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First Name

Last Name

Phone #

Date of Birth

-- Tax Type --

Australian Business # (ABN)

Tax File Number (TFN)

Streed Address

Streed Address 2

City Name

State Name

Postal Code

Form of ID

Signed & Agreed by

Signed Date

I hereby appoint Sapiens Accounting Solutions to act as Tax Agent & accountant to deal with the ATO and other authorities such as ASIC, on my behalf. I am authorise to make this declaration.

By signing, you accept Sapiens Accounting Solutions terms and conditions. You can read terms and conditions at Engagement Terms & Conditions

Signature: Draw your Signature in below box