G. To the ATO – proforma for variation of debt due to administrative error

This form is only for variations of debts due to administrative error that were incurred before 1 January 2005 for HECS, PELS, BOTPLS and OLDPS.

Advice number


 


Name

 

   

Student ID


 

Tax File Number


 

Postal address

 

Semester/year


 

Date of birth


 


Debt (circle)

 

HECS debt

PELS debt

BOTPLS debt

Original $

Revised $


Course code

 

Original

Revised

Reason for variation

 

 

The student named above has completed and signed a HECS Payment Options Declaration form or PELS Loan Request Form or BOTPLS Loan Request Form prior to the semester census date, and provided their tax file number or an ATO Certificate of application.

Higher education provider:

Signature of authorised person:

Date: