Claim Form – Audit Fees Paid |
ACCURACY OF
INFORMATION.
It is a condition of the Policy that all information provided is
accurate. Any information found not to be true may
lead to a claim being denied. The insurer has the right
to further investigate or audit any claim.
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INSTRUCTIONS.
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Please
provide the following information.
Where there is an
*, this is a compulsory
field. Other fields are optional
depending on the type of audit and
the number of quarters or years the
audit is covering. |
After
submitting the claim form, you’ll receive an email
confirming the detail provided, plus a Claim Reference
Number (‘CRN’). The CRN must be quoted to us an any
subsequent communication. |
Listed
towards the end of this online form are additional
documents required to complete the claim file. We must
have all these documents before your claim will be
considered. |
The
additional documents are likely to be in two sets. When
submitting this claim form, you need to attach a copy of
the original advice from the relevant government agency
notifying you that an audit is being undertaken. |
At a
subsequent date, you will need to provide additional
documents as listed. Preferably, these should be scanned
and emailed to
[email protected] or fax to 1300 739
817 or mail to Audit Services Pty Ltd, PO Box 7100, McMahons Point NSW 2060. For further assistance,
please contact us on 1300 595 615 to resolve. |
Insured Name being audited* |
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Contact person should we have any questions: |
Name*
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Phone number* |
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Email address* |
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Accountancy firm details handling the audit on your
behalf:
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Firm’s name* |
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Firm’s postal address*
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Firm’s phone number*
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Contact email address*
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Is the Insured Name being audited GST registered?*
Yes No
If ‘YES’, their ABN is
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What type of investigation, review or audit is being
undertaken i.e., income tax, BAS, payroll, workers
compensation?*
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Is the audit being undertaken for the purpose of
verifying a refund?*
Yes No |
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When was the Insured Name first approached by the
relevant government agency to provide additional
information or advised that an audit was to be
undertaken?*
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Is the audit being undertaken the result of the Insured
Name having volunteered changes to information provided
on previously lodged returns?*
Yes No |
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Does
the audit being undertaken involve an ‘Insured Name’
that has sought or entered into any form of
administration, receivership, liquidation, insolvency,
winding up or similar process?*
Yes No |
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Prior to the date of being advised of an audit, was the
Insured Name advised by the relevant government agency
of the need to comply or advised of a ruling or guide
that outlines what practices would attract particular
scrutiny?*
Yes No |
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Does the Insured Name have Business Pack or Management
Liability Insurance?*
Yes No
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Please list
below which periods/years are being investigated,
reviewed or audited and advise the date on which the
relevant return was lodged with the relevant government
agency: (There may be more than one quarter or year
to be audited – list all periods and date return lodged)
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If reporting this claim more than 20 business days after the original audit notice, please explain why the delay
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Estimate of the final claim cost* $
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Where attached, does the Tax Invoice represent
'FINAL’
'PROGRESS’
payment. |
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DOCUMENTS REQUIRED TO
COMPLETE THE CLAIM
ALSO READ ADDITIONAL
INFORMATION PROVIDED BELOW
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With this Claim Form: Please attach a scanned copy of original advice
from the Government Agency undertaking the audit
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Note: These additional documents should be
scanned and emailed to [email protected],
noting your Claim Reference Number in the
subject line of the email. a friendly reminder
that this claim won't be considered by QBE
unless all required documentation is provided
if unsure, please contact us on 1300 595 615
for futher assistance
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1.
Proof of lodgement of the return(s)/declaration(s)
being audited. Proofs are typically by print
outs from the relevant Government Agency’s
portal i.e., the ATO Portal or copies of the
actual returns that show when the relevant
return(s) being audited were submitted to the
relevant government agency. |
2.
Tax Invoice from your accountancy firm for fees
incurred made out to QBE Insurance (Australia)
Pty Ltd, Level 6, 2 Park Street Sydney NSW 2000.
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3.
Where the Tax Invoice is greater than $1,000, QBE requires a copy of the accountant’s ‘time
sheets’ or ‘work in progress’ documents that
support the Tax Invoice. QBE requires a detailed
breakdown that identifies the date of the
activity undertaken; the partner/employee
involved; a description of the activities
undertaken; the relevant hourly charge rate for
each partner/employee involved; the number of
units/hours involved in each activity listed;
the cost for each activity; and any disbursement
costs. (Note that the same applies where the
accountancy may have engaged another
professional to assist). |
4. A copy of the complete final letter from the
relevant Government Agency confirming that the
audit has been completed. |
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Declaration |
By electronically lodging this claim form, you are
acknowledging that (a) all information and supporting
documents provided with this Claim Form or to be
provided subsequently are (or will be) accurate and (b)
submitting electronically is the same as if you hand
personally signed Claim Form. |
Privacy
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We
are committed to protecting your privacy. We use
the personal information you provide to us in
connection with your claim only for the purpose
of assessing and managing the claim. We may need
to provide that information to our underwriters
and reinsurers (and their representatives) and
those we appoint to assist us with the claim. We
will not trade, rent or sell your information. |
If
you don’t provide us with complete information,
we cannot properly assess your claim. You can
check the personal information we hold about you
at any time.
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If
you provide us with personal information about
anyone else, we rely on you to have told them
that you will provide their information to us,
to whom we may provide it, the purposes for
which we will use it and that they can access
it. If the information is sensitive, we rely on
you to have obtained their consent on these
matters.
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For
more information about our Privacy Policy, ask
us for a copy. |
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