Business Activity Statement

This document is a Business Activity Statement (BAS) form that needs to be completed and submitted. It provides instructions and guidelines for filling out the form accurately. The form includes sections for reporting GST on sales and purchases, PAYG tax withheld, and PAYG income tax instalments. It also includes options for calculating GST and PAYG instalments quarterly or annually. Various payment methods are available, including BPAY and credit card.

METHODS OF PAYMENT
BPAY®
Contact your financial institution to make this payment from
your cheque or savings account. You will need the details
listed below.
Biller Code: 75556
Reference: Your EFT code (shown on the front
of your payment slip directly above the barcode)
Credit card
Payments can be made online or by phone, visit our
website at ato.gov.au/howtopay or phone [phone].
A card‑payment fee applies.
Other payment options
For more information about other payment options, you can:
n visit our website at ato.gov.au/howtopay
n phone us on 1800 815 886.
Payments cannot be made in person at any of our branches
or shopfronts.
A
When completing this form:
n print clearly using a black pen
n round down to whole dollars (do not show cents)
n if reporting a zero amount, print ‘0’ (do not use NIL)
n leave boxes blank if not applicable (do not use N/A, NIL)
n do not report negative figures or use symbols such as +, −, /, $.
Office use only
Form due on
Document ID
Payment due on
Business activity
statement
Contact phone number
Authorised contact person
who completed the form
GST accounting method
Complete Option 1 OR 2 OR 3 (indicate one choice with an X)
Goods and services tax (GST)
NAT 4189-03.2014 [JS 29398]
Option 2: Calculate GST quarterly and report annua
Option 3: Pay GST instalment amount quarterly
Does the amount shown
at G1 include GST?
(indicate with X) Yes No
Reason code for variationG24
OR
OR
OR if varying this amount, complete G22, G23, G24
Report GST on sales at 1A and GST on purchases at 1B
in the Summary section over the page
Write the G21 amount at 1A in the Summary section ov
(leave 1B blank)
Write the G23 amount at 1A in the Summary section ov
(leave 1B blank)
G21 $
Option 1: Calculate GST and report quarterly
Report GST on sales at 1A and GST on purchases at 1B
in the Summary section over the page
Total sales
(G1 requires 1A completed)G1 $ , , .00
Does the amount shown
at G1 include GST?
(indicate with X) Yes No
Export salesG2 $ , , .00
Other GST-free salesG3 $ , , .00
Capital purchasesG10 $ , , .00
Non-capital purchasesG11 $ , , .00
Total sales
(G1 requires 1A completed)G1 $ , , .00
Estimated net
GST for the year
G22 , , .00
Varied amount payable
for the quarterG23 $ , , .00
41890314
ABN: 12 222 222 222
$
0 3 5 5 5 5 5 5 5
2 9 4 4 2 3
X
2 9 4 4 2 3
2 6 4 4 5 2
2 7 2 4

OR
Payment or refund?
Is 8A more than 8B?
(indicate with X)
PAYG income tax instalment
PAYG tax withheld
GST on sales
or GST instalment
Credit from PAYG income tax
instalment variation
GST on purchases
Deferred company/fund
instalment
1A + 4 + 5A + 7 1B + 5B
Amounts you owe the ATO Amounts the ATO owes you
Summary
PAYG tax withheld
1A $
4 $
5A $
7 $
8A $
1B $
5B $
8B $
PAYG income tax instalment
OR
Option 2: Calculate PAYG instalment using income t
Option 1: Pay a PAYG instalment amount quarterly
Reason code for variationT4
T7 $
New varied rateT3 . %
Reason code for variationT4
T2 %
Do not complete 1B if using GST instalment amount (Option
Write the T7 amount at 5A in the Summary section belo
OR if varying this amount, complete T8, T9, T4
Write the T9 amount at 5A in the Summary section belo
Write the T11 amount at 5A in the Summary section be
Write the W5 amount at 4 in the Summary section below
Complete Option 1 OR 2 (indicate one choice with X)
then write the result of 8A minus 8B at 9. This amount is
payable to the ATO.
then write the result of 8B minus 8A at 9. This amount is
refundable to you (or offset against any other tax debt you have).
Yes,
No,
Your payment or refund amount
Do not use symbols such as +, –, /, $
9 $
Taxation laws authorise the ATO to collect information including personal information about individuals who may complete this form. For in
personal information go to ato.gov.au/privacy. Activity statement instructions are available from ato.gov.au or can be ordered by phonin
Total salary, wages and
other paymentsW1 $ , , .00
Amount withheld from
payments shown at W1
W2 $ , , .00
Amount withheld where
no ABN is quotedW4 $ , , .00
Other amounts withheld
(excluding any amount
shown at W2 or W4)
W3 $ , , .00
W5 $
Total amounts withheld
(W2 + W4 + W3) , , .00
Estimated tax for the yearT8 $ , , .00
T9 $
Varied amount payable
for the quarter , , .00
PAYG instalment incomeT1 $ , , .00
T1 x T2 (or x T3)T11 $ , , .00
, , .00
, , .00
, , .00
, , .00
, , .00
, , .00
, , .00
, , .00
, , .00
Return this completed form toDeclaration I declare that the information given on this form is true and correct, and that
I am authorised to make this declaration. The tax invoice requirements have been met.
Signature Date / /
Estimate the time taken to compl
this form. Include the time taken
collect any information.
HRS MINS
Reason for varying (G24 & T4)Code Obligation
Change in investments 21 PAYG only
Current business structure not continuing22 GST & PAYG
Significant change in trading conditions23 GST & PAYG
Internal business restructure 24 GST & PAYG
Change in legislation or product mix25 GST & PAYG
Financial market changes 26 GST & PAYG
Use of income tax losses 27 PAYG only
2 6 7 6 5 2 4 0 4 1
X
2 6 7 6 5 2 4 0 4 1
2 7 2 4