Unregistered Payroll Tax
Employers Questionnaire
Note:

This form constitutes an approved return for payroll tax under section 34 of the Taxation
Administration Act 1996.

If you need more room, complete your answers on a separate Word or Excel document.

Upload the completed form, including copies of your financial statements, FBT returns, and
all other relevant documents via ‘Upload Information’ on
http://www.osr.nsw.gov.au/info/online/payroll/questionnaire

Do not copy or use this form for other client questionnaires.

If you are not currently registered for payroll tax and consider you may be entitled to an
exemption, you must still complete this questionnaire and an Application for Exemption which
is available at www.osr.nsw.gov.au
Company details
1.
Name of the legal entity conducting this business
2.
Trading name
3.
Principal place of business
4.
5.
6.
State
Postcode
State
Postcode
State
Postcode
Postal address
Address of inspection of records
ABN
ACN
Registration
7.
Was this business already registered for payroll tax before we sent you this questionnaire?
Yes  Go to Question 8
No  Go to Question 9
8.
What is your payroll tax Client ID?
Contact details
9.
Contact name
Mobile
10.
Daytime phone (
11.
Email
12.
External accountant/Professional adviser
13.
Daytime phone (
14.
Email
)
Fax (
)
Web address
)
Unregistered Payroll Tax | Employers Questionnaire | 2013
Fax (
)
Business details
15.
What is the nature of the business?
16.
When did the business first employ staff in NSW?
17.
Does the business employ staff in other states?
Yes  Go to Question 18
No  Go to Question 20
18.
In which states and territories do you employ?
19.
VIC
QLD
ACT
SA
WA
NT
TAS
For each state in which you employ, provide the date(s) on which the employment first
commenced. Also, if your entity is registered in that state, please provide your payroll tax
registration number(s).
Grouping
20.
Is this business carried on by a trust?
Yes  Provide the details in the table below
21.
Name of trust
Type of trust
(Including name of trustee)
(Discretionary or Unit)
Value of interest
Names of beneficiaries
(If a Unit Trust, the
number of units held)
List all the shareholders, partners or proprietors of this entity during the period 1 July 2009 to
current date:
If a corporation
(including trustee company),
names of shareholders
22.
No  Go to Question 21
Value of interest
If a partnership,
names of partners
(Percentage of
shareholding or interest
in a partnership)
Acquisition
date
(dd/mm/20yy)
Disposal
date
(dd/mm/20yy)
If this entity is a corporation, list all the directors during the period 1 July 2009 to the current
date. If not  Go to Question 23
Name of director(s)
Unregistered Payroll Tax | Employers Questionnaire | 2013
Appointment date
(dd/mm/20yy)
Resignation date
(dd/mm/20yy)
2 of 8
23.
Did this entity hold an interest in any other entity during the period 1 July 2009 to current date?
Note: An interest includes shareholdings in corporations, units in a trust or shares in a
partnership.
Yes  Provide the details for each entity in the table below
No  Go to Question 24
A
B
C
Value of interest
Name of entity
24.
ABN
B
Name of shareholder, unit holder
or partner
No
Yes
No
Yes
No
Yes
No
Name of entity and ABN
in which the interest is
held
C
Value of interest
(percentage of share
or unit holding)
D
Does the entity in
column B pay any
wages?
Yes
No
Yes
No
Yes
No
Yes
No
If this entity is a corporation, did any of the directors hold directorships in other corporations
during the period 1 July 2009 to current date?
Yes  Provide the details for each other entity
No  Go to Question 26
in the table below
Name of director
26.
Yes
Do any of the shareholders, unit holders, partners or beneficiaries of this entity have an
interest in any other entity during the period 1 July 2009 to current date?
Yes  Provide the details for each other entity
No  Go to Question 25
in the table below
A
25.
(percentage of share
or unit holding)
D
Does the entity in
column A pay any
wages?
Name of corporation and ABN
Appointment date
(dd/mm/20yy)
Resignation date
(dd/mm/20yy)
Does this entity use any other business to provide it with administration services?
Yes  Provide the details for each provider
No  Go to Question 27
in the table below
Name of provider
Unregistered Payroll Tax | Employers Questionnaire | 2013
ABN
Address of provider
3 of 8
27.
Does this entity provide administration services to any other business?
Yes  Provide the details for each business in the table below
Name of business to whom
administration services are provided
28.
ABN
No  Go to Question 28
Address of business
Is this entity grouped with any other entity for payroll tax purposes?
To help you answer this question, go to www.osr.nsw.gov.au/taxes/payroll/grouping
Yes  Provide the other entities’ details in the table below
No  Go to Question 30
Name of entity
Client ID
(if registered)
ABN
Date first joined
group (dd/mm/20yy)
1.
2.
3.
4.
29.
Insert the taxable wages paid by other group members listed at Question 28 in the table below.
Note: Provide copies of financial statements for each entity for the last five (5) financial years.
Other Group Members
Entity
no.
NSW
2010
01/07/2009
to
31/12/2009
($)
01/01/2010
to
30/06/2010
($)
2011
01/07/2010
to
31/12/2010
($)
01/01/2011
to
30/06/2011
($)
2012
2013
2014
01/07/2011
to
30/06/2012
($)
01/07/2012
to
30/06/2013
($)
01/07/2013
to
* /2014
($)
1.
2.
3.
4.
Total
NSW
Interstate
1.
2.
3.
4.
Total
Interstate
Total
* Insert the last completed month (mm) for which the taxable wages have been paid.
Unregistered Payroll Tax | Employers Questionnaire | 2013
4 of 8
Contractors
30.
Does this entity make any payments for labour provided by contractors, subcontractors or consultants?
No  Go to Question 32
Yes  Go to Question 31
31.
Are any of your payments to contractors, subcontractors or consultants exempt from payroll tax?
Note: To help you answer this question, read the factsheet ‘NSW Payroll Tax Information for Contractors and Employment Agents’ at:
www.osr.nsw.gov.au/info/publications/taxes/payroll
No  Go to Question 32
Yes  Complete the table below
Name of contractor,
subcontractor or consultant
ABN
Nature of services provided
by contractor
Entity type
(Note 1)
Exemption
No. (Note 2)
Total amounts paid ($)
2010
2011
2012
2013
Total
Note 1: Insert the applicable letter as follows: C for corporation, T for trust, P for partnership, S for sole trader.
Note 2: Insert the relevant exemption number (1 to 9) as referred to in the ‘NSW Payroll Tax Information for Contractors and Employment Agents’ factsheet.
Unregistered Payroll Tax | Employers Questionnaire | 2013
5 of 8
Taxable wages
32.
Complete the taxable wages in the table below:
2010
NSW wages
(A-K)
2011
2012
01/07/2009
to
31/12/2009
01/01/2010
to
30/06/2010
01/07/2010
to
31/12/2010
01/01/2011
to
30/06/2011
01/07/2011
to
30/06/2012
($)
($)
($)
($)
($)
2013
01/07/2012
to
30/06/2013
($)
A. Salaries
B. Commissions
C. Bonuses
D. Taxable
allowances
E. Directors fees
F. Superannuation
paid to
employees/
directors
G. Employee super
salary sacrifice
H. Taxable fringe
benefits value
(Note 1)
I. Liable
contractor
payments
J. Less workers
Comp payments
paid to
employees
(Note 2)
K. Total NSW
wages (A to I
less J)
L. Add Interstate
wages
M. Add other group
members NSW
wages (from
Question 29)
N. Add other
group members
interstate
wages (from
Question 29)
O. Total Australian
Wages
(items K to N)
NSW wages and
super paid to
apprentices and
trainees included in
A and F above
Note 1: Taxable fringe benefits value is the aggregate of the type 1 and type 2 fringe benefits multiplied by 1.8692.
Attach copies of your FBT returns for the 2010–13 FBT years.
Note 2: Payments made by an insurance company to an employee on workers compensation are not liable wages. Make up
payments, being the difference between the compensation payments and the employee’s regular pay paid by the employer, are
liable as a wage.
Unregistered Payroll Tax | Employers Questionnaire | 2013
6 of 8
33.
For the current financial year, insert monthly taxable wages (including superannuation
contributions) paid up to the last completed month.
Month
Your total NSW taxable
wages (including
apprentices and trainees)
($)
Your NSW apprentice
and trainee wages (to
calculate your rebate)
($)
Your interstate taxable
wages
($)
July 2013
August 2013
September 2013
October 2013
November 2013
December 2013
January 2014
February 2014
March 2014
April 2014
May 2014
June 2014
Total
34.
If you are liable for payroll tax but not registered, please state why you were not registered.
The reason(s) you provide here will be used to decide what level of penalty tax (if any) should
be imposed.
To be entitled to a full remission of penalty tax, you will need to demonstrate to us that you
took reasonable care to comply with your payroll tax obligations or that any tax default
occurred because of circumstances beyond your control.
Unregistered Payroll Tax | Employers Questionnaire | 2013
7 of 8
Penalty Tax Remission
The Taxation Administration Act 1996 states that penalty tax and interest is payable if you do not
register and pay payroll tax when you were first required to do so.
However, if you did not register when you should have and you disclose all your taxable wages in
this questionnaire, we may remit some or all of the penalty tax that would otherwise be payable.
To be entitled to any remission you must:

fully and accurately complete and return this questionnaire together with all requested
documents, including financial statements and FBT returns, and

complete Question 34 and demonstrate that your tax default was beyond your control or that
you have taken reasonable care in the conduct of your payroll tax affairs.
Checklist
I have answered all questions.
I have attached copies of financial statements (including grouped businesses, if applicable).
I have attached copies of FBT returns, if applicable (including grouped businesses).
Declaration
I,
declare that all information provided is true and correct in every particular.
Name (Print)
Position
Signature
Date
/
/
Privacy statement
Information collected from you on this form is required by the Office of State Revenue (OSR) to determine if you have a
liability or entitlement. The information may be provided to third parties with your consent or as required or permitted by
law. OSR will correct or update your personal information at your request. Read more about privacy at
www.osr.nsw.gov.au
Contact details
(02) 9762 7550
www.osr.nsw.gov.au
GPO Box 4042, Sydney NSW 2001
Fax: (02) 9762 7500
Office of State Revenue: ISO 9001 – Quality Certified | Department of Finance & Services
© State of New South Wales through the Office of State Revenue, 2013. This work may be freely reproduced and
distributed for most purposes, however some restrictions apply. Read the copyright notice at www.osr.nsw.gov.au or
contact OSR.
Unregistered Payroll Tax | Employers Questionnaire | 2013
8 of 8