Client Information Form to apply for the Services NSW 2021 Covid-19 Business Grant Please enable JavaScript in your browser to complete this form.Please fill out the following questions, so we can assist you to apply for the Services NSW 2021 Covid-19 Business Grant. Please note a few things before you begin: You will be presented with a series of questions which should take approximately 15 minutes to complete. Selecting “Yes” in various questions will cause an information box and upload box to appear below the question, please upload all relevant documents using the upload button. You can save the questionnaire at any time by clicking “save and Resume Later” button at the bottom of each page. You will then receive a unique URL to save, which will enable you to return to your responses at a later point. If you require any assistance or have any problems, please do not hesitate to contact TMS Ph. 02 9725 6169 or email admin@tmsfinancial.com.au Thank You!Do you have a Service NSW account? *YesNoWe will contact you for the one-time login code to process your application.We will contact you over the phone and help you to set up an account for you.Attached a copy of your identification Documents: Click or drag a file to this area to upload. Driver's license or Medicare Card or Australia Passport - Allowed file format: .png, .jpgNextPersonal detailsName *FirstLastDate of Birth *Contact details Email *Phone number *Residential address *Address Line 1CityState / Province / RegionPostal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryPreviousNextEligibility Business Name *ABN *Address of your impacted business Was your business' aggregated annual turnover between $75,000 and $50 million (inclusive) for the year ended 30 June 2020? *YesNoWere your business' total annual Australian wages up to $10 million as at 1 July 2020? *YesNoFrom 1 June 2021, did your business have business costs (e.g. utilities, wages and rent) for which there was no other government assistance available? *YesNoWill your business maintain your employee headcount as at 13 July 2021 for the period for which your business is receiving this grant payment and/or payments from the JobSaver scheme? *YesNoPreviousNextSupporting details During 26 June 2021 to 26 July 2021, did your business experience a decline in turnover of at least 30% due to the Public Health Orders over a minimum two-week period compared to the same period in June and/or July 2019? *YesNoPlease provide your Daily Sales Record and Bank statements from 26 June 2021 to 26 July 2021. Click or drag a file to this area to upload. Allowed file format: .docx, .pdf | You can get Free Daily Sales Record Templates hereHas your business lodged Income Tax Return for the financial year ended 30 June 2019? *YesNoPlease upload your business Income Tax Return for the financial Year ended 30 June 2019 Click or drag a file to this area to upload. For TMS Client that we lodged Income tax return for you, no need to upload - Allowed file format: .docx, .pdfYour tax return is overdue!Please let us know why you have not yet lodge your 30 June 2019 tax return? Please provide your Daily Sales Record and Bank Statements from 26 June 2019 to 26 July 2019. ( For New Client only) Click or drag a file to this area to upload. For TMS existing clients that we lodged tax return for you , you don't need to upload this record - Allowed file format: .docx, .pdf | You can get Free Daily Sales Record Templates hereHas your business lodged Income Tax Return for the financial year ended 30 June 2020? *YesNoPlease upload your business Income Tax Return for the financial year ended 30 June 2020 Click or drag a file to this area to upload. Allowed file format: .docx, .pdfYour tax return is overdue!Please let us know why you have not yet lodge your 30 June 2020 tax return? PreviousNextBank details Account name *BSB *Account number *DeclarationThe below is Services NSW Declaration statement T&C *I have read and accept the Terms and Conditions. Our privacy statement explains how we collect and use information. Authorised to apply *I am authorised to apply on behalf of this business and I declare that the information I have provided in this application is, to the best of my knowledge, true, accurate and complete. I consent to any information I provide being audited and I understand that I may be required to provide evidence of statements made in this application.Consent to Service *I consent to Service NSW providing this business's ABN to the Department of Customer Service (Revenue NSW) to check if the business is registered for payroll tax and has total reported wages below $10 million for 2019-20, and Revenue NSW disclosing to Service NSW whether or not the business is registered for payroll tax and has total reported wages below $10 million for 2019-20.I understand *I understand that it's an offence under the Crimes Act 1900 (NSW) to provide false or misleading information to a public authority.Signature *Clear SignatureDate *PreviousSubmit