Capital Gains Tax (Cgt) Schedule - 2016 Page 3

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7
Earnout arrangements
A
Are you a party to an earnout arrangement?
Yes, as a buyer
Yes, as a seller
No
(Print
X in the appropriate box.)
If you are a party to more than one earnout arrangement, copy and attach a separate sheet to this schedule providing the
details requested here for each additional earnout arrangement.
B
How many years does the earnout arrangement run for?
C
What year of that arrangement are you in?
.
If you are the seller, what is the total estimated capital proceeds
00
$
D
,
,
,
from the earnout arrangement?
LOSS
Amount of any capital gain or loss you made under
.
/
00
E
$
,
,
,
your non-qualifying arrangement in the income year.
Request for amendment
If you received or provided a financial benefit under a look-through earnout right created in an earlier income year and you wish
to seek an amendment to that earlier income year, complete the following:
F
Income year earnout right created
LOSS
.
/
00
$
G
Amended net capital gain or capital losses carried forward
,
,
,
8
Other CGT information required (if applicable)
CODE
.
/
00
$
A
Small business 15 year exemption – exempt capital gains
,
,
,
.
00
$
B
Capital gains disregarded by a foreign resident
,
,
,
.
00
$
C
Capital gains disregarded as a result of a scrip for scrip rollover
,
,
,
.
00
$
D
Capital gains disregarded as a result of an inter-company asset rollover
,
,
,
.
00
$
E
Capital gains disregarded by a demerging entity
,
,
,
Taxpayer’s declaration
If the schedule is not lodged with the income tax return you are required to sign and date the schedule.
Important
Before making this declaration check to ensure that all the information required has been provided on this form and any attachments
to this form, and that the information provided is true and correct in every detail. If you are in doubt about any aspect of the tax
return, place all the facts before the ATO. The income tax law imposes heavy penalties for false or misleading statements.
Privacy
Taxation law authorises the ATO to collect information and disclose it to other government agencies. This includes personal
information of the person authorised to sign the declaration. For information about your privacy go to ato.gov.au/privacy
I declare that the information on this form is true and correct.
Signature
Date
Day
Month
Year
Contact name
Daytime contact number (include area code)
Sensitive (when completed)
Page 3

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