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Worksheet

Last updated 12 February 2019

Step 1

Collect all the statements for dividends you received or distributions you were entitled to relating to the period from 1 July 2000 to 30 June 2001. Using steps 2 to 7 transfer the information from each statement to the appropriate columns in the worksheet

Column 1
Company or fund

Column 2
Unfranked amounts

Column 3
Franked amounts

Column 4
Imputation credit

Column 1
TFN amounts withheld

-

$

$

$

$

-

$

$

$

$

-

$

$

$

$

-

$

$

$

$

-

$

$

$

$

-

$

$

$

$

Total

S

T

U

V

When transferring the totals for S, T, and U to your form-ignore any cents.

Step 2

Write the company or fund name shown on your statement in column 1.

Step 3

Transfer any unfranked amounts into column 2.

Step 4

Transfer any franked amounts into column 3.

Step 5

Transfer any imputation credit amounts into column 4.

Step 6

Transfer any TFN amounts withheld (or deducted) from dividends into column 5.

Step 7

Repeat steps 2 to 6 if you have more than one dividend or distribution statement.

Step 8

Add up the amounts in columns 2, 3, 4 and 5 and write them in the Total line in the worksheet.

Step 9

Transfer the amount at V on your worksheet to V item 11 on your form. Include any cents.

Step 10

Transfer the amounts at S, T and U to the matching labels at item 11 on your form. Ignore any cents.

Step 11

Add up the amounts shown at S, T and U on your form and write the total at $.

Stop: If the amount at $ is more than $6,000 you cannot use this application form. You will need to lodge a tax return to claim your refund.

Step 12

Read, sign and date your declaration on page 2 of your application form.

Example

Steven received a dividend statement from Teleco Ltd. His statement showed a franked amount of $41.00 and an imputation credit of $21.12.

Teleco Ltd Security holder reference number 018 012 111Date paid 30 October 2000Steven McKay 2 Cable Circle Telegraph Point NSW 2441Fully franked final dividend for hte period ended 30 June 2001.Franked at a 34% tax rate.Class description: Ordinary sharesDividend rate per ordinary share: 7 centsNumber of ordinary shares: 586Imputed credit: $21.12Unfranked amount: nilFranked amount: $41Dividend paid: $41TFN quoted

Steven also received 3 other statements:

JT Corporate Unit Trusts-his dividend statement showed $120.23 unfranked amount.

Koles Bier Pty Ltd-he did not give the company his tax file number (TFN) so his entitlement of $180 unfranked amount had $87.30 tax withheld (therefore he actually received $92.70).

SDW Managed Investment Fund-his distribution statement shows a franked dividend amount of $132 and an imputation credit of $68.

Steven would complete the worksheet like this:

Column 1
Company or fund

Column 2
Unfranked amounts

Column 3
Franked amounts

Column 4
Imputation credit

Column 5
TFN amounts withheld

Teleco Ltd

na

$41.00

$21.12

na

JT Corp Unit Trust

$120.23

na

na

na

Koles Bier Pty Ltd

$180.00

na

na

$87.30

SDW Fund

na

na

na

na

 

na

$132.00

$68.00

na

Total

S $300.23

T $173.00

U $89.12

V $87.30

When transferring the totals for S, T and U to your form-ignore any cents.

This amount includes both the amount received by Steven and the TFN amount withheld ($92.70 + $87.30).

Steven fills out the dividend details at item 11 on his application form like this:

 11 Dividends Label V Tax file numbe amounts withheld from dividends: $87.30 Label S Unfranked amounts: $300 Label T Franked amount: $173 Label U Imputation credit: $89

Steven will receive a refund of $176.30 ($87.30 + $89) providing he has no outstanding tax debts.

End of example

QC16274