You should use this form to make one or more salary sacrific claims as described in the Salary Packaging Fact Sheet.   If you have any questions while completing this form, please do not hesitate to call PayMe Australia on 1800 082 006 to ensure that you complete it correctly.

Note: A maximum of three items can be claimed on this form.



Note: this option is subject to PayMe approval.

A copy of the original tax invoice / proof of purchase (where the product, amount and GST are clearly identifiable) must be attached before this claim can be considered.


I declare that the above expense(s) is directly related to my work, I understand and acknowledge that:

  1. I am wholly responsible for this salary sacrifice claim.

  2. I am responsible for obtaining independent financial advice regarding the salary sacrifice of this item.  PayMe accepts no liability should I fail to seek financial advice or for any financial advice I have independently sought.

  3. PayMe accepts no liability should I incur additional income tax or other costs, now or in the future, as a result of this salary sacrifice claim.

  4. I agree to reimburse PayMe the full cost of any Fringe Benefits Tax liability or penalty incurred as a result of this salary sacrifice claim.

  5. If my contract terminates before the full amount is able to be salary sacrificed, any outstanding amount will be settled in my final pay.

Please note: This expense(s) should not be claimed again in your personal income tax return, as the ATO would consider it to be double-dipping.

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