Benefit Claim Form and Business Use Declaration

Benefit Claim Form
salarypackaging@fleetplus.com.au
Your Personal Details

Given Name(s) Surname
Contact Phone Number Mobile No
Email Address
Your Email Address is used for communica on of ma ers related to your Package only, and is kept conf iden al
Employer Name
Full/Part Time Payroll Number

Employment
Status Monthly Fortnightly
Fixed Term, Contract Ends: Pay Cycle
____________________________ Weekly
Reimbursement Details & Your Personal Bank Details

Number of
Benefit Type e.g. laptop
Deduc ons
Reimbursement amount Tax Invoice must be provided for Y
$
inclusive of GST substan a on purposes N
Name of Account Holder

BSB Number (must be 6
Account Number
digits)
Note: The above amount will be reimbursed in the minimum number of pay deduc ons unless otherwise advised. Please
note that there is an administra on fee applicable.
Employee Dec on
I hereby declare that:
The informa on provided is true and correct to my knowledge;
I authorise FleetPlus to alter my deduc ons in accordance to the requirements of my salary package; and
I acknowledge that payments/or reimbursements can only occur a er sufficient salary sacrifice has occurred for
that benefit item
I am responsible for all subsequent FBT liability associated with all benefit items I package howsoever caused plus
ATO interest, fees, charges, and penal s levied against any/all benefit item(s) packaged
Signature Date
1300 353 381

enquiries@fleetplus.com.au | Level 6, 601 Pacific Highway, St Leonards, Sydney 2065 | ABN 59 099 217 320 FLEETPLUS.COM.AU
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Business Use Declara on
salarypackaging@fleetplus.com.au
Your Personal Details
Given Name Surname
Employer Name
Employee Declara
I, ____________________________________________________________ , declare that I have incurred

the costs on the substan a on a primarily for work related purposes and the expenses were
required for the following purpose(s):__________________________________
______________________________________________________________________________
for the purposes of earning you assessable income)
I declare that the percentage of those expenses incurred in earning my assessable income was 100% or
_______% (please select)
I hereby declare that the inform on provided is true and correct
Employee Signature Date
Employer Declara
I, ________________________________________________________ , an authorised signatory

for_______________________________ (insert company name), declare that the above expenses relate to
the employee’s du es as follows: _______________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
I hereby declare that the inform on provided is true and correct
Employer Signature Date
1300 353 381

1
Collection Statement for FleetPlus
FleetPlus Pty Limited and its wholly owned subsidiaries (“FleetPlus” or “we” “us” or “our”) collect your personal
information (such as, but not limited to your name, address, employment history, bank account details, statement
of assets and liabilities and income details).
This information will generally be provided by either you, your employer or a third party you have assisting you
when you request that FleetPlus provides you with any of the following services:
Leasing
Salary Packaging
Fleet Management
We collect this personal and credit related information for the purposes of providing the requested
product/services to you. We also collect this personal information for the purpose of sending you marketing
communications about our products and/or services including via email and SMS. If we do not collect your
personal and credit related information as described, we may not be able to provide you with the products or
services you have requested.
We may disclose this personal and/or credit related information to entities including:
a bank;
your employer;
anyone you authorise us to disclose information to;
credit reporting agencies;
accountants, lawyers and other professional consultants;
suppliers, insurers, roadside assistance providers and repairers;
insolvency practitioners such as an administrators, receivers, liquidators or bankruptcy trustees;
motor vehicle registration authorities;
finance intermediaries; or
anyone to whom we are required to disclose the information by law
We may disclose this credit related information to the credit reporting body such as Veda Advantage. Veda
Advantage may include the information in reports provided to FleetPlus to assist them to assess your credit
worthiness. You may request Veda Advantage not to use such information for the purpose of pre-screening for
direct marketing by FleetPlus and not to use or disclose such information if you believe on reasonable grounds
that you are, or are likely to be, a victim of fraud. You can obtain a copy of Veda Advantage's credit reporting
policy by visiting its website at www.mycreditfile.com.au .
Our privacy policy at http://www.fleetplus.com.au/privacy -policy and our credit reporting policy at
http://www.fleetplus.com.au/privacy -policy contains information about:
how you may access the personal information that is held by us and seek correction of such
information; and
how you may complain about a breach of the Australian Privacy Principles or Part IIIA of the Privacy
Act 1988 (Cth) or a registered privacy code that binds us and how we will deal with such a
complaint.
We may disclose your personal and/or credit related information overseas to our service providers in countries
such as United States of America, Japan and Singapore.
You can contact us at treasury@fleetplus.com.au or by telephone at 1300 353 381 if you have any questions.
You can obtain a copy of our privacy policy or credit reporting policy without charge on request.
1300 353 381

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Beneﬁt Claim Form

Your Personal Details

Contact Phone Number Mobile No

Full/Part Time Payroll Number

Reimbursement Details & Your Personal Bank Details

Name of Account Holder

1300 353 381

Your Personal Details

Given Name Surname

I, ____________________________________________________________ , declare that I have incurred

for the purposes of earning you assessable income)

I hereby declare that the inform on provided is true and correct

Employee Signature Date

I, ________________________________________________________ , an authorised signatory

I hereby declare that the inform on provided is true and correct

Employer Signature Date

1300 353 381

anyone you authorise us to disclose information to;

credit reporting agencies;

accountants, lawyers and other professional consultants;

suppliers, insurers, roadside assistance providers and repairers;

insolvency practitioners such as an administrators, receivers, liquidators or bankruptcy trustees;

motor vehicle registration authorities;

anyone to whom we are required to disclose the information by law

1300 353 381

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