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Begin with Section A: Supplier Details. Fill in your name, address, suburb/town, state/territory, and postcode clearly in BLOCK LETTERS using a black pen. Ensure each character is printed in its own box.
Next, indicate your reason for not quoting an ABN by placing an 'X' in the applicable boxes provided. Review the options carefully to select all that apply.
Proceed to Section B: Declaration. Enter the name of the supplier or authorized person and provide their signature. Include a daytime phone number and date of completion.
Once completed, remember not to send this statement to any authority; instead, give it directly to the payer you are supplying goods or services to.
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