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Appointment of Attorney and Declaration of Representative

This power of attorney and declaration of representative is made on this date: _____ / _____ / _____

by Taxpayer Name: _______________________________________________ Date of Birth: _____ / _____ / _____

Tax File Number (TFN): ___ ___ ___ ___ ___ ___ ___ ___ ___ Phone: _____________________________________

of Overseas Home Address: __________________________________________________________________________

I hereby appoint the following representative: Pro Tax Pty Ltd. (ABN: 31 603 957 802) 119 Kent Street Sydney, NSW 2000 Australia / PO Box 20019, World Square Sydney, NSW, 2002 Australia, Ph: (02) 9247 2330 Fax: (02) 8068 4375 Email: info@protaxreturns.com.au To act as my attorney and representative.

We have indicated all possible tax years a tax refund is claimable for. My attorney may exercise the authority to claim my income tax for the following tax years if applicable: 1.07.18 – 30.06.19, 1.07.17 – 30.06.18, 1.07.16 – 30.06.17, 1.07.15 – 30.06.16, 1.07.14 –

30.06.15, 1.07.13 – 30.06.14, 1.07.12 – 30.06.13, 1.07.11 – 30.06.12, 1.07.10 – 30.06.11, 1.07.09 – 30.06.10, 1.07.08 – 30.06.09. My attorney may exercise the authority to do all such things and perform all such acts on my behalf as I could do or perform personally. The attorney shall carry out any act and sign any document on my behalf in every way as fully and effectively as I could do those things

myself on all Australian matters set out below: (a) Prepare, sign and lodge my Australian tax return(s); (b) Sign a Statutory Declaration in the event of lost PAYG Payment Summary(ies); (c) Request and receive from my employer(s) any Payment Summaries, statements of earnings, superannuation details

(including member number) and Tax File Number; (d) Prepare, sign and process any agreements, consents or other documents (including superannuation claim forms and tax

return forms) required to refund any taxes or facilitate the payment of any superannuation benefits; (e) Request and receive any monies from the Australian Taxation Office or any superannuation refund(s) of which I am or was a

member; (f) Deposit any Australian tax or superannuation refund cheques or monies into Pro Tax Pty Ltd’s trust account or other such

trust accounts; (g) Charge and be paid fees for the work my attorney performs pursuant to this Power of Attorney; (h) Deduct the amount of the attorney’s fees from any tax or superannuation refund received on my behalf; (i) Forward the amount referred to in clause (f) to me by depositing the amount into the bank account I nominate for that

purpose, after deducting payment for any fees and payments owing to Pro Tax Pty Ltd and/or any other authorised parties; (j) If the amount referred to in clause (i) remains unpaid or unclaimed for three months (for reasons such as my bank account having been closed or not accepting the deposit), I authorise my attorney to deduct an administration fee of twenty per cent (20%) of the amount to be paid from the account in quarterly instalments; (k) Fast Tracked Tax Returns: If I am applying for a fast-tracked tax return, I understand my application is subject to pre-

approval, 20% fee, and I will be paid in advance up-front. I assign any refund due to be paid to me to Pro Tax Pty Ltd in its entirety and Pro Tax Pty Ltd will be the absolute owner.

Appointment of Tax Agent & Electronic Tax Return and Superannuation Return Lodgement Declaration and Funds Transfer Declaration

I authorize and declare that:

• Pro Tax is appointed to act as my tax agent (Tax Agent Reference Number 25595247) • The information provided to Pro Tax for the preparation of the document is true and correct• Pro Tax is authorized to give the document to the Australian Taxation Office (ATO)

By signing this declaration, the taxpayer agrees to Pro Tax holding these records on the taxpayer’s behalf. I agree to and accept the terms and conditions of service as written online at www.protaxreturns.com.au and to any changes in the terms and conditions which Pro Tax may effect from time to time, and to the fees of the agent which represents the services I have requested and which are provided by Pro Tax and/or its affiliate companies. The standard minimum processing fee is $220. Extra or promotional fees may apply. Questions regarding fees may be directed to: fees@protaxreturns.com.au. All prospective clients are advised that Pro Tax Pty Ltd reserves the right to make the commercial decision as to whether or not they choose to act on the behalf of any prospective client irrespective of this Power of Attorney. Clients are advised that they must notify Pro Tax in writing within 24 hours should they wish to cancel their application. Unless there are extenuating circumstances, Pro Tax reserves the right to not accept any notices of cancellation after 24 hours when processing and / or lodgement work on the application has commenced.

I authorise that payment be made out in the name of PRO TAX PTY LTD and any correspondence be forwarded to: PRO TAX, PO BOX 20019, WORLD SQUARE, NSW 2002.

Signed, sealedand delivered by: X ________________________________________ Date: ____________________

Taxpayer / Principal’s Signature

In the presence of: _______________________________________________ Pro Tax Representative

Appointment of Attorney and Declaration of Representative

This form cannot be lodged as a paper representation of the form

Day Month Year

declare that this tax return has been prepared in accordance with information supplied by the taxpayer, that the taxpayer has given us a declaration stating that the information provided us is true and correct and that the taxpayer has authorised us to lodge the tax return.Agent’s signature

Contact name Agent’s telephone number Agent’s reference numberArea code Telephone number

Date Client’s reference

Your signature Date

Day Month Year

ZImportant: You also need to provide your spouse’s name, date of birth and their sex on page 7.

Family Assistance consent

Privacy

Taxation Administration Act 1953

ato.gov.au/privacy

Read and sign the declaration after completing your tax return, including the Supplementary section, Business and professional items section and other schedules if applicable.

I declare that:

• the information provided to my registered tax agent for the preparation of this tax return is true and correct, and

• I authorise my registered tax agent to lodge this tax return.

The ATO will issue your assessment based on your tax return. However, the ATO has some time to review your tax return,

Important

Taxpayer’s signature

Day Month Year

I, PRO TAX

92472330 2559524702

Individual tax return Taxpayer’s NameTFN

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:

•

• your spouse has given you authority to quote their customer reference number (CRN) on your tax return – if your spousedoes not know their CRN they can contact the Department of Human Services and

• your spouse has a Family Assistance debt or expects to have a Family Assistance debt for 2017 and• you expect to receive a tax refund for 2017 and• you consent to use part or all of your tax refund to repay your spouse’s Family Assistance debt.

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

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 on page 7. I have obtained my spouse’s permission to quote their CRN.

Date

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Page 6IN CONFIDENCE - when completed

Did you provide your payer with a Tax file number (TFN) declaration or Employment declaration?

Did you provide your tax file number on the TFN declaration or Employment declaration?

Did you provide your payer with a Withholding declaration?

I understand that a person who intentionally makes a false statement in a statutory declaration is guilty of an offence under section 11 of the Statutory Declarations Act 1959, and I believe that the statements in this declaration are true in every particular.

Answer ‘No’ or ‘Yes’ to each of the following questions:4

Signature of person making the declarationx

MAKING AND SIGNING THE DECLARATIONUnder the Statutory Declarations Act 1959, you can make a declaration before:na person who is currently licensed or registered under a

law to practise in one of the following occupations– chiropractor– dentist– legal practitioner– medical practitioner– nurse– optometrist– patent attorney– pharmacist– physiotherapist– psychologist– trade marks attorney, or– veterinary surgeon

na person who is enrolled on the Supreme Court roll of a State or Territory or the High Court of Australia as a legal practitioner (however described), or

none of the following people– an agent of the Australian Postal Corporation who is in

charge of an office supplying postal services to the public – an Australian Consular Officer or Australian Diplomatic

Officer (within the meaning of the Consular Fees Act 1955) – a bailiff– a bank officer with five or more continuous years of service– a building society officer with five or more years of

continuous service– a chief executive officer of a Commonwealth court– a clerk of a court– a Commissioner for Affidavits– a Commissioner for Declarations– a credit union officer with five or more years of

continuous service– an employee of the Australian Trade Commission who is

- in a country or place outside Australia- authorised under paragraph 3(d) of the Consular Fees

Act 1955, and -  exercising his or her function in that place

– an employee of the Commonwealth who is- in a country or place outside Australia- authorised under paragraph 3(c) of the Consular Fees

Act 1955, and -  exercising his or her function in that place

– a fellow of the National Tax Accountants’ Association– a finance company officer with five or more years of

continuous service– a holder of a statutory office not specified in another item

in this list– a judge of a court

– a Justice of the Peace– a magistrate– a marriage celebrant registered under Subdivision C of

Division 1 of Part IV of the Marriage Act 1961– a master of a court– a member of Chartered Secretaries Australia– a member of Engineers Australia, other than at the

grade of student– a member of the Association of Taxation and

Management Accountants– a member of the Australasian Institute of Mining

and Metallurgy– a member of the Australian Defence Force who is

- an officer- a non-commissioned officer within the meaning of

the Defence Force Discipline Act 1982 with 5 or more years of continuous service, or

- a warrant officer within the meaning of that Act – a member of the Institute of Chartered Accountants in

Australia, the Australian Society of Certified Practising Accountants or the National Institute of Accountants

– a member of- the Parliament of the Commonwealth- the Parliament of a State- a Territory legislature, or- a local government authority of a state or territory

– a minister of religion registered under Subdivision Aof Division 1 of Part IV of the Marriage Act 1961

– notary public– a permanent employee of the Australian Postal Corporation

with five or more years of continuous service who isemployed in an office supplying postal services to the public

– a permanent employee of one of the following with five ormore years of continuous service who is not specified inanother item in this list- the Commonwealth or a Commonwealth authority- a state or territory or a state or territory authority, or- a local government authority

– a person before whom a statutory declaration may bemade under the law of the state or territory in which thedeclaration is made

– a police officer– a registrar or deputy registrar of a court– a senior executive service employee of

- the Commonwealth or a Commonwealth authority, or- a state or territory or a state or territory authority

– a sheriff– a sheriff’s officer, or– a teacher employed on a full-time basis at a school or

tertiary education institution.

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