Use this form to apply to vary the rate or amount of PAYG withheld from payments made to you during the financial year ending 30 June. Your application will be reviewed by Tenfold Wealth Accountants and lodged with the Australian Taxation Office on your behalf.

Before you start: You will need an estimate of your annual income, deductions, tax offsets, and details of your payer(s). Variations apply for one financial year only and must be lodged at least 6–8 weeks before you want them to take effect.

1Application Type

Type of application

Financial year

Previous ATO reference number (if renewal/amendment)

Requested date variation to take effect

Allow 6–8 weeks from lodgement.

2Applicant Details

Title

Given name(s)

Family name (surname)

Any other names known by

Date of birth

Tax File Number (TFN) — optional in this form

For your privacy, we recommend providing your TFN via our secure client portal rather than this form.

Residential address

Postal address (if different)

Phone (daytime)

Australian resident for tax purposes?

Do you have a HELP/HECS, VSL, SSL, ABSTUDY SSL, TSL or SFSS debt?

3Payer (Employer) Details

Provide details of each payer who withholds tax from your income. If you have additional payers, list them in the "Additional payers" field.

Payer 1 — Legal/business name

Payer 1 — ABN or WPN

Payer 1 — Contact phone

Payer 1 — Address

Type of income from Payer 1

Estimated gross income from Payer 1 (AUD)

Additional payers (name, ABN, estimated income for each)

4Estimated Income for the Financial Year

All amounts in Australian dollars (AUD). Provide your best estimate for the full financial year.

Total salary & wages

Allowances, tips, director's fees

Employment termination payments (ETPs)

Australian superannuation income streams & lump sums

Government allowances & pensions

Gross interest

Gross dividends (including franking credits)

Franking credits

Gross rental income

Net business / sole trader income

Partnership / trust distributions

Net capital gains

Foreign source income

Other assessable income

5Estimated Deductions

Work-related expenses (D1–D5)

Rental property expenses

Interest & investment expenses

Personal super contributions (deductible)

Gifts & donations

Cost of managing tax affairs

Prior year tax losses

Other deductions

6Tax Offsets & Medicare

Invalid / invalid carer offset

Seniors and pensioners tax offset (SAPTO)

Zone or overseas forces offset

Other tax offsets

Medicare levy & surcharge

I held appropriate private patient hospital cover for the full year

I am entitled to a Medicare levy exemption or reduction

I expect the Medicare levy surcharge to apply

7Variation Requested

Type of variation requested

Proposed withholding rate (%)

Proposed withholding amount per pay ($)

Pay frequency

Reason for the variation

8ATO Compliance & Lodgement History

Are all prior year income tax returns lodged?

Do you have any outstanding ATO debts?

Previous variation in last 3 years?

If yes, was the prior variation accurate (variance <10%)?

Additional notes / supporting information

9Declaration & Authorisation

Privacy & Tax File Number collection notice. The ATO is authorised to collect your TFN under the Taxation Administration Act 1953. Quoting your TFN is not compulsory, but failure to do so may delay or prevent processing of your application. Tenfold Wealth Accountants collects this information solely for the purpose of preparing and lodging your PAYG withholding variation application with the ATO. Information is handled in accordance with the Privacy Act 1988 (Cth) and the TFN Rule 2015. See our Privacy Policy.

Required declarations

I declare that the information provided in this application is true and correct, and that I have shown all relevant assessable income and deductions for the financial year stated.

I declare that the income and deduction estimates are a reasonable assessment based on my circumstances.

I undertake to notify Tenfold Wealth Accountants if my circumstances change materially during the financial year.

I authorise Tenfold Wealth Accountants (Registered Tax Agent) to prepare, sign and lodge this PAYG withholding variation application with the ATO on my behalf.

I acknowledge the privacy and TFN collection notice above.

Full name (electronic signature)

Date

Submissions are sent securely via Formspree to Tenfold Wealth Accountants. A team member will be in touch within 2 business days.
Tenfold Wealth Accountants — Chartered Accountants — Registered Tax Agent. This form does not in itself constitute lodgement with the ATO.