TX210 INCOME TAX – INDIVIDUALS/SOLE TRADERS

APPOINTMENT OF TAX AGENT / REGISTERED AGENT NUMBER: 26174353

Family Name or Surname
Given Name (s)
Date of Birth
Place of Birth
ABN & ACN	ABN:	ACN:
Tax File Number (TFN)
Address	Street: Suburb: Post Code:
Postal Address if different to above	Street: Suburb: Post Code:
Address for Service of Notices	C/O CHARLTONS ACCOUNTANTS PTY LIMITED GPO BOX 188 SYDNEY NSW 2001
Contact Number	Mobile: Other:
Email Address
Additional Contact	Name: Tel: Email:
Number of Dependents if Any
Previous Tax Agent
Referral Source
Taxpayer’s name: Taxpayer’s signature: Date:	Tax agent’s name: Tax agent’s signature: Date:

Note: This form, duly completed and signed by the taxpayer should be returned to Charltons Accountants Pty Limited, GPO BOX 188, SYDNEY NSW 2001 or to info@charltons.com.au for lodgement with the Australian Tax Office, Tax Agent Liaison Centre

CHARLTONS TEAM MEMBER TO COMPLETE

Please complete ALL of the fields in the table below

Partner
Manager
Billing Entity if different
Retainer Client	Yes/No
Prepare Activity Statement if Sole Trader	Yes/No
Registered for GST	Yes/No
Relationship with Existing Client	Yes/No If Yes, please type nature of relationship and with which client
Client Verification	Yes/No
Date Verified
Verified by
Verification Method Pls tick as appropriate	Document Check	❏
Verified in-person	❏
Verified online	❏
Other	❏
Verification Notes Pls provide details on method verified / what documents sighted