METHODS OF PAYMENT
BPAY®
Contact your financial institution to make this payment from
your cheque or savings account. You will need the details
listed below.
Biller Code: 75556
Reference: Your EFT code (shown on the front
of your payment slip directly above the barcode)
Credit card
Payments can be made online or by phone, visit our
website at ato.gov.au/howtopay or phone XXXXXXXXXX.
A card‑payment fee applies.
Other payment options
For more information about other payment options, you can:
n visit our website at ato.gov.au/howtopay
n phone us on XXXXXXXXXX.
Payments cannot be made in person at any of our
anches
or shopfronts.
Variation codes (T4)
Reason for varying T4 code
Change in investments 21
Cu
ent business structure not continuing 22
Significant change in trading conditions 23
Internal business restructure 24
Change in legislation or product mix 25
Financial market changes 26
Use of income tax losses 27
NAT XXXXXXXXXX [JS 29438]
When completing this form:
n print clearly using a black pen
n round down to whole dollars (do not show cents)
n if reporting a zero amount, print ‘0’ (do not use NIL)
n leave boxes blank if not applicable (do not use N/A, NIL)
n do not report negative figures or use symbols such as +, −, /, $.
G
Office use only
Form due on
ABN
Document ID
Payment due on
Business activity
statement
Contact phone number
Authorised contact person
who completed the form
GST accounting method
Complete Option 1 OR 2 (indicate one choice with an X)
PAYG income tax instalment
OR
Option 1: Pay a PAYG instalment amount quarterly
Reason code for variation T4
Write the T7 amount at 5A in the Summary section over the page
OR if varying this amount, complete T8, T9, T4
Write the T9 amount at 5A in the Summary section over the page
and then complete the other sections
T7 $
Estimated tax for the year T8 $ , , .00
Varied amount payable
for the quarter T9 $ , , .00
OR
Option 2: Calculate PAYG instalment using income times rate
New varied rate T3 . %
Reason code for variation T4
T2 %
Write the T11 amount at 5A in the Summary section over the page
and then complete the other sections
PAYG instalment income T1 $ , , .00
T1 x T2 (or x T3) T11 $ , , .00
Does the amount shown at
G1 include GST?
(indicate with an X)
Yes No
Report GST on sales at 1A and GST on purchases at 1B in the
Summary section over the page and then complete the other sections
Goods and services tax (GST)
Total sales
(G1 requires 1A completed) G1 $ , , .00
Export sales G2 $ , , .00
Other GST-free sales G3 $ , , .00
Capital purchases G10 $ , , .00
Non-capital purchases G11 $ , , .00
XXXXXXXXXX
Payment or refund?
Your payment or refund amount
9 $
Estimate the time taken to complete
this form. Include the time taken to
collect any information.
HRS MINSReturn this completed form toDeclaration I declare that the information given on this form is true and co
ect, and that
I am authorised to make this declaration. The tax invoice requirements have been met.
Signature Date /
PAYG tax withheld
Total salary, wages and
other payments W1 $ , , .00
Write the W5 amount at 4 in the Summary section below
Amount withheld from
payments shown at W1
W2 $ , , .00
Amount withheld where
no ABN is quoted W4 $ , , .00
Other amounts withheld
(excluding any amount
shown at W2 or W4)
W3 $ , , .00
W5 $Total amounts withheld (W2 + W4 + W3) , , .00
F1 $
Fringe benefits tax (FBT) instalment
Reason code for variation F4
Write the F1 amount at 6A in the Summary section below
OR if varying this amount, complete F2, F3, F4
Write the F3 amount at 6A in the Summary section below
Estimated FBT
for the year F2 $ , , .00
Varied amount payable
for the quarter F3 $ , , .00
Summary
Amounts you owe the ATO
GST on sales 1A $ , , .00
Wine equalisation tax 1C $ , , .00
Luxury car tax 1E $ , , .00
PAYG tax withheld 4 $ , , .00
PAYG income tax instalment 5A $ , , .00
FBT instalment 6A $ , , .00
Defe
ed company/fund
instalment 7 $ , , .00
1A + 1C + 1E + 4
+ 5A + 6A + 7 8A $ , , .00
Amounts the ATO owes you
GST on purchases 1B $ , , .00
1D $Wine equalisation tax refundable , , .00
1F $Luxury car tax refundable , , .00
Credit from PAYG income tax
instalment variation 5B $ , , .00
Credit from FBT
instalment variation 6B $ , , .00
1B + 1D + 1F
+ 5B + 6B 8B $ , , .00
, , .00
Is 8A more than 8B?
(indicate with X)
then write the result of 8A minus 8B at 9. This amount is
payable to the ATO.
then write the result of 8B minus 8A at 9. This amount is
efundable to you (or offset against any other tax debt you have).
Yes,
No, Do not use symbols such as +, –, /, $
Taxation laws authorise the ATO to collect information including personal information about individuals who may complete this form. For information about privacy and
personal information go to ato.gov.au/privacy. Activity statement instructions are available from ato.gov.au or can be ordered by phoning XXXXXXXXXX.
METHODS OF PAYMENT
BPAY®
Contact your financial institution to make this payment from
your cheque or savings account. You will need the details
listed below.
Biller Code: 75556
Reference: Your EFT code (shown on the front
of your payment slip directly above the barcode)
Credit card
Payments can be made online or by phone, visit our
website at ato.gov.au/howtopay or phone XXXXXXXXXX.
A card‑payment fee applies.
Other payment options
For more information about other payment options, you can:
n visit our website at ato.gov.au/howtopay
n phone us on XXXXXXXXXX.
Payments cannot be made in person at any of our
anches
or shopfronts.
XXXXXXXXXX
NAT XXXXXXXXXX [JS 29451]
Y
Office use only
Form due on
ABN
Document ID
Payment due on
Business activity
statement
Contact phone number
Authorised contact person
who completed the form
GST accounting method
PAYG income tax instalment
OR
Option 1: Pay a PAYG instalment amount quarterly
Reason code for variation T4
Write the T7 amount at 5A in the Summary section over the page
OR if varying this amount, complete T8, T9, T4
Write the T9 amount at 5A in the Summary section over the page
and then complete the other sections
T7 $
Estimated tax for the year T8 $ , , .00
Varied amount payable
for the quarter T9 , , .00
OR
Option 2: Calculate PAYG instalment using income times rate
New varied rate T3 . %
Reason code for variation
(see variation codes table) T4
T2 %
Write the T11 amount at 5A in the Summary section over the page
and then complete the other sections
PAYG instalment income T1 $ , , .00
T1 x T2 (or x T3) T11 , , .00
Complete one of the two options below (place in ONE option box only)X
When completing this form:
n print clearly using a black pen
n round down to whole dollars (do not show cents)
n if reporting a zero amount, print ‘0’ (do not use NIL)
n leave boxes blank if not applicable (do not use N/A, NIL)
n do not report negative figures or use symbols such as +, −, /, $.
Does the amount shown at
G1 include GST? Yes No
Report GST on sales at 1A and GST on purchases at 1B in the
Summary section over the page and then complete the other sections
Goods and services tax (GST)
Total sales
(G1 requires 1A completed) G1 $ , , .00
Export sales G2 $ , , .00
Other GST-free sales G3 $ , , .00
Capital purchases G10 , , .00
Non-capital purchases G11 $ , , .00
Variation codes (T4)
Reason for varying T4 code
Change in investments 21
Cu
ent business structure not continuing 22
Significant change in trading conditions 23
Internal business restructure 24
Change in legislation or product mix 25
Financial market changes 26
Use of income tax losses 27
Estimate the time taken to complete
this form. Include the time taken to
collate any information.
HRS MINSReturn this completed form toDeclaration I declare that the information given on this form is true and co
ect, and that
I am authorised to make this declaration. The tax invoice requirements have been met.
Signature Date /
F1 $
Fringe benefits tax (FBT) instalment
Reason code for variation F4
Write the F1 amount at 6A in the Summary section below
OR if varying this amount, complete F2, F3, F4
Write the F3 amount at 6A in the Summary section below
PAYG tax withheld
Total salary, wages and
other payments W1 $ , , .00
Write the W5 amount at 4 in the Summary section below
Amount withheld from
payments shown at W1
W2 $ , , .00
Amount withheld where
no ABN is quoted W4 $ , , .00
Other amounts withheld
(excluding any amount
shown at W2 or W4)
W3 $ , , .00
W5 $Total amounts withheld (W2 + W4 + W3) , , .00
Estimated FBT
for the year F2 $ , , .00
Varied amount payable
for the quarter F3 $ , , .00
Taxation laws authorise the ATO to collect information including personal information about individuals who may complete this form. For information about privacy and
personal information go to ato.gov.au/privacy. Activity statement instructions are available from ato.gov.au or can be ordered by phoning XXXXXXXXXX.
Summary
Amounts you owe the ATO
GST on