Personal & Business Details - CQ Taxation Services

Authority to Act as Tax Agent

Authority for Tax Agent (CQ Taxation Services Pty Ltd) to act on behalf of the Taxpayer/s named in this form in respect to the taxpayer’s dealings with the Australian Taxation Office.

Full name(Required)

First Names (including middle names) Last

Mobile Phone Number(Required)

Email Address(Required)

Date of Birth(Required)

Tax File Number(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Business Details

Add Business Details(Required)

Yes

Entity Type

Entitiy Name

Trustee Name

Partners Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Tax File Number(Required)

ABN Number (if applicable)

Signature

Name of person making the declaration