226-245 Street address country Blank fill 246-248 Number of schemes 1 249-268 SRN/HIN I987654321 269-269 Scheme type E 270-281 Security reference code Blank fill Number of ESS interests from up front schemes 00000001000 282-292 eligible for reduction Discount from taxed up front schemes eligible for 00000005000 – 293-303 reduction Number of ESS interests from taxed up front 00000000000 304-314 schemes - not eligible for reduction Discount from taxed up front schemes not eligible 00000000000 – 315-325 for reduction Number of ESS interests acquired during the year 00000000000 326-336 under deferral scheme Number of ESS interests with a deferred taxing point 00000000000 337-347 arising during the year 348-358 Discount from deferral schemes 00000000000 Discount on ESS interests acquired pre 1 July 2009 00000000000 and time’ occurred during the financial – ‘cessation 359-369 year Number of ESS interests from a foreign source or 00000000000 370-380 foreign employment 381-393 TFN amounts withheld from discounts 0000000000000 394-394 Discount amounts are assessable or gross (=A or G) A Number of shares acquired under start-up 00000000000 395-405 concession Market value of shares acquired under start-up 0000000000000 406-418 concession Acquisition price of shares acquired under start-up 0000000000000 419-431 concession 432-442 Number of options acquired start-up concession 00000000000 Market of ordinary shares on the date options 0000000000000 443-455 acquired under start-up concession Exercise price of options acquired under start-up 0000000000000 456-468 concession 469-476 Start date of overseas employment 00000000 477-484 End date of overseas employment 00000000 485-514 Plan reference/identifier ABC PLAN 179 515-522 Plan date 20150701 523-530 Acquisition date 20150701 531-531 Amendment indicator (=A ,C or O) O 532-996 Filler fill The other employee data records (2 to 50) would follow.
226-245 Street address country Blank fill 246-248 Number of schemes 1 249-268 SRN/HIN I987654321 269-269 Scheme type E 270-281 Security reference code Blank fill 282-292 Number of ESS interests from up front schemes eligible for reduction 00000001000 293-303 Discount from taxed up front schemes – eligible for reduction 00000005000 304-314 Number of ESS interests from taxed up front schemes - not eligible for reduction 00000000000 315-325 Discount from taxed up front schemes – not eligible for reduction 00000000000 326-336 Number of ESS interests acquired during the year under deferral scheme 00000000000 337-347 Number of ESS interests with a deferred taxing point arising during the year 00000000000 348-358 Discount from deferral schemes 00000000000 359-369 Discount on ESS interests acquired pre 1 July 2009 – and ‘cessation time’ occurred during the financial year 00000000000 370-380 Number of ESS interests from a foreign source or foreign employment 00000000000 381-393 TFN amounts withheld from discounts 0000000000000 394-394 Discount amounts are assessable or gross (=A or G) A 395-405 Number of shares acquired under start-up concession 00000000000 406-418 Market value of shares acquired under start-up concession 0000000000000 419-431 Acquisition price of shares acquired under start-up concession 0000000000000 432-442 Number of options acquired start-up concession 00000000000 443-455 Market of ordinary shares on the date options acquired under start-up concession 0000000000000 456-468 Exercise price of options acquired under start-up concession 0000000000000 469-476 Start date of overseas employment 00000000 477-484 End date of overseas employment 00000000 485-514 Plan reference/identifier ABC PLAN 179 515-522 Plan date 20150701 523-530 Acquisition date 20150701 531-531 Amendment indicator (=A ,C or O) O 532-996 Filler fill The other employee data records (2 to 50) would follow.