I. To the department – proforma for variation of debt due to administrative error

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TO THE DEPARTMENT OF EDUCATION – VARIATION OF DEBT – PELS AND BOTPLS (incurred before 1 January 2005). This form can be sent to IncomeContingentLoanProduct@ato.gov.au or TCSIsupport@education.gov.au

Name of higher education provider: _________________________


Year: _______________ Payment Period: Jan – June or Jul – Dec (circle one)


Case number – use the format YYYY-Sequential No. (e.g. 2002-001)

Semester/year (e.g. 1 / 2002)

Original PELS and BOTPLS debt reported $

Revised PELS and BOTPLS debts $

Reason for variation

Scheme (PELS or BOTPLS)

Date variation sent to ATO























DECLARATION (to be signed by the Senior Finance Officer or delegate)

I declare the information provided in this report is an accurate record of the variations to PELS and BOTPLS debts that have been referred to the Australian Taxation Office (ATO) for the indicated period.

Name (print): _________________________________ Phone: _______________

Signature: ____________________________________ Date: _______________

The information on this form is collected for the purpose of advising the Department of Education, Skills and Employment of the institution’s expected claim under PELS and BOTPLS for the specified period. The information collected will be used only for the purpose for which you provided it, and we will not disclose it without your consent except where authorised or required by law.