Federal Democratic Republic of The National Regional Government of Oromia
Ethiopia
Schedule A
Ethiopian Revenues & Employment Income Tax Declaration Bureau of Revenues
Custom Authority
Section 1 - Taxpayer Information
1. Taxpayer’s Name (Company Name or Your Name, Father’s Name, Grandfathers Name) 3. Taxpayer Identification Number 4. Tax Account Number 8. Tax Period:
Page 1 of
Spectrum Industry PLC 0050411217 Month Year
1
May 2015
2a. Region: Oromia 2b. Zone/K-Ketema 5. Tax Center Document Number (Official Use Only)
East Shewa/ Dukem
2c. Woreda: Akaki 2d. Kebele/Farmers 2e. House 6. Telephone Number 7. Fax Number
Association: 01 Number: New +251 – 911 30 00 05
Section 2 – Calculation of Payments to Employees
Additional Benefits
a) f) Total
j) Taxable
Se b) c) Employee Name d) Start Date Transpo
e) Basic g) Taxable i) Other Income k) Tax l) Cost n) Employee
q Employee (Name, Father’s Name and of rtation h) Over m) Net Pay
Salary Transportatio Taxable (Sum Columns Withheld Sharing Signature
Nu TIN Grandfather’s Name) Employment Allowan Time
n Allowance Benefits e, g, h, and i)
m ce
1 Tofik Ahmed Abubeker 01/05/2015 30,462.00 2,000 - - - 30,462 9,161.70 23,300.30
2 Jacob Mann 01/05/2015 30,462.00 2,000 - - - 30,462 9,161.70 23,300.30
3 Khalil Ture Mohammed 01/07/2015 30,462.00 2,000 - - - 30,462 9,161.70 23,300.30
4 Fenet Asalfew Bezuneh 01/05/2015 8,010.00 800 - 346.59 - 8,356.59 1,551.98 7,604.61
5 Gemechu Alemu Mikel 21/06/2015 20,000.00 500 - 2,326.92 - 22,326.92 6,314.42 16,512.50
Transfer Totals from All Continuation Sheets to this Line >> 149,944.56 21,430.05
Total 272,014.07 56,781.55
(line 20) (line 30)
Section 3 – Calculation of Tax Due this Period Section 4 – Employees Removed from Payroll as of this month
For Official Use Only
Number of Employees on Your Payroll for 39 Seq Employee’s Name
10 Employee TIN Date of Payment
this Tax Period Num (Name, Father’s Name, Grandfather’s Name)
20
Total Taxable Income 272,014.07 Teodros Teklit Tesfay Receipt Number
(From Column j Above)
Total Tax Withheld Amount of
30 56,781.55
(From Column k Above) Payment
Cheque Number
Cashier’s
Signature
Section 5 – Taxpayer Certification
I declare that the above declaration and all information provide here-with (including continuation sheets) is Printed Name Signature & Date of Employer Seal Preparers Printed Name, Signature & Date
correct and complete. I understand that any misrepresentation is punishable as per the tax Laws and the Penal Authorized Officer
code. Declaration of preparer (other than the taxpayer) is based on all information of which the preparer has any
knowledge.
The National Regional Government of Oromia Bureau of Revenue
Federal Democratic Republic
of Ethiopia
Schedule A
Ethiopian Revenues & Employment Income Tax Declaration
Custom Authority
The National Regional Government of
Oromia Section 1 - Taxpayer Information
1. Taxpayer’s Name (Company Name or Your Name, Father’s Name, Grandfathers Name) 3. Taxpayer Identification Number 4. Tax Account Number 8. Tax Period:
Spectrum Industry
BureauPLC
of Revenues 0050411217 Month Year Page 1 of ___
May 2015
2a. Region: Oromia 2b. Zone/K-Ketema: East Shewa/ Dukem 5. Tax Center Document Number (Official Use Only)
2c. Woreda: Akaki 2d. Kebele/Farmers 2e. House 6. Telephone Number 7. Fax Number
Association: 01 Number: New +251 911 30 00 05
Section 2 – Calculation of Payments to Employees
a) Additional Benefits
f) Total j) Taxable
Seq b) c) Employee Name (Name, d) Start Date n)
e) Basic Transport g) Taxable i) Other Income k) Tax l) Cost
Employ Father’s Name and of h) Over m) Net Pay Employee
Salary ation Transportatio Taxable (Sum Columns Withheld Sharing
Nu ee TIN Grandfather’s Name) Employment Time Signature
Allowance n Allowance Benefits e, g, h, and I )
m
6 Yalemzewd Tebabl Abebe 6,010.00 - - - - 6,010.00 937.50 5,072.50
7 Ayana Etefa Gemeda 3,500.00 - - - - 3,500.00 397.50 3,102.50
8 Kebede Muleta Gonfa 3,500.00 - - - - 3,500.00 397.50 3,102.50
9 Debela Gudina Amente 3,835.00 - - - - 3,835.00 464.50 3,370.50
10 Bayisa Bedada Gita 3,500.00 - - - - 3,500.00 397.50 3,102.50
11 Gebeyehu Chali Sedi 3,500.00 - - - - 3,500.00 397.50 3,102.50
12 Bona Abera Dugasa 3,500.00 - - - - 3,500.00 397.50 3,102.50
13 Atsede G/Michael Tadele 3,700.00 500 - - - 3,700.00 437.50 3,262.50
14 Asres Adugna Beyene 3,025.00 - - - - 3,025.00 311.25 3,213.75
15
Helina Mengesha Kebede 4,385.00 750 - 63.25 - 4,448.25 587.15 3,861.10
16
Seyoum Balcha Gemechu 2,076.92 - - - - 2,076.92 169.04 2,657.88
17 T/birhan Tadese - 449.31 -
G/Mariam 8,500 1,650 8,949.31 1,729.79 7,219.52
18
Lema Eshetu Asnake 8,500 2,000 - 2,135.01 - 10,635.01 2,235.50 10,049.51
19
Kalo Jemal Ali 8,500 1,600 - 961.15 - 9,461.15 1,883.35 9,577.80
20
Abduselam Ahmed Reshid 5,500.00 - - 742.90 - 6,242.90 995.73 6,847.17
21
Mohammed Fu'ad Gezale 5,500.00 - - 651.67 - 6,151.67 972.92 5,178.75
22
Leta Tesfaye Terefe 4,500.00 1,000 - 898.81 - 5,398.81 784.70 4,614.11
23
Aboma Dechasa Olana 4,500.00 500 - 898.81 - 5,398.81 784.70 5,614.11
24
Teka Worku Debaba 4153.85 - - 749.53 - 4,903.38 678.18 5,002.12
Transfer Totals from All Continuation Sheets to this Line >> 52,208.35 6,470.74
Total 149,944.56 21,430.05
(line 20) (line 30)
2
Federal Democratic Republic of Schedule A
Ethiopia
Employment Income Tax Declaration
Ethiopian Revenues &
Custom Authority
The National Regional Government of
1. Taxpayer’s Name (Company Name or Your Name, Father’s Name, Grandfathers Name) 3. Taxpayer Identification Number 4. Tax Account Number 8. Tax Period:
Oromia
Spectrum Industry PLC 0050411217 Month Year Page 1 of ___
May 2015
2b. Zone/K-Ketema 5. Tax Center
Bureau of Revenues
Document Number (Official Use Only)
2a. Region: Oromia East Shewa/ Dukem
2c. Woreda: Akaki 2d. Kebele/Farmers 2e. House 6. Telephone Number 7. Fax Number
Association: 01 Number: New +251 911 30 00 05
Section 2 – Calculation of Payments to Employees
a) Additional Benefits
Se j) Taxable
b)
q c) Employee Name (Name, f) Total Income l) Cost
Empl d) Start Date of e) Basic g) Taxable i) Other k) Tax n) Employee
Father’s Name and Transportation h) Over (Sum Sharin m) Net Pay
oyee Employment Salary Transportation Taxable Withheld Signature
N Grandfather’s Name) Allowance Time Columns e, g
TIN Allowance Benefits
u g, h, and I )
m
25
Abera Bekele Dufera 4,500.00 - - 749.53 - 5,249.53 747.41 4,502.12
26
Mustefa Haji Aman 4,500.00 - - 383.91 - 4,883.91 674.28 4,209.63
27
Asefaw Edesa Chalchisa 4,500.00 - - 383.91 - 4,883.91 674.28 4,209.63
28
Adem Ahmed Umer 346.15 - - 302.88 - 649.04 4.90 644.13
29
Mustefa Gebeya Jara 865.38 - - 129.81 - 995.19 39.52 955.67
30
Gemechis Tilahun Jafe 4,500.00 - - 309.27 - 4,809.27 659.35 4,149.92
31
Hiko Gashena Tafo 4,500.00 - - 533.19 - 5,033.19 704.14 4,329.05
32
Musa Birka Hassen 4,500.00 - - 458.55 - 4,958.55 689.21 4,269.34
33
Haji Beker Wake 4,500.00 - - 600.25 - 5,100.25 717.55 4,382.70
34
Mohammed Haji 1,730.77 - - 61.01 - 1,791.78 126.27 3,951.31
35
Jemal Abdulfeta ….. 3,807.69 - - 383.91 - 4,191.60 535.82 4,209.63
36
Mohammed Shekedir 1,384.62 - - 61.01 - 1,445.63 84.56 3,951.31
37
Baresa Alemu Terefe 2769.23 - - 600.25 - 3,369.48 371.40 4,382.70
38
Girma Belete Bulbula 2,076.92 - - 383.91 - 2,460.83 226.62 4,209.63
39
Elias Bersisa Wogi 2,076.92 - - 309.27 - 2,386.19 215.43 4,149.92
Transfer Totals from All Continuation Sheets to this Line >>
Total 52,208.35 6,470.74
(line 20) (line 30)
