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  • Worksheet

    Attention

    Warning:

    This information may not apply to the current year. Check the content carefully to ensure it is applicable to your circumstances.

    End of attention

    Column 1

    Column 2

    Column 3

    Column 4

    Column 5

    Company or fund

    Unfranked amounts

    Franked amounts

    Imputation credit

    TFN amounts withheld

     

    $

    cents

    $

    cents

    $

    cents

    $

    cents

             
             
             
             
             

    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

    Date period

    Steven Mckay
    2 Cable Circle
    Telegraph Point
    2441 NSW

    018 012 111

    30 October 2000

       
     

    Fully franked final dividend for the period ended 30 June 2001.
    Franked at a 34% tax rate

    Class
    description

    Dividend rate
    per ordinary share

    Number of
    ordinary shares

    Imputed
    credit

    Unfranked
    amount

    Franked
    amount

    Ordinary shares

    7 cents

    586

    $21.12

     

    $41.00

    TFN quoted

    Dividend paid $41.00

    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

    Column 2

    Column 3

    Column 4

    Column 5

    Company or fund

    Unfranked amounts

    Franked amounts

    Imputation credit

    TFN amounts withheld

     

    $

    cents

    $

    cents

    $

    cents

    $

    cents

    Teleco Ltd

     

    41.00

    21.12

     

    JT Corp Unit Trust

    120.23

         

    Koles Bier Pty Ltd

    180.00

       

    87.30

    SDW Fund

           
       

    132.00

    68.00

     

    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

    the instructions includes a worksheet to help you complete these amounts if you have more than one statement.

    Unfranked amount

    S

    300

     

    Franked amount

    T

    173

     

    Imputation credit

    U

    89

     

    Tax file number amounts
    withheld from dividends

    Show dollars and cents.

    V 87.30

     

    Do not show cents

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

    Last modified: 23 Dec 2005QC 16274