• ## Instructions for the worksheet

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 10 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 2015 to 30 June 2016. 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, and
• 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).

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 10 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 10 on your application. Do not show cents.

### Step 8

Transfer the amount at V on your worksheet to V at item 10 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.

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 McKay
2 Cable Circle
Telegraph Point NSW 2441

Security holder reference number
018 012 111

Date paid
30 October 2015

Fully franked final dividend for the period ended 30 June 2015.
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 amount
S

Franked amount
T

Franking credit
U

TFN amount withheld
V

\$     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 300.73

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).

 10 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