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Worksheet

Last updated 12 February 2019

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-do not show 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 at TOTAL on the worksheet.

Step 9

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

Step 10

Transfer the amounts at S, T and U on your worksheet to S, T and U item 11 on your application. Do not show any cents.

Step 11

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

Stop

If you are over 18 years of age on 30 June 2002 and the amount at $ is more than $6,000, or you are under 18 years of age on 30 June 2002 and the amount at $ is more than $416, you cannot use this application. 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.

Example

Steven received a dividend statement from Teleco Ltd. His statement showed a franked amount of $42.00 and an imputation credit of $18.00.

Teleco Ltd

   
 

Security holder reference number

Date period

Steven Mckay
2 Cable Circle
Telegraph Point
2441 NSW

018 012 111

30 October 2001

   
 

Fully franked final dividend for the period ended 30 June 2002.
Franked at a 30% tax rate

Class
description

Dividend rate
per ordinary share

Number of
ordinary shares

Imputed
credit

Unfranked
amount

Franked
amount

Ordinary shares

7 cents

600

$18.00

 

$42.00

TFN quoted

Dividend paid $42.00

Note

This is just one example of a statement. There are many different formats.

Steven also received 3 other statements:

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

Koles Bier Pty Ltd-he did not give the company his 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 $131 and an imputation credit of $56.14.

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

 

42.00  

18.00  

 

JT Corp Unit Trust

120.23  

     

Koles Bier Pty Ltd

180.00* 

   

87.30  

SDW Fund

 

131.00  

56.14  

 
         

Total

S

T

U

V

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

Steven completes the dividend details at item 11 on his application like this:

11-Dividends

Pages 4-5 in the instructions include 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

74

Tax file number amounts withheld from dividends

Show dollars and cents.

V 87.30

Do not show cents

Steven will receive a refund of $161.30 ($ 87.30 + $74) if he has no outstanding tax debts.

QC95681