Individual Questionnaire

Client Information
Full Name

First NameMiddle NameLast Name
Financial Year Ended

DayMonthYear
Date
Date of Birth

DayMonthYear
Date
IRD Number
Phone Number
E-mail
Address

Street Address or PO Box

Suburb

CityState / Province

Post CodeCountry
Spouses Name

First NameMiddle NameLast Name
Spouses IRD Number
Spouses Income
Spouses Date of Birth

DayMonthYear
Date
Income
Did you receive income from any of the sources listed below?
Salary or wages

YesNo
Unemployment or other income tested benefits

YesNo
Family assistance payments from Work and Income

YesNo
ACC Earnings

YesNo
Withholding payments

YesNo
NZ Super

YesNo
Other New Zealand pensions, annuities and superanuation

YesNo
Interest

YesNo
Dividends

YesNo
An estate/trust/partnership business where we don't prepare accounts

YesNo
Overseas earnings and investments/foreign rights disclosure

YesNo
Shareholder earnings (an employee salary of director fees from a company where we don't prepare the accounts)

YesNo
Non-cash benefits from a company in which you are a shareholder and on which FBT has not been paid

YesNo
Rental Income

YesNo
A mixed use holiday home (a home rented and used privately)

YesNo
Income from the sale of land/business

YesNo
Income from the sale of shares or other property (not your residence)

YesNo
Income from the sale or redemption of securities

YesNo
Income from government bonds

YesNo
Any other income e.g. royalties

YesNo
Expenses
Did you have any expenses related to schedular/withholding payments?

YesNo
Did you pay any tax preparation fees?

YesNo
Did you pay any income protection insurance?

YesNo
Did you pay any commission on interest or dividend income?

YesNo
Did you pay any investment advisor fees?

YesNo
Rebates
Did you make any voluntary payments on your student loan?

YesNo
Do you have a Special Home/Farm/Fishing Vessel Ownership account?

YesNo
Do you have any charitable donations to claim?

YesNo
NOTE: If you believe you are entitled to Working for Families Tax Credits (WFFTC), please download and complete the supplementary questionaire from our website or contact us to request a copy
Investments
During the year did you purchase and/or sell any real estate?

YesNo
Did you purchase any shares?

YesNo
Did you make any other investments?

YesNo
Are you a shareholder in a look-through company for which we do not prepare accounts?

YesNo
Tax
Are you registered for GST?

YesNo
What dates were you registered for GST?
Should you be registered for GST?

YesNo
Rental Income
Address of Property

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Rent Received
Number of Months Renting
Please list your expenses:
Advertising
Tip fees
Insurance
Mortgage Interest
Rates
Postage and Stationery
Repairs and Maintenance
Agents Collection Fees
Car use for Rent Collection and Maintenance
Was the property purchased or sold during the year?

YesNo
Bank Account Information
Please provide your bank account details so we can directly deposit any IRD refunds into your account.
Account Name
Account Number
Attach Your Documents
Please attach your supporting documents to accompany this form. The preferred file formats are: Microsoft Word documents, PDF's or Microsoft Excel spreadsheets.

Based on the answers you have supplied in this questionnaire, the documents you need to supply to us to complete your return are:
- Details of any New Zealand pensions, annuities and superanuations (excluding NZ Super)
- Interest details including RWT form from payer showing interest PAYE paid to Inland Revenue.
- Dividend statements.
- Details on the estate/trust/partnership business that we don't prepare the accounts for.
- Details of any overseas earnings and investments and the taxation paid on those earnings.
- Details of your shareholder income (the employee salary of director fees from the company where we don't prepare the accounts).
- Details of the non-cash benefits from the company in which you are a shareholder and on which FBT has not been paid.
- Details of the days your mixed use holiday home was used privately and the days rented.
- Details on the income received from the sale of land/business.
- Details on the income from the sale of shares or other property (not your residence).
- Details of income from the sale or redemption of securities.
- Details of accrued interest on purchase of government bonds.
- Details of any other income you've received not mentioned in this questionnaire.
- Details of your expenses related to Schedular / Witholding Payments.
- Details of your tax preparation fees.
- Details of your income protection insurance fees.
- Details of any commission paid on your interest or dividend income.
- Details of any investment advisor fees.
- Details of the the voluntary payments made on your student loan.
- Your Increase in Savings Certificate IR30 from your savings institution.
- Charitable donation receipts.
- Details of the real estate that you sold or purchased.
- Details of the shares you purchased.
- Details of the other investments you made.
- Solicitors statements from the sale or purchase of property.
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Declaration
I confirm that I have examined all the matters mentioned, and I accept responsibility for the accuracy and completeness of the information supplied and the relevant details as requested.

I hereby request Tax Link to compile my financial statements based on the information supplied and acknowledge that Tax Link is not to complete an audit to substantiate the accuracy of my information and therefore Tax Link will be unable to detect any error or fraud, nor to provide any assurance as to the accuracy of my financial statements to any person or any party for any reason.

I agree that my financial statements are prepared as a service to me and agree to Tax Link attaching to these financial statements their standard accountant’s statement of responsibilities.
Full Name

First NameLast Name
Todays Date

DayMonthYear
Date
Signature*

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Should be Empty:

Client Information

Income

Expenses

Rebates

Investments

Tax

Rental Income

Bank Account Information

Attach Your Documents

Declaration