• ## Instructions for the worksheet

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

If you have more than one dividend or distribution statement, follow these steps to fill in the worksheet and calculate the amounts to show at item 11 on your application.

### Step 1

Collect all the statements for dividends you received and for distributions you were entitled to for the period 1 July 2010 to 30 June 2011. Using steps 2 to 4, transfer the information from each statement to the appropriate columns in the worksheet.

### Step 2

Print the company or fund name shown on your statement under Company or fund.

### Step 3

Write the amount of any unfranked (or supplementary), franked or franking credit amounts in the appropriate columns.

If your dividend is from a New Zealand company, and

• you paid New Zealand non-resident withholding tax on that dividend
• that company paid you a supplementary dividend

then you must subtract the amount of that supplementary dividend from the amount of franking credits that you include in the worksheet.

Do not include New Zealand imputation credits in column 4 (only include Australian franking credits).

Note

If your statement does not show the franked and unfranked portions of the dividend, include the total dividend amount in column 3 Franked amount.

### Step 4

Write any TFN amounts withheld (or deducted) from dividends in column 5.

### Step 5

Add up the amounts in columns 2, 3, 4 and 5 and write the total for each column at Total - S, T, U and V respectively on the worksheet.

### Step 6

Print X at the YES box at item 11 on your application, if you have received:

• any dividend distributions from a managed fund, or
• Australian franking credits from a dividend paid by a New Zealand company.

### Step 7

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

### Step 8

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

### Worksheet

Column 1

Column 2

Column 3

Column 4

Column 5

Company or fund

Unfranked amount
S

Franked amount
T

Franking
credit
U

TFN amount
withheld
V

\$     cents

\$     cents

\$     cents

\$     cents

Total

S

T

U

V

Transfer the totals for S, T and U to your application. Do not show cents.

Transfer the total for V to your application. Show cents.

Note

This worksheet is to help you work out the amounts you need to put on your application. You do not need to send this worksheet to us.

Example

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

The statement below is just an example. There are many different formats of statements.

 Teleco Ltd Steven McKay2 Cable CircleTelegraph Point NSW 2441 Security holder reference number 018 012 111 Date paid 30 October 2010 Fully franked final dividend for the period ended 30 June 2010. Franked at a 30% tax rate. Class description Dividend rate per ordinary share Number of ordinary shares Franking credit Unfranked amount Franked amount Ordinary shares 7 cents 600 \$18.00 \$42.00 TFN quoted Dividend paid \$42.00

Steven also received three other statements:

• JT Corporate Unit Trust - his dividend statement showed \$120.73 unfranked amount.
• Koles Bier Pty Ltd - he did not give the company his TFN so his entitlement of \$180 unfranked amount had \$83.70 tax withheld (therefore he actually received \$96.30).
• SDW Managed Investment Fund - his distribution statement shows a franked dividend amount of \$131 and a franking 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 amountT Franking creditU TFN amount withheldV \$     cents \$     cents \$     cents \$     cents Teleco Ltd 42.00 18.00 JT Corp Unit Trust 120.73 Koles Bier Pty Ltd 180.00 83.70 SDW Fund 131.00 56.14 TOTAL S 300.00 T 173.00 U 74.14 V 83.70 Transfer the totals for S, T and U to your application. Do not show cents. Transfer the total for V to your application. Show cents.

* This amount includes both the amount received by Steven and the TFN amount withheld (\$96.30 + \$83.70).

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

 11 Dividends Do not show cents If you have more than one dividend or distribution statement, see pages 3-5 in the instructions. Unfranked amount S 300 Franked amount T 173 Franking credit U 74 Did you receive any dividend distributions from a managed fund or Australian franking credits from a New Zealand company? YES X Tax file number amounts withheld from dividends V 83.70

Steven will receive a refund of \$157.70 if he has no outstanding tax debts. This is made up of the amount withheld because he didn't provide his TFN (\$83.70) plus his franking credit (\$74).

End of example