Registration Form

Personal Details

* Indicates required field

Title *

Name *

First

Last

Tax File Number *

Date of Birth *

Phone Number *

Email *

ABN (if any) *

Residential Address *

Line 1

Line 2

City

State

Zip Code

Country

Postal address (if different) *

Bank Account

Bank Name *

Account Name *

BSB *

Account Number *

Visa & Medicare & Spouse Details

Please choose one of the following *

Do you have a Medicare card or entitled to Medicare? *

Yes - for full year Yes - for only part year No

Do you have any dependent children? *

Yes No

Comment (if any) *

I hereby certify that the above information is correct to the best of my knowledge and I acknowledge the substantiation declaration. I hereby authorise RJ & Co Tax Accounting to prepare and lodge tax return on my behalf.

Tick and submit *

Agree

I agree to receiving marketing and promotional materials *

Submit