How to complete the statement

Section A: Supplier information

Complete this section if you are the supplier of the AVA statement information. For example, if you are any of the following:

  • a tax agent
  • an accountant
  • a super administrator
  • the provider.

Question 1
Tax file number (TFN)

Provide your TFN.

Question 2
Australian business number (ABN)

Provide your ABN.

Question 3
Tax agent number (TAN)

Provide your TAN if you are a tax agent reporting the contributions information on behalf of the provider.

Question 4
Organisation name

Provide the full name of your organisation.

Question 5
Street address

Provide your street address, not a post office box.

Question 6
Postal address

Provide your postal address for service of notices.

Question 7
Contact person

Provide details of a person who may be contacted if we have any questions about the information in the statement.

Question 8

Provide a reference that you will find useful in identifying the statement if we need to contact you about the information given in the statement.

Question 9

The statement must be signed and dated by the person supplying the statement to us.


The statement will be returned if it is not signed.

End of attention
Last modified: 05 Jul 2014QC 37248