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Gold Coast Accountant

New Client Form

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    Thank you for considering Accounting & Tax Solutions as your Tax Agent and Accountant.
    We would appreciate it if you could please take the time to fill out the following details:

    Business Information

    Business Name:

    GST Registered YESNO

    Trading as:

    Tax File Number:

    ABN:

    ACN:

    Client Personal Information

    Full Name:

    MRMRSMSMISS

    Date of Birth:

    Place of Birth:

    Occupation:

    Tax File Number:

    Medicare No:

    Spouse/Partners Information

    Full Name:

    Date of Birth:

    Place of Birth:

    Occupation:

    Tax File Number:

    Medicare No:

    Children Information

    YES If Yes, names and dates of birth:

    Centrelink/Child Support Obligations: YESNO

    Child Name (1):

    DOB:

    Child Name (2):

    DOB:

    Child Name (3):

    DOB:

    Child Name (4):

    DOB:

    Contact Information

    Full Name:*

    Address:*

    PO Box:

    Mobile#:

    Home Phone#:

    Business Phone#:

    Fax#:

    Email:

    Bank Account Details (for ATO Refund):

    BSB:

    Acc Number:

    Acc Name:

    Other Information

    Income Protection Insurance: - (Interested? YES / NO)

    Medical Insurance:

    Copy of ID: (ie. Drivers License, Medicare Card, Passport)

    YESNO

    Upload your ID

    How did you hear about Accounting & Tax Solutions?

    GoogleWalk InReferral

    Client wishing to use secure 'Client Portal' (e-signing)?

    YESNO