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Financial Statements Questionnaire – 30 June 2014
Please ensure this questionnaire is completed and included with your records[Name]
To: ICL Limited
Terms of Engagement
I/We hereby instruct you to prepare my/our Financial Statements and Taxation Returns for the year/ period ending 30 June 2014. I/We undertake to supply all information necessary to carry out such services, and will be responsible for the accuracy and completeness of such information. Your services are not intended to, and accordingly will not result in the expression by you of an opinion on the financial statements in so far as third parties are concerned, or in the fulfilling of any statutory audit requirements. You are hereby authorised to communicate with my/our bankers, solicitors, finance companies and all government agencies including the Inland Revenue Department to obtain such information as you require in order to carry out the above assignments.
You are to represent me/us as my/our tax agent. You are therefore authorised to sign any taxation return on behalf of myself/ourselves or any of my/our associated entities.
Financial Statements prepared by you will carry the following disclaimers:
"A compilation is limited primarily to the collection, classification and summarisation of financial information supplied by the client. A compilation does not involve the verification of that information. We have not audited or reviewed the Financial Statements and therefore neither we nor any of our employees accept any responsibility for the accuracy of the materials from which the Financial Statements have been prepared. Further, the Financial Statements have been prepared at the request of and for the purpose of the client only and neither we nor any of our employees accept any responsibility on any ground whatever, including liability in negligence, to any other person."
Please forward a copy of our 2014 Financial Statements to our bank unless you receive other instructions from us.
Signature ______Date ______
Signature ______Date ______
When would you like your accounts completed by? / Date:Phone: / [phone] / Fax: / [fax]
Mobile: / [mobile] / Email: / [email]
Computer programme used / [computer programme (1)]
Personal Section
Rebate InformationHow many weeks of the year were you in paid employment for at least 20 hours per week? / ______
Personal Interest & Dividends
Did you receive any personal interest or dividends in the current financial year? If so please supply the interest certificate from the bank or other lending institutions, and dividend advice/statements for the period 1 April 2013 to 31 March 2014 for your tax return. / Yes No
Other Income
Did you receive any other income, for example, estates, trusts, partnerships, Look Through company, overseas, investment portfolio, annuity or pension? If yes, please provide supporting documentation. / Yes No
Family Assistance
All families maybe entitled to family assistance. In order for us to determine your entitlement please supply details of the names and date of birth of your children and the date that any of them left school.
NameDate of BirthDateLeftSchool
/ Yes No
Donations
If yes forward copies of donation certificates or receipts.
Please provide the bank account number you would like your donations rebate paid into: Account Number: ______/ Yes No
Childcare Payments
If yes forward details of any payments made for childcare. / Yes No
Income Protection Insurance
Do you have income protection insurance?
If yes, please attach a copy of the invoice and policy. / Yes No
Records Required / /
Comment
Bank DetailsPlease supply a copy of your bank statement including PGG, CRT, any savings, call or term deposit account dated [Balance month]2014or spanning this date.
Loan / Mortgage Statements
Please supply a copy of all loan transaction statements for the financial year up to [balance month] 2014.
Interest and Dividend Certificates for the Business
Please supply copies of statements from the bank showing interest earned and resident withholding tax deducted for the year.
Supply copies of certificates for rebates dividends and bonus shares for Ballance, Silver Fern Farms, Ravensdown and Alliance.
Accounts Receivable (Debtors)
All accounts or amounts owing to you at balance date should be scheduled. Exclude bad debts.
Can we extract your debtors from the payments made after balance date as shown in your next GST return after balance date? / Total at Balance Date:
$______
GST Included
Yes No
Accounts Payable (Creditors) – see attached Schedule A
All accounts or amounts owing by you at balance date should be scheduled indicating name of creditor, amount and what the debt is for.
Can we extract your creditors from the payments made after balance date as shown in your next GST return after balance date? / Total at Balance Date:
$______
GST Included
Yes No
Legal and Loan Documents
Please attach any solicitor's statements and Sale and Purchase Agreements relating to any legal transactions during the year including Statements and Agreements relating to any mortgages, leases or loans.
Hire Purchase Loans
Please provide details of any assets purchased during the year on finance, including details of any assets traded in. Also provide copies of the loan documents that detail the amount, term, interest rate and repayment schedule. / Asset purchased…………………………
Asset traded……………………………….
Rate Demand
Please supply a copy of latest rate demand for Valuation Information
Land Area
EffectiveFarmLand Area
Area used for cropping
Area used for grazing (of stock not owned) / ………………………….……………….Ha
…………………………………………..Ha
…………………………………………..Ha
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Livestock – see attached Green SheetA sheet has been provided showing livestock figures for the last financial year with space for the closing stock for the current year at [balance month] 2014.
Forestry and Emissions Trading Scheme (ETS) – Carbon Credits
- Have you deforested any Pre 1990 land and not replanted (ie, changed the land use) – If yes:
Have you surrendered credits?
If yes, how many / ……………..….. Ha
Yes No
………………….. credits
- Have you deforested any Post 1989 land and not replanted (ie, changed the land use) – If yes:
Have you surrendered credits?
If yes, how many / ……………..….. Ha
Yes No
………………….. credits
- Have you deforested any Post 1989 land and not replanted (ie, changed the land use) – If yes, how many hectares?
Yes No
- Have you sold pre 1990 or post 1989 Forestry ETS carbon credits?
- Have you purchased ETS carbon credits?
Schedule A – Accounts Payable (Creditors)
Amounts owing by you at [balance month] 2014
Name of Creditor / Description of Goods / Code / Quantity / Total Inc GSTTotal