Profit And Loss Statement Page 3
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5Instructions
Profit and Loss Statement
1
Title
Mrs
Miss
Ms
Other
Your name
Mr
Family name
First given name
Second given name
2
Your date of birth
/
/
3
Your Centrelink Reference Number
4
Name of your business
5
Type of business
6
Your phone number
(
)
7
Go to next question
Are you self-employed and
No
operating your business as a
Go to 9
Yes
sole trader?
8
Do you operate the business in
You have indicated you are neither a sole trader nor in a partnership. Call us on 132 850 to
No
partnership with other people?
discuss the nature of your business and to confirm that we need this form completed.
Number of business partners
Yes
Your share of income
%
Your partner’s share of income
%
9
We need to see a copy of your
(and your partner’s) latest personal
and partnership (if applicable)
income tax return(s) and
supporting information such as
balance sheet, depreciation
schedule etc.
Have you already provided copies
No
You will need to attach copies of documents.
of these documents to us?
Yes
10
Period of statement
/
/
/
/
to
Go to the calculation sheet on the next page.
CLK0SU580 1404
SU580.1404
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