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TAX AGENTS REGISTRATION BOARD APPLICATION FOR REGISTRATION AS A TAX AGENT GOVERNMENT OF FIJI T.I.N.: First Name: Middle Name: Last Name: Date of Birth: Father's Name: Male: Mailing Address: Female: Phone No.: (Home) Phone No.: (Business) Fax. No.: Business Name: Email: Occupation: Are you a Fiji Resident? Yes No If you are a member of the Fiji Institute of Accountants, please state membership type Please state FIA membership number If yes, please give details If you sheet are aif member (Continue on separate necessary)of the CPA Australia, please state membership type If you are a Certified Public Practitioner (CPP) of FIA, please state membership number If you are a CPP from other Institutes or Organizations, please state Have you been convicted of any offence against the law of Fiji or any other law? Yes No If yes, please give details Continue on separate sheet if necessary) Summary of Experience Please give summary of experience in taxation matters over the last five (5) years. Summary of Experience Please give summary of experience taxation matters over the last five (5) in years. taxation matters over the last five (5) years. (Continue on separate sheet if necessary) IRS300 [Revised: 29-Dec-2015] ACADEMIC QUALIFICATIONS - State details of Degree, Diploma etc. Year Obtained Institute Name Qualification Name (Continue on separate sheet if necessary) EMPLOYER DETAILS Employer's Use Employer details for TARB Correspondence? Name: Email: T.I.N.: Location: Mailing Address: Phone No.: Fax. No.: DECLARATION I hereby apply forfor registration asas a Tax Agent under thethe provisions of of part VIIA I hereby apply registration a Tax Agent under provisions part VIIAofofthe theIncome IncomeTax TaxAct Act1974 1974 In support of this application I have set out the information shown above. I declare this information to be In true support this application I have set out the information shown above. I declare this information to be true and of correct in every particular. and correct in every particular. Signature of Applicant Electronic Signature Date: ITApplicant: IS A SERIOUS OFFENCE TO MAKE A FALSE STATEMENT TO THE COMMISSIONER Signature of Date: IRS300 [Revised: 29-Dec-2015] FOR OFFICIAL USE ONLY Certificate posted Entered By: Check: Verified All items andBy: declarations must be completed Attach two (2) current Character References Attach documentary evidence of academic qualifications Application Attach documentaryNo:evidence of Yes: professional qualifications Approval: Remit with this application, a Registration fee of $460.00 Approved By: Fee Paid ($) Receipt No. Tax Agent No. Date of Application Date of Registration Tax Agents Registration Checklist: Bachelor of Arts Degree or a Bachelor of Business Studies in Accounting & Financial Management Taxation Unit attended [Unit [Name] at [Institute] Documentary evidence of academic qualifications. Chartered Accountant membership Certificate with the Fiji Institute of Accountants. Chartered Accountant membership Certificate with CPA Australia. Chartered Accountant membership with any other Institute outside Fiji. [Specify] Certified Public Practitioner (CPP) holder with FIA Others [Specify] Latest Tax Compliance Certificate (TCC) Number. Two current character references. Attached soft copy of passport size photo on the application form. Birth certificate. Curriculum vitae MQR for Registration (Registration Fee $436 VIP/ Renewal $218 VIP): i. Have either Bachelor of Arts or Bachelor of Commerce or Business Degree in Accounting & Financial Management. ii. Successfully completed Taxation Law Unit from any of the recognized institute by FIA. iii. Have a Chartered Accountant Membership with FIA or any other Institute of Accountants outside Fiji. iv. Have no outstanding tax returns and tax debts with FRCA. IRS300 [Revised: 29-Dec-2015]