I, ^name of competent authority^ of The Netherlands, one of whose addresses is ^address^:
(1)declare that:
(a)I am a duly appointed competent authority of The Netherlands, for the purposes of the Multilateral Convention on Mutual Administrative Assistance in Tax Matters as amended by the 2010 Protocol (“the Convention”);
(b)an amount totalling $Aust^amount^ (€^amount^) (“the Revenue Claim”) calculated as at the date of this request, is owed, or will be owed, by ^name of debtor^ under the laws of The Netherlands, in respect of taxes and associated amounts, particulars of which are as follows:
Taxes | $Aust^amount^ |
Interest | $Aust^amount^ |
Administrative penalties | $Aust^amount^ |
Costs | |
Total | $Aust^amount^; |
(c)the Revenue Claim owed by ^name of debtor^ is enforceable, or will be enforceable, under the laws of The Netherlands;
(d)A Request for Assistance in Collection will be made by The Netherlands for the recovery of the tax claim pursuant to the Convention and under section 263-15 of the
Taxation Administration Act 1953 by (
date).
(e)the Revenue Claim is consistent with the provisions of the Convention and fulfils the requirements of the Convention; and
(2)request that the Revenue Claim specified in the above declaration be accepted for the conserving of assets for the purposes of such collection; and
(3)advise that
(please advise of the stage in the process of assessment or recovery that the Revenue Claim has reached under the laws and administrative practices of the Netherlands); and
(4)advise that
(please advise how and in what respects conservancy relates to assets, including ‘claims and expectancies’, of ^name of debtor^ against whom the Revenue Claim applies or relates to a third party against whom process is available as a consequence of the tax claim, pursuant to which the third party may be obliged to disgorge property or otherwise contribute to the funds or property of ^name of debtor^).
Dated:
.....
^name of competent authority^
Competent Authority
The Netherlands
Please return this form to the Competent Authority of the Australian Taxation Office in paper form, by electronic transmission or by facsimile. |