INDIVIDUAL QUESTIONNAIRE 2017

Name *
Name
1. Did you receive income with tax deducted?
If no, skip to question 2
1a. If yes, have you sent us all certificates?
1b. Have you earned any salary from a company (with no PAYE deducted) in your capacity as a shareholder/employee? If yes, please provide full details.
2. Did you have any New Zealand interest paid or credited to you, including any interest from partnerships and trusts?
If no, skip to question 3
2a. If yes, have you sent us all certificates, eg IR15s?
You should have received interest statements or certificates from your financial institutions.
3. Did you have any New Zealand dividends paid or credited to you, or did you receive shares instead of dividends?
If no, skip to question 4
3a. If yes, have you sent us all dividend statements?
3b. Did you have any investments in PIEs?
3c. If yes, have you sent us investment summary schedules for the year including details for the prescribed investor rate (PIR) used?
4. Did you receive any New Zealand estate or trust income?
If no, skip to question 5
5. Did you receive any overseas income?
If no, skip to question 6
5a. If yes, have you sent us details of this overseas income and tax paid on the income?
6. Did you receive any partnership income other than interest and dividends as shown above?
If no, skip to question 7
7a. Did you receive New Zealand superannuation?
This excludes income-tested NZ Super already shown above. If no, skip to question 8
7b. Did you receive a veteran's pension?
7c. If you answered yes to either of the previous two questions, have you sent us all tax deduction certificates?
8. Did you receive any rental income?
If no, skip to question 9
If you have more than one property and you cannot fit the information into the text boxes below, please send additional details in an email to reception@smefinancial.co.nz.
9. Did you buy or sell any rental properties during the year?
If no, skip to question 10
If you have purchased several properties and the details will not fit into this space, please email the information to reception@smefinancial.co.nz
9b. Have you sent us a copy of the sale and purchase agreement?
9c. Have you sent us a copy of the solicitor's settlement statement for the property?
9d. Have you sent us a copy of the latest property valuation (capital or rateable)?
9e. Have you sent us a copy of any valuation by a registered property valuer/consultant?
If you have sold several properties and the details will not fit into this space, please email the information to reception@smefinancial.co.nz
9g. Have you sent us a copy of the sale and purchase agreement?
9h. Have you sent us a copy of the solicitor's settlement statement?
9i. Have you sent us details of commission paid to any agency, if any?
10. Did you receive income from self-employment?
If no, skip to question 11
10a. If yes, have you supplied details of all deductible expenses, including expenses you have to pay in order to earn this income.
Please check with us if you are unsure what can be claimed
11. Do you have a shareholding in a look-through company (LTC)?
If no, skip to question 12
12. Did you receive any other type of income other than that stated above?
If no, skip to question 13
12a. If yes, have you supplied all the relevant information?
Please also ensure you have supplied copies of all invoices issued to you by ACC during the year
14. Do you have income protection insurance?
If yes, please provide a copy of the policy or invoice If no, skip to question 15
14a. If yes, do you pay your premiums monthly or annually?
15. Did you or do you have a student loan?
16. Do you have any holdings in offshore entities?
These could be – bank accounts, superannuation schemes, unit trusts, life insurance policies, shares in overseas companies, loans to foreign entities, foreign credit cards. Note: if you have offshore investments, we will need to contact you in relation to applying the foreign investment fund (FIF) rules.
17. Did you make a donation of $5 or more to an approved charity?
Please note this does not include school fees If no, skip to question 18
17a. If yes, have you supplied all the receipts?
18. Did you purchase or sell any government or local body stock or corporate bonds this year?
If yes, please provide documentation
21. Did you acquire any shares or exercise any rights or options to acquire shares under an employee share or option scheme?
22. Have you recently reviewed your business and personal insurances?
23. Have you settled a trust during the year?
24. Have you made any gifts during the year?
If yes, please provide deeds
25. Do you wish to discuss trusts?
26. Do you wish to discuss wealth management issues?
27. Has your income changed or will it be likely to change for the coming year?
This is particularly relevant for provisional taxpayers
Declaration *
By submitting this form, you agree that the above information will be used SME Financial Limited in the preparation of financial statements and taxation returns as agent on my behalf. I have read and understood the obligations which I am required to meet included in the “Information to be Provided” section. Under the terms of the Privacy Act (1993), authorise SME Financial Limited to obtain from any third party any records or information you require for the purpose of preparing my Financial Statements and Income Tax Returns and accordingly any such third party is authorised to provide you with information required.