do not have to complete every field. For example, where an amount has not been paid or withheld, leave those boxes blank.

Show all amounts in whole dollars – do not show cents. For example, show an amount of $122.76 as $122.

Find out about:

• After completing this form

Avoiding common errors

Section A: Payee details

Tax file number

You must show the tax file number (TFN) the payee quoted in this field. For example, show a nine-character TFN as:

To help us process your form, you must substitute the TFN with the numbers listed below where:

• a new payee has not made a TFN declaration, but 28 days have not passed – use 111 111 111
• the payee is under 18 years old and earnings do not exceed $350 per week, $700 per fortnight or $1,517 per month – use 333 333 333
• the payee is an Australian Government pensioner payee – use 444 444 444
• the payee chose not to quote a TFN and has not claimed an exemption from quoting a TFN or does not fit into any of the above categories – use 000 000 000.

Name

Separate the surname or family name from the given names and print in the appropriate boxes. For example, show Jane Mary Covers as:

Residential address

You must show the street number and name, suburb/town/locality, state or territory and postcode separately in the boxes provided. For example, show the address 2 Bell St, Ablem WA 6999 as:

Date of birth (if known)

Provide this information if you have it. Use the format DDMMYYYY, for example:

Death benefit (Reversionary income stream)

Is the payee under 60 years old and a death benefits dependant, where the deceased died at 60 years old or over?

This is used to calculate the payee's defined benefit income cap for payee's receiving capped defined benefit income streams.

Answer 'Yes' to this question if the payee is receiving a reversionary capped defined benefit income stream and is under 60 years old, and where the deceased died at 60 years or over.

Answer 'No' to this question where any of these apply:

• the member is 60 years old or over
• the member is not in receipt of a reversionary income stream
• the member is under 60 years old and a death benefits dependent, but the deceased had not yet turned 60.

Section B: Payment details

Period during which payments were made

Show the period during which the payments were made to the payee. Use the format DD/MM/YYYY.

For a payee receiving an account-based pension income stream you are only required to provide the payee with a payment summary where you have a withholding obligation.

For a payee receiving a capped defined benefit income stream, the period that you report on your payee's payment summary will affect their defined benefit income cap.

Where the payee:

• has been in receipt of a super income stream for the entire year, show the period as 1 July to 30 June
• starts the super income stream during the year, show the starting date of the first payment
• has a super income stream prior to turning 60 during the financial year, show the period prior to turning 60, the end date will be the day before the payee's birthday
• has a capped defined benefit income stream after turning 60 in the financial year, the period should be the payee's birthday to the end of the period
• has a reversionary death benefit income stream, then the start date is the later of 1 July in that financial year or the date the deceased died
• ends the super income stream during the year, show the date of the last payment.

For example, a part year period of 25 September 2017 to 4 January 2018 is shown as:

You will need to provide the payee with multiple payment summaries in the following circumstances:

• the payee is in receipt of a capped defined benefit income stream and they turned 60 during the year. You will need to provide one payment summary for the period they were 59 and a second payment summary for the period they were 60
• the payee is under 60 and receives their own income stream, and also a death benefit capped defined benefit income stream (reversionary) where the deceased was 60 or older at the time of death. You will need to provide two payment summaries, one for each income stream
• the payee turned 60 during the year and is in receipt of their own income stream and a reversionary income stream where the deceased was 60 or older at the time of death. You will need to provide four payment summaries. One payment summary for the period the payee was 59 and a second payment summary for the period the payee was 60, for each capped defined benefit income stream.

Note: The Death benefit (Reversionary income stream) field and the periods that you report on your payee's payment summary will assist your payee in calculating their defined benefit income cap and their assessable capped defined benefit income, where applicable.

Total tax withheld

Show the total tax withheld in whole dollars. For example, show $12,672.70 as:

Taxable component

The taxable component of a super benefit may consist of a taxed element and/or an untaxed element, depending on whether the benefit is paid from a taxed or untaxed source. The taxable component of a super benefit consists of the following:

• taxed element
• an untaxed element.

The taxed element and untaxed element should be shown in whole dollars.

For example, show a super capped defined benefit income stream paid to a person 62 years old with a taxable component comprised of a taxed element of $17,553.24 and an untaxed element of $13,669.88 as:

See also:

• Calculating components of a super benefit

Tax-free component

For super income streams from 1 July 2007, the tax-free component is made up of the:

• contributions segment
• crystallised segment.

If there is a tax-free component to report, show it in whole dollars. For example, show a tax-free component of $6,594.55 as:

See also:

• Taxation of super benefits

Note the tax-free component will now be taken into consideration when your payee calculates their additional assessable amount from a capped defined benefit income stream.

Tax offset amount

You only need to report a tax offset amount where the payee is under 60 years old, has a taxed element and:

• is above the preservation age or is in receipt of a disability super income stream, and
• the income stream is not a reversionary capped defined benefit income stream where the deceased was over 60 at the time of death.

The tax offset is an amount equal to 15% of the taxed element.

Where the payee is over 60, or is under 60 and in receipt of a reversionary income stream where the deceased was over 60, do not show the tax offset for a capped defined benefit income stream.

Show the amount of the tax offset in whole dollars. For example, show a tax offset amount of $3,589.14 as:

Lump sum in arrears – taxable component

This is the taxable component of payments received as a lump sum (or single payment) for a super income stream amount that accrued in a previous year or years. The taxable component of a lump sum in arrears payment of a super benefit may consist of:

• taxed element
• an untaxed element
• taxed and untaxed elements.

Show these elements in whole dollars.

Lump sum in arrears – tax-free component

This is the tax-free component of payments received as a lump sum (or single payment) for a super income stream amount that accrued in previous year or years.

Show this amount in whole dollars.

Section C: Payer details

Payer's Australian business number (ABN) or withholding payer number (WPN)

As a payer, you must have either an ABN or WPN.

Show your ABN or WPN as it appears on your activity statement.

For example, show an ABN of 12 345 678 912 as:

Branch number

If a business has one ABN but multiple branches, each branch has an individual branch number. Show your branch number in the boxes provided. If you do not have a branch number, leave the boxes blank.

Name

Show your name as it appears on your activity statement.

For example, show ABC Pty Ltd as:

Declaration

Only the payer, or a person authorised to sign on the payer's behalf, can sign. You can print or type the name of the person authorised to sign the form. You must keep details of the authorised person with your records.

For details about the personal information we collect from you see Privacy notice – PAYG payment summary – superannuation income stream.