Bookkeeper, BAS & Tax Agent Renewal Declaration

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Work Request ID

Your Information

Name*

Business Name*

ABN

Email*

Best Contact Number*

Website

Has your mailing address details changed in the past 12 months*

Yes
No

Mailing Address*

About Your Business

Are you a qualified:*

Bookkeeper
BAS Agent
Tax Agent
Accountant
Other

Please tick all that apply

If other, please specify*

Services you provide*

Recording of Day to Day Transactions
Calculating & Lodging of BAS Related Items
Liaising with ATO on clients behalf
Income Tax Returns
Superannuation Calculations
Superannuation Calculations (For purpose of reducing tax)
Tax Planning Advice & Services for Business Structure, Asset Protection & Strategy
Wealth Creation methods including Superannuation & Investment Strategy

Please tick all that apply

Gross Fees - Projected this Financial Year?*

Gross Fees - Last Financial Year?*

Which States do you provide services to?*

Percentage of Work in NSW*

Percentage of Work in QLD*

Percentage of Work in VIC*

Percentage of Work in SA*

Percentage of Work in WA*

Percentage of Work in TAS*

Percentage of Work in NT*

Percentage of Work in ACT*

Percentage of Work Overseas*

NSW Stamp Duty Declaration

Are you a small business Individual / Partnership / Company and/or Trust, which is carrying on a business, and the business has an aggregated turnover of less than $2 million*

Yes
No

Are you a small business Individual / Partnership / Company and/or Trust, which is carrying on a business, and the business has an aggregated turnover of less than $2 million

Click here to read more about this exemption

Limits of Cover Required

Professional Indemnity Limit of Cover Required*

If other, please advise limit required*

Do you also require Public Liability Cover?*

Yes
No

If yes, please advise what level of cover is required?*

$5,000,000 (+$180)
$10,000,000 (+$275)
$20,000,000 (+$574)

Claims Experience

After all due and proper enquiries, I/We hereby declare that I/We am/are aware:

Of any incidents, facts or circumstances which may give rise to a claim against the firm, company or sole practitioner, its predecessors in business or any past or present partners, directors, principals, consultants or employees?*

Yes, I have something to notify
No, there is nothing to declare
I have previously declared an incident to my insurer and have nothing new to declare

If Yes, please provide further information

Other Insurances

Do you require a quote or additional information on any other insurances?

Office / Contents Insurance
Management Liability Insurance
Cyber / Privacy Protection Insurance
Motor Vehicle Insurance
Income Protection / Life Insurance
Construction / Contract Works Insurance
Tools / Mobile Equipment Insurance
Home Insurance
Other Insurance

If other, please provide further information*

Additional Information

Is there any other information or business changes that you need to provide to the insurer?*

YES there is
NO there is not

Please provide further details*

Important Information

Please take a moment to read these important documents prior to submitting your form.

Please tick all to confirm that you have read the following documents:*

Privacy Policy
Financial Services Guide
Duty of Disclosure
Terms of Engagement

Signature

This electronic signature will be treated the same as if signed personally.

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Bookkeeper, BAS Agent & Tax Agent Renewal Request

Bookkeeper/BAS Agent/Tax Agent Renewal Form