Withholding Declaration - Australian Government Taxation Office Page 3
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3HoW to complete tHe WITHHoldINg dEClArATIoN Form
upwards variation agreement
read the instructions before completing this agreement.
n
the information in the completed Upwards variation
print neatly in BlocK letters and use a BlacK or
n
agreement must be treated in confidence.
DarK Blue pen.
step 1: election by payee
to be completed by the payee.
I elect that the payer will:
(a) withhold amounts from payments made to me at the rate of
.
%
or
x
(b) increase the amount that would otherwise be withheld by $
,
.00 per payment.
Day
month
year
This applies to payments made to me from the
pay period.
i understand that the varied rate or increased amount will apply only to the payments made to me starting
from the pay period indicated above, when it results in a higher amount being withheld than would otherwise
apply under the payG withholding tax tables or by regulation for the relevant withholding event.
step 2: declaration by payee
there are penalties for deliberately
making a false or misleading statement.
I declare that the information I have given on this agreement is true and correct.
signature of payee
Day
month
year
Date
name of payee
step 3: Complete the Withholding declaration form
complete the Withholding declaration form on the previous page and give this
agreement and the declaration to your payer. your payer will sign both the agreement and
declaration, retain the declaration and return this agreement to you for your records.
step 4: declaration by payer
to be completed by the payer.
I agree to increase the amount withheld from payments made as indicated at (a) or (b).
signature of payer
Day
month
year
Date
australian business number (aBn) or withholding payer number (Wpn)
registered business name or trading name (or individual name if not in business)
payer: return tHe completeD aGreement to tHe payee
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