Agent Authority Form Individual

Agent Authority Form Individual

Purpose of this document
A2Z Accountants Pty Ltd is a Registered Tax Agent, holding Tax Agent Registration Number 26039321.
By completing this declaration, you are authorising A2Z Accountants Pty Ltd to provide TAX Services as defined by the Tax Agent Services Act 2009 to the Individual or Entity.

Name
Name
First Name
Last Name
Bank Account Details
Bank Account Details
BSB
Account Number
Spouse Name
Spouse Name
First Name
Last Name
Private Health Insurance Details if you have
Private Health Insurance Details if you have
Health Insurance Provider
Membership Number
I declare that I am authorized to make this declaration:
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