DECLARATION FORM - MOTOR VEHICLE ODOMETER

DECLARATION FORM MOTOR VEHICLE ODOMETER
For Fringe Benefit Tax (FBT) purposes please provide the following information and your odometer reading as at 31/03/2016.
This form MUST be returned no later than 05/04/2016.
If you would like more information, please contact the Customer Service team on 1800 680 180
A - MEMBER DETAILS
CONTRACT ID:
EMPLOYER:
FIRST NAME:
SURNAME:
ADDRESS:
CITY:
STATE:
PHONE:
EMAIL:
POSTCODE:
B - VEHICLE DETAILS
MAKE & MODEL:
REGISTRATION NUMBER:
OPENING ODOMETER READING:
KM
(if not previously provided) (start of FBT year or start of novation)
CLOSING ODOMETER READING*:
KM
(end of FBT year, termination of employment or payout)
BUSINESS USE PERCENTAGE:
%
(if using Operating Cost Method)
DAYS NOT AVAILABLE*:
DAYS
A motor vehicle will only be regarded as not available for private use when:
a. The vehicle was in the garage for service or repairs in excess of 2 days; this would not include a routine service where
the vehicle is available prior to or after the service on that day
b. You have taken leave/holidays or a business trip and the vehicle has been stored at the employers’ garage with
the keys left with your employer
*NOTE: Days not available does NOT reduce your required kilometres to travel for the FBT year.
C - DECLARATION
I declare that:
•
the opening and closing odometer reading, business use percentage, and days motor vehicle was not available for use, as
disclosed above, relate to the vehicle mentioned above and is a true and accurate statement and I realise if this declaration
is incorrect I may incur additional FBT liability.
SIGNATURE:
DATE:
Please return the completed form with all supporting documentation:
Fax
Email
1800 221 988
[email protected]