Fields on page 7
Your Centrelink
Reference Number (if
Number (if known)
CRN.3
Family name
First given name
Second given name
Your date of birth
No
the definition of a
Yes
Family name
First given name
Second given name
Your partner’s date of birth
This private trust will be referred to as ‘the trust’ on the rest of this form.
Trust tax file number
tax file number (Trust TFN)
(Trust TFN)
Trust Australian
Australian Business
Business Number (Trust
(Trust ABN)
No
Yes
No
Fields on page 8
Name
Business name (if applicable)
Position in relation to the trust discussed in this form
Postal address
Postal address
Q10.PostalAddress3
Postcode
Daytime phone number
Fax number (
)
You
The person named at question 10
The person named below
below
Name
Business name (if applicable)
Position in relation to the trust discussed in this form
Postal address
Postal address
Q11Details.PostalAddress3
Postcode
Daytime phone number
Fax number (
)
In which month are the taxation returns statements for the trust normally
No
testamentary trust is one by the death of
Yes
Name of testator
Date of death of testator
Relationship to the beneficiaries
No
Is there a
Yes
Name of surviving partner
Date of birth
Their permanent address
Their permanent address
Q14Details.PermAddress3
Postcode
No
Yes
No
No
more information about
Yes
Fields on page 9
What date was the trust set up (such on the trust deed)
What date did the trust commence
No
Yes
No
What date did the trust cease trading
Explain why the trust ceased trading
Trading name
Type of business (for example, primary production, retail, commercial, investment)
Trading name
Type of business (for example, primary production, retail, commercial, investment)
Trading name
Type of business (for example, primary production, retail, commercial, investment)
No
a member of your family a company that is a
Yes
Trading name of business
You
Your partner
Trading name of business
You
Your partner
Trading name of business
You
Your partner
Fields on page 10
No
Yes
Give details below
Change in circumstances since last financial statement
Name of trustee
Date of birth (if a person)
Centrelink Reference
Reference Number (if
(if known)
Q27.0.CRN.3
Name of trustee
Date of birth (if a person)
Centrelink Reference
Reference Number (if
(if known)
Q27.1.CRN.3
Name of trustee
Date of birth (if a person)
Centrelink Reference
Reference Number (if
(if known)
Q27.2.CRN.3
No
Yes
Fields on page 11
No
Yes
Give details of each appointor
Name of the appointor
Date of birth
Name of the appointor
Date of birth
No
Yes
Give details of each person
Name
Date of birth
This person can exercise control independently
This person can exercise control jointly
Name
Date of birth
This person can exercise control independently
This person can exercise control jointly
No
Yes
Give details of each person
Name
Date of birth
Name
Date of birth
No
Yes
Give details of each person
Name
Date of birth
Name
Date of birth
Fields on page 12
No
Yes
Give details of each person
Name
Date of birth
Name
Date of birth
Name
Date of birth
No
Yes
Give details of the previous
Name
Date of birth
Date of the change
Reason for change
Trustee
Appointor
Name
Date of birth
Date of the change
Reason for change
Trustee
Appointor
Name
Date of birth
Date of the change
Reason for change
Trustee
Appointor
Fields on page 13
No
Yes
Give details of all unitholders and their unitholding
1
Date of birth
/
Class of unit
Number price
$
2
/
/
Class of unit
Number price
$
3
/
/
Q35Details.Class.2
Q35Details.Number.2
$
4
/
/
Q35Details.Class.3
Q35Details.Number.3
$
5
/
/
Q35Details.Class.4
Q35Details.Number.4
$
6
/
/
Q35Details.Class.5
Q35Details.Number.5
$
7
/
/
Q35Details.Class.6
Q35Details.Number.6
$
8
/
/
Q35Details.Class.7
Q35Details.Number.7
$
1
Date of birth
/
Relationship to: • trustee if a person • director if a corporate trustee
2
/
/
• director if a corporate trustee
3
/
/
Q36Details.RelToTrusteeDir.2
4
/
/
Q36Details.RelToTrusteeDir.3
5
/
/
Q36Details.RelToTrusteeDir.4
6
/
/
Q36Details.RelToTrusteeDir.5
7
/
/
Q36Details.RelToTrusteeDir.6
8
/
/
Q36Details.RelToTrusteeDir.7
9
/
/
Q36Details.RelToTrusteeDir.8
10
/
/
Q36Details.RelToTrusteeDir.9
Fields on page 14
No
manage
Yes
Name of the beneficiary
Date of birth
• a transport accident compensation payment • an inheritance.
access the monies held on their a certain age, for example, 21 years
Not applicable
No
Yes
• the Resolution to • evidence of the
No
fixed trust is one where names the person who
Yes
No
on 9 May
Yes
No
Yes
Give details of each change
Owner of entitlement(s)
What changed
Date of change
Owner of entitlement(s)
What changed
Date of change
Owner of entitlement(s)
What changed
Date of change
Fields on page 15
No
Yes
Give details below
Contribution by (name or person or organisation)
Date of birth (if applicable) Amount
$
What was contributed
Contribution by (name or person or organisation)
Date of birth (if applicable) Amount
$
What was contributed
3
Date of birth (if applicable) Amount
$
What was contributed
Not applicable
No
Yes
the units were issued
Name
Date of birth
Number of units
Name
Date of birth
Number of units
Name
Date of birth
Number of units
No
Yes
Give details below
Yes
Fields on page 16
No
Yes
Give details of each contribution
Name of contributor
Date of birth
Still living
Deceased
Gifted
Transferred
Sold for less than market value
What was contributed
Date of contribution
$
$
Name of contributor
Date of birth
Still living
Deceased
Gifted
Transferred
Sold for less than market value
What was contributed
Date of contribution
$
$
Fields on page 17
No
Yes
Give details below
Name of the public company or ASX code
Number of shares held
Name of the public company or ASX code
Number of shares held
Name of the public company or ASX code
Number of shares held
Name of the public company or ASX code
Number of shares held
Name of the public company or ASX code
Number of shares held
Name of the public company or ASX code
Number of shares held
No
Yes
Give details below
Name of the fund manager
Name of the product and product option
Number of units held (if applicable)
APIR code (if known)
$
Name of the fund manager
Name of the product and product option
Number of units held (if applicable)
APIR code (if known)
$
Name of the fund manager
Name of the product and product option
Number of units held (if applicable)
APIR code (if known)
$
Fields on page 18
Name of the fund manager
Name of the product and product option
Number of units held (if applicable)
APIR code (if known)
$
No
Yes
Give details below
Name of the company
Company ABN or ACN
Name of the company
Company ABN or ACN
Name of the company
Company ABN or ACN
No
Yes
Give details below
Name of the private trust
TFN
the private trust
Q51Details.0.TTFN3
ABN
ABN
ABN
Q51Details.0.ABN4
Name of the private trust
TFN
the private trust
Q51Details.1.TTFN3
ABN
ABN
ABN
Q51Details.1.ABN4
Name of the private trust
TFN
the private trust
Q51Details.2.TTFN3
ABN
ABN
ABN
Q51Details.2.ABN4
No
Does the
Yes
Fields on page 19
$
$
$
$
$
$
$
$
$
$
$
$
$
$
Other (describe)
$
$
Other (describe)
$
$
Q53.9.Other
$
$
Q53.10.Other
$
$
Q53.11.Other
$
$
Q53.12.Other
$
$
Q53.13.Other
$
$
Q53.14.Other
$
$
Fields on page 20
No
Yes
Give details below
1
Date of birth
$
Interest rate paid by a on the loan
%
2
/
$
%
%
3
/
$
%
%
4
/
$
%
%
5
/
$
%
%
No
Yes
Give details for each liability
1
$
Asset secured against
$
$
$
2
$
against
$
$
$
3
$
$
$
$
$
4
$
$
$
$
$
5
$
$
$
$
$
Fields on page 21
No
Yes
Give details of each person
Name
Date of birth
$
$
$
$
Other income type (for example, director’s fees, bonus shares)
$
Financial year of payment
No
Yes
Name
Date of birth
$
$
$
$
Other income type (for example, director’s fees, bonus shares)
$
Financial year of payment
No
Yes
Name
Date of birth
$
$
$
$
Other income type (for example, director’s fees, bonus shares)
$
Financial year of payment
No
Yes
Fields on page 22
No
Yes
Give details of each person
Name
Date of birth
/
$
Financial year of payment
Name
Date of birth
/
$
Financial year of payment
Name
Date of birth
/
$
Financial year of payment
No
the trust own any real
Yes
How many properties
Fields on page 23
Name of the trust which holds the real estate
Trust CRN – if
– if applicable
Q59.CRN.2
Q59.CRN.3
Trust ABN
ABN
Q59.ABN3
Q59.ABN4
Address of the property
Address of the property
Q60.PropertyAddress3
Q60.PropertyAddress4
Postcode
Country (if not in Australia)
What date did the property become an
Vacant land
Bush block
Home office/business
House
Self contained flat (part of or
Units/flats/town house
Retail premises
Commercial premises
Industrial premises
Farm (or hobby farm)
Market garden
Residential block larger than
Other
Give details
Other
If the property is made up of more than 1 title, give details for each separate title.
$
No
Is there a
Yes
No
on the
Yes
No
Is the
Yes
$
No
Does the
Yes
Fields on page 24
$
Provide the legal description and area of the title on which the residence sits.
No
Carer Payment Pension Bonus
Yes
No
more
Yes
No
Yes
themselves
Yes themselves
No
Yes
Describe the potential commercial use
Yes
No
Yes
No
No
there any reason that
Yes
Rural residential block
Land is not viable for commercial
Caring responsibilities
Health reasons
Zoning restrictions
Environmental restrictions
Other
Give details
Other
Do not currently make any use of
Primary production
Rural residential only
Leased
Other commercial or business
Hobby farm
Other
Give details
Other
No
Yes
No
Yes
No
Fields on page 25
Name of person/entity
Percentage owned
Name of person/entity
%
Q81.Name.2
%
Area in hectares
Area in acres
Area in square metres
Dimensions
X
What is the approximate floor How old is area in square metres
How old is the building
Exterior (for example, brick, timber)
Interior (for example, plaster, not lined)
Roof (for example, metal, tiles)
General condition (for example, good, fair, poor)
Total number of flats/units in the
in the
of
What is the approximate floor How old is area in square metres
How old is the building
Exterior (for example, brick, timber)
Interior (for example, plaster, not lined)
Roof (for example, metal, tiles)
General condition (for example, good, fair, poor)
good, fair, poor)
in the
of
Fields on page 26
No
Yes
Give details below
Date of loan
Interest rate
$
$
Name of finance provider
No
Yes
Give details below
Describe the asset or give the address of the property used to secure the loan.
$
No
Yes
Give details below
$
No
Yes
Give details below
Yes
If the property is hard to locate, give full directions or provide a map.
Fields on page 27
Name of Trustee
On completion of this form,
Trustee’s signature
Date
Second signature (if a corporate trustee) Date
Person to be contacted by the valuer
Their daytime phone number
Fields on page 28
No
special
Yes
No
Yes
Indicate which type of beneficiaries
Income beneficiaries
Capital beneficiaries
Name of operator
Date of birth
Their relationship to you
No
Yes
Name of partnership
Yes
Date appointorship changed to
Financial year
/
Your primary production income $
$
Financial year
/
Your primary production income $
$
Financial year
/
Your primary production income $
$
No
Yes
primary production assets
$
$
$
$
$
$
$
Other (describe)
$
Other (describe)
$
Q97Details.9.Other
$
Fields on page 29
Personal Income Tax Return for you
Personal Income Tax Return for your partner if they
Latest Income Tax Return for the trust
Profit and Loss Statement for the trust
Depreciation Schedule for the trust
Balance sheet for the trust
Notes to and forming part of the accounts
Trading account details for the trust
A Profit and Loss Statements for all income
If you are not able to lodge any of the required
documentation, give an explanation below
If you are not able to lodge any of the required documentation, give an explanation below
A copy of the will of the testator
A copy of the evidence the trust has had a change
Private Company (Mod PC) form
A copy of the Resolution to Distribute and evidence
A copy of the latest statement detailing the
A complete copy of a document which gives
Private Trust (Mod PT) form
Copies of any written agreements concerning
A completed ‘Trust real estate details’ section for
A copy of the council rate/valuation notice for each
A copy of the water rights, allocation or licence
A copy of each title deed (required at question 70)
The mortgage or loan agreement(s) showing which
A stamped copy of the initial trust deed, a stamped
Business details (Mod F) form
Fields on page 30
Your signature
Date
Your partner’s signature
Date
