Claim Form – Audit Fees Paid

ACCURACY OF INFORMATION.  It is a condition of the Policy that all information provided is accurate.  Any information found not to be true may lead to a claim being denied. The insurer has the right to further investigate or audit any claim.

INSTRUCTIONS. 
Please provide the following information. Where there is an *, this is a compulsory field. Other fields are optional depending on the type of audit and the number of quarters or years the audit is covering.
After submitting the claim form, you’ll receive an email confirming the detail provided, plus a Claim Reference Number (‘CRN’). The CRN must be quoted to us an any subsequent communication.
Listed towards the end of this online form are additional documents required to complete the claim file. We must have all these documents before your claim will be considered.
The additional documents are likely to be in two sets. When submitting this claim form, you need to attach a copy of the original advice from the relevant government agency notifying you that an audit is being undertaken.
At a subsequent date, you will need to provide additional documents as listed. Preferably, these should be scanned and emailed to audit@auditservices.com.au or fax to 1300 739 817 or mail to Audit Services Pty Ltd, PO Box 7100, McMahons Point NSW 2060. For further assistance, please contact us on 1300 595 615 to resolve.
Insured Name being audited*  
 

Contact person should we have any questions:


Name*     
Phone number*  
Email address*  

Accountancy firm details handling the audit on your behalf:


Firm’s name*  
Firm’s postal address*
 Firm’s phone number*  
Contact email address*  
Is the Insured Name being audited GST registered?* Yes No  
What type of investigation, review or audit is being undertaken i.e., income tax, BAS, payroll, workers compensation?*
Is the audit being undertaken for the purpose of verifying a refund?* Yes No  
When was the Insured Name first approached by the relevant government agency to provide additional information or advised that an audit was to be undertaken?*  
Is the audit being undertaken the result of the Insured Name having volunteered changes to information provided on previously lodged returns?* Yes  No  
Does the audit being undertaken involve an ‘Insured Name’ that has sought or entered into any form of administration, receivership, liquidation, insolvency, winding up or similar process?* Yes No  
Prior to the date of being advised of an audit, was the Insured Name advised by the relevant government agency of the need to comply or advised of a ruling or guide that outlines what practices would attract particular scrutiny?* Yes No  
Does the Insured Name have Business Pack or Management Liability Insurance?* Yes No
 
 

Please list below which periods/years are being investigated, reviewed or audited and advise the date on which the relevant return was lodged with the relevant government agency: (There may be more than one quarter or year to be audited – list all periods and date return lodged)

Period/Year Date return lodged
/ /(dd/mm/yyyy)
/ /(dd/mm/yyyy)
/ /(dd/mm/yyyy)
/ /(dd/mm/yyyy)
/ /(dd/mm/yyyy)
If reporting this claim more than 20 business days after the original audit notice, please explain why the delay

Estimate of the final claim cost$
Where attached, does the Tax Invoice represent  'FINAL 'PROGRESS payment.
 

DOCUMENTS REQUIRED TO COMPLETE THE CLAIM


 

ALSO READ ADDITIONAL INFORMATION PROVIDED BELOW

 

With this Claim Form: Please attach a scanned copy of original advice from the Government Agency undertaking the audit  
Note: These additional documents should be scanned and emailed to audits@auditservices.com.au, noting your Claim Reference Number in the subject line of the email. a friendly reminder that this claim won't be considered by QBE unless all required documentation is provided if unsure, please contact us on 1300 595 615 for futher assistance
1. Proof of lodgement of the return(s)/declaration(s) being audited. Proofs are typically by print outs from the relevant Government Agency’s portal i.e., the ATO Portal or copies of the actual returns that show when the relevant return(s) being audited were submitted to the relevant government agency.
2. Tax Invoice from your accountancy firm for fees incurred made out to QBE Insurance (Australia) Pty Ltd, Level 6, 2 Park Street Sydney NSW 2000.
3. Where the Tax Invoice is greater than $1,000, QBE requires a copy of the accountant’s ‘time sheets’ or ‘work in progress’ documents that support the Tax Invoice. QBE requires a detailed breakdown that identifies the date of the activity undertaken; the partner/employee involved; a description of the activities undertaken; the relevant hourly charge rate for each partner/employee involved; the number of units/hours involved in each activity listed; the cost for each activity; and any disbursement costs. (Note that the same applies where the accountancy may have engaged another professional to assist).
4. A copy of the complete final letter from the relevant Government Agency confirming that the audit has been completed.
Declaration
By electronically lodging this claim form, you are acknowledging that (a) all information and supporting documents provided with this Claim Form or to be provided subsequently are (or will be) accurate and (b) submitting electronically is the same as if you hand personally signed Claim Form.
Privacy
We are committed to protecting your privacy. We use the personal information you provide to us in connection with your claim only for the purpose of assessing and managing the claim. We may need to provide that information to our underwriters and reinsurers (and their representatives) and those we appoint to assist us with the claim. We will not trade, rent or sell your information.

If you don’t provide us with complete information, we cannot properly assess your claim. You can check the personal information we hold about you at any time.

If you provide us with personal information about anyone else, we rely on you to have told them that you will provide their information to us, to whom we may provide it, the purposes for which we will use it and that they can access it. If the information is sensitive, we rely on you to have obtained their consent on these matters.

For more information about our Privacy Policy, ask us for a copy.