Tax return for individuals

1 July 2016 to 30 June 2017

2017
Use Individual tax return instructions 2017 to fill in this tax return.
n Print clearly using a black pen only.
n Print X in all appropriate boxes.
n Use BLOCK LETTERS and print one character in each box. n Do not use correction fluid or tape.
S M I T H S T n Complete your details carefully to avoid delays
in processing your tax return.

25410617
Individual information
See the Privacy note in the Taxpayer’s
Your tax file number (TFN) declaration on page 10 of this return.

Are you an Australian resident? Yes No

Your name (Print your full name)

Title: Mr Mrs Miss Ms Other
Surname or family name

First given name Other given names

Has any part of your name changed See Completing individual information on your
since completing your last tax return? No Read on. Yes tax return on page 8 of the instructions.

Your postal address Print the address where you want your mail sent.

Suburb/town/locality State/territory Postcode

Country if not Australia

Has this address changed since
completing your last tax return? No Yes

Is your home address different from

No Read on. Yes Print your home address below.
your postal address?

Suburb/town/locality State/territory Postcode

Country if not Australia

Your contact details Your daytime phone number

Your mobile phone number (if different from your mobile phone number)

Your email address

Your contact details may be used by the ATO:

n to advise you of tax return lodgment options
n to correspond with you with regards to your taxation and superannuation affairs
n to issue notices to you, or
n to conduct research and marketing.

NAT 2541-06.2017 Sensitive (when completed) Page 1

Will you need to lodge an Australian
Yes Don’t know No FINAL TAX RETURN
tax return in the future?

Your date of birth Day Month Year

If you were under 18 years old on 30 June 2017 Provide your date of birth to avoid delays in
you must complete item A1 on page 7. the processing of your tax return.

Electronic funds transfer (EFT)

We need your financial institution details to pay any refund owing to you, even if you have provided them to us before.
Write the BSB number, account number and account name below.

BSB number (must be six digits) Account number

Account name (for example, JQ Citizen. Do not show the account type, such as cheque, savings, mortgage offset)

Income
1 Salary or wages Your main salary and
wage occupation
Payer’s Australian business number Tax withheld – do not show cents Income – do not show cents TYPE

$ .00 C $ .00
, ,
TYPE

$ .00 D $ .00
, ,
TYPE

$ .00 E $ .00
, ,
TYPE

$ .00 F $ .00
, ,
TYPE

$ .00 G $ .00
, ,

2 Allowances, earnings, tips, director’s fees etc $ .00 K $ .00

, ,
3 Employer lump sum payments Amount A in lump sum payments box TYPE

$ .00 R $ .00
, ,
5% of amount B in lump sum payments box
$ .00 H $ .00
, ,
4 Employment termination payments (ETP)
Day Month Year Taxable component CODE
Date of
$ .00 I $ .00
payment , ,
Payer’s
ABN
5 Australian Government allowances and
payments like Newstart, Youth Allowance $ .00 A $ .00
, ,
and Austudy payment
6 Australian Government pensions and allowances .00 B $ .00
You must complete item T1 in Tax offsets. $ , ,
7 Australian annuities and superannuation .00
income streams
$ ,
Taxable component Taxed element J $ .00
,
Untaxed element N$ .00
,
Lump sum in arrears – taxable component Taxed element Y$ .00
,
Untaxed element Z$ .00
,

Page 2 Sensitive (when completed) TAX RETURN FOR INDIVIDUALS 2017

 Your tax file number (TFN)
Attach here all documents that the instructions tell you to attach.
Do not send in your tax return until you have attached all requested attachments.

25410717
Income – continued
Tax withheld – do not show cents Income – do not show cents
8 Australian superannuation lump sum payments .00
Day Month Year
$ , TYPE
Date of
Taxable component Taxed element Q$ .00
payment ,
Payer’s
Untaxed element P$ .00
ABN ,
9 Attributed personal services income $ .00 O $ .00
, ,
.00 Do not include
TOTAL TAX WITHHELD Add up the $ boxes. $ , , total income here

Income – do not show cents

10 Gross interest
If you are a foreign-resident make sure you have printed Gross interest L $ .00
, ,
your country of residence on page 1.
Tax file number amounts .
withheld from gross interest
M$ ,
11 Dividends .00
Unfranked amount S$ , ,
If you are a foreign-resident make sure you have printed
your country of residence on page 1.
Franked amount T$ .00
, ,
Tax file number amounts .00
withheld from dividends V $ , . Franking credit U$ , ,
12 Employee share schemes
Discount from taxed upfront
D$ .00
schemes – eligible for reduction , ,
Discount from taxed upfront schemes
E$ .00
– not eligible for reduction , ,
Discount from deferral schemes F $ .00
, ,
Discount on ESS Interests acquired
pre 1 July 2009 and ‘cessation time’ G$ .00
, ,
occurred during financial year
Total assessable discount amount B$ .00
, ,
TFN amounts withheld from discounts C$ , , .

Foreign source discounts A$ .00

, ,
LOSS
I If you completed the Tax return for individuals (supplementary .00
section) 2017, write here the amount from TOTAL SUPPLEMENT INCOME $ , ,
OR LOSS on page 15.
LOSS
TOTAL INCOME Add up the income amounts and deduct any loss amount in the $ boxes .00
OR LOSS on pages 2 and 3. $ , ,
TAX RETURN FOR INDIVIDUALS 2017 Sensitive (when completed) Page 3
Deductions
CLAIM

D1 Work-related car expenses A$ .00

, TYPE

D2 Work-related travel expenses B$ .00

You must read ,
the deductions
D3 Work-related uniform, occupation specific CLAIM
section in the .00
instructions if you
or protective clothing, laundry and dry C$ ,
are claiming cleaning expenses TYPE

deductions for CLAIM

expenses that relate D4 Work-related self-education expenses D$ .00
to your work as an , TYPE
employee at items
D1–D6. D5 Other work-related expenses E$ .00
,
D6 Low value pool deduction K$ .00
,
D7 Interest deductions I $ .00
,
D8 Dividend deductions H$ .00
,
D9 Gifts or donations J $ .00
,
D10 Cost of managing tax affairs M$ .00
,
D If you completed the Tax return for individuals (supplementary section) $ .00
2017, write here the amount from TOTAL SUPPLEMENT DEDUCTIONS on page 15. , ,

TOTAL DEDUCTIONS Add amounts at items D1 to D $ .00

, ,
LOSS

SUBTOTAL TOTAL INCOME OR LOSS less TOTAL DEDUCTIONS $ .00

, ,

Losses
L1 Tax losses of earlier income years
Primary production losses carried
Q$ .00 Primary production losses
F $ .00
forward from earlier income years , claimed this income year ,
Non-primary production losses carried
R$ .00 Non-primary production losses Z $ .00
forward from earlier income years , claimed this income year ,
LOSS
If you were not required to complete L1, .00
TAXABLE INCOME write the amount from SUBTOTAL above here. $ , ,
OR LOSS If you completed L1, add up the amounts you wrote at F and Z and take the total away from
the amount you wrote at SUBTOTAL. Write the answer at $ TAXABLE INCOME OR LOSS.

Make sure that you complete item M2 on page 6.

Page 4 Sensitive (when completed) TAX RETURN FOR INDIVIDUALS 2017

 Your tax file number (TFN)

25410817
Tax offsets
T1 Seniors and pensioners (includes self-funded retirees) TAX OFFSET

N
CODE
If you had a spouse during 2016 –17 you must also The ATO will work out this tax offset VETERAN
complete Spouse details – married or de facto amount. Print your code letter in the
on pages 8–9. TAX OFFSET CODE box. Y
CODE

T2 Australian superannuation income stream S$ .00

,

T If you completed the Tax return for individuals (supplementary section) $ .00
2017, write here the amount from TOTAL SUPPLEMENT TAX OFFSETS on page 16. ,

TOTAL TAX OFFSETS Add up all the tax offset amounts at items T2 and T . U$ .00
,

TAX RETURN FOR INDIVIDUALS 2017 Sensitive (when completed) Page 5

Medicare levy related items
M1 Medicare levy reduction or exemption
Reduction based on family income
  NOTE Number of dependent children and students Y
Only certain taxpayers are entitled to a Medicare
CLAIM
levy reduction or exemption. Read M1 Medicare Exemption categories
levy reduction or exemption in the instructions Full 2.0% levy exemption – number of days V
to work out if you are eligible to claim. TYPE

Half 2.0% levy exemption – number of days W

If you have completed item M1 and had a spouse during 2016 –17 you must also
complete Spouse details – married or de facto on pages 8–9.

M2 Medicare levy surcharge (MLS)

THIS ITEM IS COMPULSORY FOR ALL TAXPAYERS.
If you do not complete this item you may be charged the full Medicare levy surcharge.
To help you determine if you have to pay the surcharge read M2 Medicare levy surcharge in the instructions.
For the whole period 1 July 2016 to 30 June 2017 were you and all of your dependants (including your spouse) – if you
had any – covered by private patient hospital cover?
You must complete Private health insurance policy
E Yes details on the next page. You have now finished this item. No Read on.

For the whole of 2016 –17 were you:

n a single person – without a dependent child or children – and your income for surcharge purposes
(including your total reportable fringe benefits amounts) was $90,000 or less or
n a member of a family – which may consist of you and your spouse (married or de facto) with or without
a dependent child or children; or a sole parent with a dependent child or children – and the combined
income for surcharge purposes (including the total reportable fringe benefits amounts) of you and your
spouse (if you had one) was $180,000 or less (plus $1,500 for each dependent child after the first)?
You may have to pay the surcharge. Read M2 Medicare You do not have to pay the surcharge.
No levy surcharge in the instructions. Yes You must write 365 at A.

You must write the following at A: Number of days you do not

n 0 when you have to pay the surcharge for the whole period have to pay the surcharge
A
1 July 2016 to 30 June 2017
n 365 when you do not have to pay the surcharge for the
whole period 1 July 2016 to 30 June 2017
n the number of days you do not have to pay the surcharge
for part of the period 1 July 2016 to 30 June 2017.

If you had a spouse during 2016 –17 complete Spouse details – married or de facto on pages 8–9.
If you were covered by private patient hospital cover at any time during 2016 –17 you must complete Private health
insurance policy details on the next page. Read the Private health insurance policy details section in the instructions.

Page 6 Sensitive (when completed) TAX RETURN FOR INDIVIDUALS 2017

Private health insurance policy details
You must read Private health insurance policy details in the instructions before completing this item.
Fill all the labels below unless directed in the instructions.
Health Membership
insurer ID B number C
Your premiums eligible for
J $ .00 Your Australian Government
K $ .00
Australian Government rebate , rebate received ,
CODE

Benefit code L Tax claim code. Read the instructions.

Health Membership
insurer ID B number C
Your premiums eligible for
J $ .00 Your Australian Government
K $ .00
Australian Government rebate , rebate received ,
CODE

Benefit code L Tax claim code. Read the instructions.

Health Membership
insurer ID B number C
Your premiums eligible for
J $ .00 Your Australian Government
K $ .00
Australian Government rebate , rebate received ,
CODE

Benefit code L Tax claim code. Read the instructions.

Health Membership
insurer ID B number C
Your premiums eligible for
J $ .00 Your Australian Government
K $ .00
Australian Government rebate , rebate received ,
CODE

Benefit code L Tax claim code. Read the instructions.

Adjustments
A1 Under 18 TYPE
If you were under 18 years old on 30 June 2017 you must complete
J $ .00
this item or you may be taxed at a higher rate. Read A1 Under 18 ,
in the instructions for more information.

A2 Part-year tax-free threshold

Day Month Year
Months eligible for threshold N
Date

A3 Government super contributions

Read A3 Government super contributions in the instructions before completing this item.
CODE

Income from investment, partnership and other sources F $ .00

, ,
LOSS

Other income from employment and business G $ .00

, ,
Other deductions from business income H $ .00
, ,
A4 Working holiday maker net income D $ .00
, ,

TAX RETURN FOR INDIVIDUALS 2017 Sensitive (when completed) Page 7

Income tests
You must complete this section. If you had a spouse during 2016 –17 you must also complete
Spouse details – married or de facto on pages 8–9.
If the amount is zero write 0.

IT1 Total reportable fringe benefits amounts

Employers exempt from FBT under section 57A of the FBTAA 1986 N $ .00
,
Employers not exempt from FBT under section 57A of the FBTAA 1986 W$ .00
,
IT2 Reportable employer superannuation contributions T $ .00
,

IT3 Tax-free government pensions U $ .00

,

IT4 Target foreign income V $ .00

,

IT5 Net financial investment loss X $ .00

,

IT6 Net rental property loss Y $ .00

,

IT7 Child support you paid Z $ .00

,

IT8 Number of dependent children D

Spouse details – married or de facto

If you had a spouse during 2016 –17 you must complete Spouse details – married or de facto.
We need the information included in this section to assess your tax accurately.
If you did not have a spouse, go to page 10.

Your spouse’s name

If you had more than one spouse during 2016 –17 print the name of your spouse on 30 June 2017 or your last spouse.
Surname or family name

First given name Other given names

Day Month Year

Your spouse’s date of birth K

Your spouse’s gender Male Female Indeterminate

Period you had a spouse – married or de facto

Did you have a spouse for the full year
– 1 July 2016 to 30 June 2017?
L Yes No

From
Day Month Year
If you did not have a spouse for the M
full year, write the dates you had a spouse
between 1 July 2016 and 30 June 2017. To
Day Month Year

Did your spouse die during the year? Yes No

Page 8 Sensitive (when completed) TAX RETURN FOR INDIVIDUALS 2017

Spouse details – married or de facto – continued
The information on this page relates to your spouse’s income.
You must complete all labels. If the amount is zero write 0.

Your spouse’s 2016 –17 taxable income O $ .00

, ,
Your spouse’s share of trust income on which the trustee is assessed under .00
section 98, and which has not been included in your spouse’s taxable income T $ ,
Distributions to your spouse on which family trust distribution tax has been paid and which
U $ .00
your spouse would have had to show as assessable income if the tax had not been paid ,
Your spouse’s total reportable fringe benefits amounts
Employers exempt from FBT under section 57A of the FBTAA 1986 R $ .00
,
Employers not exempt from FBT under section 57A of the FBTAA 1986 S $ .00
,
Amount of Australian Government pensions and allowances (see Q6 Australian
P $ .00
Government pensions and allowances in the instructions) that your spouse ,
received in 2016 –17 (exclude exempt pension income)
Amount of exempt pension income (see Spouse details – married or de facto .00
in the instructions) that your spouse received in 2016 –17. Do not include any Q $ ,
amount paid under the Military Rehabilitation and Compensation Act 2004
Amount of your spouse’s reportable superannuation contributions
A $ .00
(which is the total of reportable employer superannuation ,
contributions and deductible personal superannuation contributions)
Other specified exempt payments (see Spouse details – married or .00
de facto in the instructions) that your spouse received B $ ,
Your spouse’s target foreign income C $ .00
,
Your spouse’s total net investment loss (total of net financial .00
investment loss and net rental property loss) D $ ,
Child support your spouse paid E $ .00
,
Your spouse’s taxed element of a superannuation lump sum for which the
F $ .00
tax rate is zero (see M2 Medicare levy surcharge in the instructions) ,
Family Assistance consent – Complete this section only if you consent to use part or all of your 2017
tax refund to repay your spouse’s Family Assistance debt.

Complete the details below only if:

n you were the spouse of a family tax benefit (FTB) claimant, or the spouse of a child care benefit claimant on 30 June 2017 and
n your spouse has given you authority to quote their customer reference number (CRN) on your tax return – if your spouse does
not know their CRN, they can contact the Department of Human Services and
n your spouse has a Family Assistance debt or expects to have a Family Assistance debt for 2017 and
n you expect to receive a refund for 2017 and
n you consent to use part or all of your refund to repay your spouse’s Family Assistance debt.

Do you consent to use

part or all of your 2017
You do not need to complete
tax refund to repay your No Your spouse’s CRN Z
this section. Go to page 10. Yes
spouse’s Family
Assistance debt?
I consent to the ATO using part or all of my 2017 tax refund to repay any Family Assistance debt of my spouse,
whose details I have provided above. I have obtained my spouse’s permission to quote their CRN.
Your signature for Department of Human Services consent purposes only

Date
Day Month Year

TAX RETURN FOR INDIVIDUALS 2017 Sensitive (when completed) Page 9

 If you are completing the supplementary section (pages 13–16) of your tax return, attach it here.

Taxpayer’s declaration All taxpayers must sign and date the declaration below.

Read and answer the questions below before you sign the Taxpayer’s declaration.
1 Are you required to complete any of the items on the Tax return for individuals (supplementary section) 2017?
To find out, read Will you need Individual tax return instructions supplement 2017? in the instructions.
No Read on. Yes Attach pages 13–16 to this page and read on.

2 Have the instructions asked you to attach further information relating to specific questions?
No Read on. Yes Attach the information to page 3 of your tax return and read on.

Make sure you have also attached all other documents that the instructions tell you to.

Privacy
The ATO is authorised by the Taxation Administration Act 1953 to request your tax file number (TFN). We will use your
TFN to identify you in our records. It is not an offence not to provide your TFN. However if you do not provide your TFN,
your assessment may be delayed.
Taxation law authorises the ATO to collect information and to disclose it to other government agencies. For information
about your privacy go to ato.gov.au/privacy
I declare that:
n all the information I have given on this tax return, including any attachments, is true and correct
n I have shown all my income – including net capital gains – for tax purposes for 2016 –17
n I have completed and attached the supplementary section, schedules and other attachments – as appropriate – that
the instructions told me to provide
n I have completed item M2 – Medicare levy surcharge
n I have the necessary receipts and/or other records – or expect to obtain the necessary written evidence within a
reasonable time of lodging this tax return – to support my claims for deductions and tax offsets.

IMPORTANT
The tax law imposes heavy penalties for giving false or misleading information.

FOR YOUR TAX RETURN TO BE VALID YOU MUST SIGN BELOW.

Date
Day Month Year

The ATO will issue your assessment based on your tax return. However, the ATO has some time to review your tax return, and
issue an amended assessment if a review shows inaccuracies that change the assessment. The standard review period is two
years, but for some taxpayers it is four years. For more information go to ato.gov.au/notices

WHERE TO SEND YOUR TAX RETURN

Send your completed tax return to:
Australian Taxation Office
GPO Box 9845
IN YOUR CAPITAL CITY
Do not replace the words IN YOUR CAPITAL CITY with the name of your capital city and its postcode.

For more information, read the Important information section in the instructions.

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