Individual Client Checklist

Full Legal Name

Preferred Name

Date of Birth

Gender GenderFemaleMaleUndisclosed

Full Address

Email Address

Your Tax File Number

Are you a Resident for Tax Purposes? Are you a Resident for Tax Purposes?YesNo

Do you have a Spouse? Do you have a Spouse?YesNo

Do you have a Dependent? Do you have a Dependent?YesNo

Your Spouse's Full Legal Name

Your Spouse's Preferred Name

Your Spouse's Date of Birth

Your Spouse's Gender Your Spouse's GenderFemaleMaleUndisclosed

Is your Spouse a Resident for Tax Purposes? Is your Spouse a Resident for Tax Purposes?YesNo

Can we discuss your taxes with your Spouse?

Please enter the First Name and Age of each of your Dependents:

Bank Account Name:

Bank Account BSB

Bank Account Number

Job Role/Description

Do you have any additional information you'd like to supply?

Questionnaire - Income - Please tick all that apply Questionnaire - Income - Please tick all that apply Did/Do you have any Salary or Wage Income? Did/Do you give any Government Payments? Did/Do you have any Business Income? Did/Do you have a “Side-Hustle” or receive Cash Payments? Did/Do you earn any Bank Interest? Did/Do you have any Investments (Shares, Trusts, Managed Funds)? Did/Do you have any Crypto Investments? Did/Do you have any Rental Properties? Did/Do you have any Overseas Income or Investments? Did you make any early withdrawals from your Super? Did you make any Capital Gains?

Questionnaire - Expenses - Please tick all that apply Questionnaire - Expenses - Please tick all that apply Did you make any Additional Super Contribution? Did you make any Donations? Did you have any Tax Agent Fees incurred during the year? Do you have Income Protection Insurance? Did you use your Vehicle for Work-Related Purposes? Did you have any Self-Education Deductions? Did you have any Investment Deductions? Did you have any other Deductions?

Questionnaire - Other - Please tick all that apply Questionnaire - Other - Please tick all that apply Do you have Private Health Insurance? Do you have a HELP debt? Did you pay Child Support during the year? Do you have any Centrelink or Child Support Debt? Have you had an ATO Audit previously?

Validation Consent Validation Consent I confirm that I am authorised to provide the personal details presented and have obtained the consent of the individuals to which the personal details relate for this information to be passed to and checked with the document issuer, official record holder, a credit bureau and authorised third parties for the purpose of verifying my identity and address. I also confirm that if required, evidence of this consent can be produced.

Drivers Licence State Drivers Licence StateACTNSWNTQLDSAWATAS

Drivers Licence Number

Drivers Licence Card Number

New Field

Medicare Card Type Medicare Card TypeBlueGreenYellow

Medicare Card Expiry Date

Full Name as Displayed on Medicare Card

Individual Reference Number

Legal Agreements Legal Agreements I hereby acknowledge and accept the terms of the engagement as outlined in the Terms of Business available from the Chequer Accounting Website I acknowledge that an "Estimate of Fees" will be provided to me and that my usage of Chequer Accounting Services will be taken as agreement to said fees. I agree to be liable for all fees for services performed in accordance with this agreement. I understand that unless otherwise agreed, the terms of payment under this engagement will be strictly 14 Days from the Date of Invoice. I hereby give consent for Chequer Accounting to act as my Tax Agent with the Australian Taxation Office