Authorisation for Lodgement of
Business Activity Statements (BAS) By a BAS Service Provider (BSP)

You will need to complete this form to enable a BAS Service Provider (BSP) to lodge Business Activity Statements (BAS's) on your behalf.

Details of Business Entity
1. What is the legal name of your business?
2. What is your Australian Business Number (ABN)
3. What is your GST Branch Number?
(the three numeric characters that appear after your ABN on your Bas)
4. Who is your authorised contact person?   Provide details of a person who may be contacted for further information.
This may be you or another person authorised by you to make changes on your behalf.
Title
Family name Preferred name
Position held
Business hours phone number Mobile phone number
After hours phone number Fax number
e-mail address
5. What is your postal address for services of notices and correspondence?
Address1
Address2
Suburb/Town
State/Territory Postcode

Business Service Povider Details
6. What is the legal name of the BAS Service Provider you wish to authorise to act on your behalf?
Business hours phone number Mobile phone number
After hours phone number Fax number
e-mail address
7. Type of BAS Service Provider
A member of a recognised professional association
     (as defined in section 251LA of the income Tax Assessment Act 1936)
A registerd tax agent
A bookkeeper working under the dirction of a registered tax agent
An organisation providing free BAS preparation and lodgement services
     to nominated entities or clients
Barrister or Solicitor
If your BSP is a registered tax agent, please provide their tax agent number 

Declaration
I declare that I am carrying on an enterprise and certify that the information given on this application is accurate and complete
Signature Date
Name
Position/title