(Click above to download a hardcopy of our questionnaire or complete online below)

Name:*
Balance Date:*
Contact Person:*
Contact Person 2:
Contact Phone Number:*
Cell Phone Number:*
Fax Number:*
Email Address:*
Convenient Time To Contact:
Income Tax Year:*	Please Select 2011 2010 2009 2008 2007 2006 2005 2004 2003 junk

Records and Information Required

Please tick the boxes to the left of the items if you intend to send that item in by post

1	Bank Account (for all business accounts, including loan accounts)
	Cash Manager
	Quickbooks
	MYOB Backup Disk
	OR
	Cashbook
	OR
	Bank Statements
	Cheque Books
	Deposit Books
2	Interest and Dividend Certificates / Investment Account Statements
3	Copies of GST Returns and Workpapers
4a)	Copies of Fringe Benefit Returns and Workpapers
4b)	Copies if ACC Levy Statements
5	Summary of Gross Wages paid for Year
	OR
	Employees earning schedules (IR348's), PAYE pay-in schedules (IR345's)
6	Dividend or Interest PAYE (Paid by you)
	If you have made dividend PAYE or interest PAYE payments to the IRD please supply copies of IR4K or IR5P forms on which the payments were made and the supporting annual reconciliation.
7	Stock on Hand / Work in Progress
a)	Stock
	$ GST Included GST Excluded
	Stock on hand should be counted at balance date and separate stock sheets prepared for stock and purchased for resale, stock used in production and stock manufactured. The IRD require these stock sheets to be retained for 7 years.
	Stock on hand may be valued at the lower of cost, market selling value or replacement value. Different stock lines can be valued using different methods.
	Obsolete items must be valued at cost unless a lower market value can be substantiated.
	$ GST Included GST Excluded
	Profit margins should not be included.
b)	Work in Progress
	$ GST Included GST Excluded
	Work in Progress should be valued at cost of materials, direct labour and production overheads less any progress payments.
	Profit margins should not be included.
8	Debtors (money owing to you at balance date)
	$ GST Included GST Excluded
	Bad Debts Written Off During the Year (Schedule attached):
	$ GST Included GST Excluded
9	Creditors (money owing by you at balance date)
	$
	Attach a list (show nature of expenses e.g. purchases, PAYE etc), showing amounts as GST inclusive
	NOTE: If you are using an accounting package, please ensure that the
	total for accounts payable reconciles to the creditors list.
10	Cash on Hand
a)	What was the last banking for the financial year
	Date Banked   Amount Banked $
b)	Cash on Hand at balance date.
	a) Unbanked takings                                            $ b) Till Floats                                            $ c) Petty Cash Floats                                            $
	Total Cash on hand at balance date:                  $
11	Cash income not banked during the year
	Please supply a list (or a day book) of payments made for business expenditure (identifying nature of expense e.g. wages), for personal expenditure and amounts lodged into other bank accounts.
	Specify whether GST included or excluded.
12	Fixed Assets
	Attach a list of assets purchased and/or sold during the year.
	Please provide copies of:
	Sale and Purchase Agreements Hire Purchase Agreements Solicitors Settlement Statements Valuations (e.g. Rates Demands, Valuers Reports etc.)
	Specify whether GST included or excluded.
13	Repairs and Maintenance
	Ensure all details are recorded in full on cheque butts or cash books.
14	Tax Allowance for Work Done at Home
	Do you use your own home for business purposes? If so, what proportion of the total area is used for business?
	Area Used:   Total Area:
	Interest paid on mortgages: $ Insurance House/Contents: $ If rented, total rents paid: $ Rates: (attach latest rates demand) $ Power: $ Repairs: $ Any other house expenses: $
15	Business Motor Vehicle(s) - from Log Book
	Please supply a summary of business and private travel from your log book. You need to keep a log book for three months every three years.
16	Private Use Adjustments
	Portion of expenses to be allocated as private: - Please supply a dollar value or a percentage.
	Telephone $  or    % Power $  or    % Insurance $  or    % Goods taken for own use $  or   %
17	Business Expenses
a)	Attach a list of business expenses paid from personal funds.
	Specify whether GST included or excluded.
b)	Has there been any change in nature of your business since last balance date? If "Yes" please specify:                                                  Yes  No
c)	Have you raised or repaid any loans/mortgages during the year? If "Yes" please specify:                                                                           Yes  No
	Please also supply:
	copies of solicitors statements, loan documents and bank statements. details of latest Government Valuation and/or a copy of a rates demand for Land and Buildings owned and used in business activities.
d)	Other Details
	1) Are you saving for retirement?  Yes  No 2) Do you have a Family Trust?  Yes  No
	If you have answered no to any of the above,
	3) Would you like to know more about these topics?  Yes  No 4) Are all your business assets/risks adequately insured?  Yes  No
	Any other relevant information:
	*Have you filled out a "Terms of engagement form"?  Yes  No
	On completion of this form you will be emailed a copy of the information for your records. This Email will contain the link to the "Terms of Engagement form" You are required to either fax or mail this back to PKF Goldsmith Fox as soon as possible.
	For the attention of :   junk Please Select Roger Keys Dennis Lay Dawn Alexander Gordon Hansen John Purvis Carol Fletcher Robin Wah Trevor Bayliss Dorian Crighton