FORM FOR A REQUEST FOR ASSISTANCE IN COLLECTION OR CONSERVANCY-THIS MUST BE COMPLETED IN ITS ENTIRETY
ATTACHMENTB1FORM FOR A REQUEST FOR ASSISTANCE IN COLLECTION OR CONSERVANCY-THIS MUST BE COMPLETED IN ITS ENTIRETY
I, ^name of competent authority^ of Australia, one of whose addresses is ^address^:
(1)declare that:(a)I am a duly appointed competent authority of Australia, 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 €^amount^ (^$AUD amount^) (“the Revenue Claim”) calculated as at the date of this request, is owed by ^name of debtor^ under the laws of Australia, in respect of taxes and associated amounts, particulars of which are as follows: Taxes | €^amount^ |
Interest | €^amount^ |
Administrative penalties | €^amount^ |
Costs | |
Total | €^amount^; |
Dated:
.....
^name of competent authority^
Competent authority
Australia
Please return this form to the Competent Authority for the Netherlands in paper form, by electronic transmission or by facsimile. |