Form Nat 2817 - Change Of Details For Individuals Page 6
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7Section E: Declaration
This section is compulsory.
If you are nominating a representative (authorised contact) in section D, only you can sign this declaration. If you have
not completed section D, only you or a person currently on our records as having authority to update these details can
sign this declaration. If you would like another person to update your details on your behalf, they must already be listed
on our records.
12 Who is the authorised person signing this declaration?
(Complete all of the fields below.)
Full name of signatory
Daytime phone number
Mobile phone number
After hours phone number
Fax number
Email address
Before you sign this form
Make sure you have answered all the relevant questions correctly and read the privacy statement below before you sign
and date this page. An incomplete form may delay processing and we may ask you to complete a new form.
Penalties may be imposed for giving false or misleading information.
I declare that the information given on this form is true and correct.
OR
I declare that:
this document has been prepared in accordance with information supplied by the individual
■
I have received a declaration from the individual authorising me to complete this form and
■
stating that the information provided to me is true and correct.
Signature
Date
Day
Month
Year
You MUST SIGN here
Privacy
Taxation law authorises the ATO to collect information and to disclose it to other government agencies.
For information about your privacy go to ato.gov.au/privacy
We may check the supporting documents you supply with the agencies that issued them.
Sensitive (when completed)
Page 6
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