Superannuation Health Check

The details you provide in this form give us the information we require as a registered Tax Agent to access your ATO records.

After receiving your completed form, we will provide you with a personalised Superannuation Health Check report.

First Name *

Last Name *

Date of Birth *

Tax File Number (TFN) *Must be 9 digits

ABN (if applicable)Must be 11 digits

Residential Address *

Postal Address (if different to Residential)

Mobile PhoneInclude at least one phone number

Daytime Phone (if different to Mobile)

Email Address *

Preferred method of contact

Occupation

Are you a Veteran (as recognised by the Department of Veterans Affairs)

YesNo

Number of Dependent ChildrenThis is used for some income tests and may impact on your Medicare or Medicare Levy Surcharge liabilities.

Do you have a spouse for tax purposes? *

YesNo

'Spouse' has a specific meaning in tax law and includes another person of any sex who "lives with [you] on a genuine domestic basis in a relationship as a couple".

Spouse's Name *If you would like us to prepare and lodge your tax return and your spouse's tax return, your spouse will need to complete a separate Client Details and Authority form. Your spouse can access the form through the link in the email we sent you.

Spouse's Date of Birth *

Name of account holder(s) *

Authority

In submitting this form, I authorise Quintilis to access my tax records from the ATO and prepare my Superannuation Health Check. If I request, Quintilis is authorised to provide me with Tax Agent Services (as defined by the Tax Agent Services Act 2009) including preparing my tax documentation and offering me tax advice. I am aware of and accept Quintilis' Privacy policy and its Statement of Service.
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