This form is for disclosing income interests of 10% or greater (including interests held by nominees and associated persons) in companies resident in any country specified in Part A of Schedule 3 to the Income Tax Act 1994.

Complete this form for interests in companies resident in a Schedule 3, Part A country for which a tax preference specified in Schedule 3, Part B has not been applied, and which has not been disclosed on an IR4G form.

Schedule 3, Part A countries are: Australia, Canada, Germany, Japan, Norway, the United Kingdom and the United States.

This form may be used instead of completing multiple IR4G forms.

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After you finish

Attach this completed form to your Income Tax Return (IR3).

You may wish keep a copy of this return for your personal records.