Company/Organisation Name*

Tax File Number*

Australian Business Number

Registered Address

Post Code

AUTHORISED PERSON DETAILS

Full Name*

Email*

Telephone/ Mobile*

OTHER INFORMATION -

For which month have you experienced or are likely to experience a reduction in turnover of 30% or more?*

Do not include yourself in the count of eligible employees. You may apply as business Participant below.

Number of eligible employees who have been or will be remunerated $1,500 or more (this may include wages, tax and salary-sacrificed super) for each JobKeeper fortnight. if No employees put 0*

Are you intending to register an eligible business participant*?
YesNo

BANK DETAILS FOR JOB KEEPER PAYMENTS

Account Name*

BSB*

Account Number*

Other details (if any)

Do you meet all of the following? *
1. Does the entity’s business participant meet all of the following?*
- relevant individual is not employed by the entity at any time in the fortnight
- relevant individual actively engaged in the entity’s business
- relevant individual aged 16 or over (or 18 year if beneficiary in the case of the Trust)
- relevant individual is not currently receiving parental leave pay, dad and partner pay
- relevant individual is not currently totally incapacitated for work and receiving payments under an Australian workers’ compensation law in respect of their total incapacity to work
- relevant individual is an Australian resident (within the meaning of section 7 of the Social Security Act 1991), or a resident for income tax purposes and was the holder of a special category (Subclass 444) visa.
- relevant individual is not an employee (other than a casual employee) of another entity

* compulsory
"Liability Limited by a scheme approved under Professional Standards Legislation"