Salary Packaging Application Form

1. Your personal details

Please enter your legal name as per your drivers licence or passport, your preferred name can be added below

Please enter your legal name as per your drivers licence or passport, your preferred name can be added below

Please enter your legal name as per your drivers licence or passport, your preferred name can be added below

Yes No

If you have a secondary job, you may only claim the tax free threshold from one employer. If you are not claiming the tax free threshold you will be taxed at a higher rate initially. Once your tax-return is completed the actual tax payable will be calculated based on the combined income from both employers.

Yes No
Yes No

Please tick any item below if they apply to you:

Please Note: Casual employees must check with their employer if they are eligible to participate in salary packaging.

If you are on a short term contract SalaryPackagingPLUS can maximise your salary deductions to enable you to package your full benefit within the period of your contract. Just select the option below to maximize your benefit.

* Only required if your employer has multiple pay cycles

NSW Health employees only

Yes No

Yes No
2. Personal bank account details (Expense reimbursement bank account)
3. Expenses you wish to salary package
Do you wish to maximise your salary packaging?

If you choose to maximise your salary packaging, SalaryPackagingPLUS will set your deductions to the highest value possible using your full tax free cap over the remaining number of pays in the FBT year (April 1 to March 31)

Yes No

You are not required to enter in any amounts below

Living Expenses Amount
Per {{var.application.payFrequency}} Cycle
Additional Expenses

Enter FBT exempt items that may be allowed under your employer policy. If you have any questions about what you can claim please contact our team.

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4. Attach documented evidence

You must prove that the payments SalaryPackagingPLUS will make are for legitimate expenses for FBT purposes.

Please attach Documented Evidence of every expense you have selected to salary package.

The total value of evidence you supply should be equal to or more than the amount you wish to salary package annually. If not, you will need to forward evidence as required in order for SalaryPackagingPLUS to continue payments to your account/s. Examples of evidence include:

  • Mortgage/personal loan: statement showing your minimum repayment
  • Rent: rental agreement with real estate or landlord
  • Credit Card: credit card statement showing your repayments
  • Other: tax invoice/bill with proof of payment
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Please include your complete employee benefit card application form

Please also upload a recent payslip (NSW Health employees only)

5. Additional notes (Please advise us of any further information we need to be aware of below)
6. Salary packaging policy

The salary packaging policy set down by your employer offers a number of remuneration options that can be taken as a cash salary and non-cash benefit items. Each staff member is able to select their own salary packaging benefits only from those offered by their employer.

When entering into this agreement, the employee authorises the payroll deductions to enable payment of the salary packaging benefit and administration fee, recognising that the amount of deduction will vary from time to time.

  • I am eligible to participate in my employer’s salary packaging program.
  • I have read and agree to the terms and conditions of salary packaging as set by my employer and SalaryPackagingPLUS.
  • I understand that benefit payments can only be made following deduction from my salary, and that non-payment of salary will result in non-payment of my chosen benefit if there is insufficient balance in my salary packaging account.
  • Any incorrect information provided to SalaryPackagingPLUS that results in a Fringe Benefits Tax liability will be the responsibility of the employee.
  • I acknowledge that it is my responsibility to confirm what effect, if any, this salary packaging will have on any government payments I receive or are required to make.
  • If Meal Entertainment is selected, I confirm that this benefit will only be used for Meal Entertainment expenses as per my employer’s policy.
  • The information provided in this form is true and correct to the best of my knowledge.
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Submission Completed

Please check your mail box for the confirmation email from SalaryPackagingPLUS.