Form Nat 2817 - Change Of Details For Individuals Page 5
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7Section D: Do you want to nominate a representative?
Go to section E.
Complete this section.
No
Yes
Complete this section to nominate a representative (authorised contact) to deal with us on your behalf and receive
information about your taxation affairs.
It is important to know that:
nominating a representative (authorised contact) does not cancel any previous nomination
■
any nomination will continue indefinitely until you let us know it no longer applies.
■
Think carefully about the extent of the authority you are giving. We will only discuss your taxation affairs with your
representative according to your statement of authority on this form.
If you are appointing a professional (such as a registered tax or BAS agent, barrister or solicitor) as your
representative you cannot use this form. Visit ato.gov.au or phone us for more information.
10 Who is your representative?
Title:
Mr
Mrs
Miss
Ms
Other
Family name
First given name
Other given names
Daytime phone number
Mobile phone number
After hours phone number
Fax number
Email address
11 Indicate which matters you nominate the representative to deal with on your behalf.
(Place
X
in ONE box only.)
To deal with the ATO and receive information concerning all of my taxation affairs.
OR
To deal with the ATO concerning the following specific matter(s):
This nomination will continue indefinitely until you phone and let us know you no longer want your representative to act
on your behalf. See Find out more on page 1.
Sensitive (when completed)
Page 5
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