FORM FOR A REQUEST FOR ASSISTANCE IN COLLECTION OR CONSERVANCY – THIS MUST BE COMPLETED IN ITS ENTIRETY
ATTACHMENTB3FORM 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, or will be 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 of The Netherlands in paper form, by electronic transmission or by facsimile. |