Client Information Form

Please complete your details below so we can set you up as a client. All information is kept strictly confidential.

Personal details

Title *

First name *

Middle name

Last name *

Date of birth *

Gender *

Residency status *

Tax File Number (TFN) *

ABN (if any)

Occupation *

Residential address

Street address *

City / suburb *

State *

Postcode *

Country (if not Australia)

My postal address is different from my residential address

Contact details

Email address *

Mobile number

Spouse & dependants

Spouse full name (if any)

Spouse date of birth

Dependants

Do you pay or receive child support?

Bank account details

The account where you would like any tax refunds deposited.

Account name

BSB

Account number

Engagement

Preferred accountant *

How did you hear about us?

Where should ATO correspondence be sent? *

Do you have a MyGov account?

Additional information

Representative

Would you like to nominate a representative?

A representative is someone you authorise to deal with us and discuss your tax affairs on your behalf.

Declaration & signature

I hereby AUTHORISE SuccessPath Advisory to act / deal on my behalf as my tax agent with any matters related to obtaining information regarding my accounting and tax matters using current cloud computing services.

I have read and agree to the declaration above *

Signature *

Draw your signature above using your mouse or finger.