Federal Democratic Balance sheet and Annexes

Republic of Ethiopia
Ministry of Revenue
Check Filing Status:
Federal Inland Schedule B rental Income Tax
Revenue Authority Schedule C Business income Tax
Mining income Tax
Section 1 -Taxpayer Information
1. Taxpayer's Name (company Name or Name, Father's Name, 3. Taxpayer identification Number 8. For the year ended
Grandfather's Name)

2a. Region: 2b. Zone/k-Ketema 4. Tax Account Number Document Number (official Use only)

2c. Woreda 2d. Kebele/Farmers Association 2e. House No. 5. Tax center

6. Telephone Number 7. Fax Number

Section 2 - Business Assets, liabilities and Capital

Instruction: prior to completing this portion of the Balance sheet you will need to complete the individual Annexes on the following three pages. Be sure and
check your filing status at the top of this form.

Asset
1 Cash 10 -
2 Accounts Receivable (Transfer Total from Annex1, Line 4 20 -
3 Allowance for Bad debts 30 -
4 Net accounts Receivable (Subtract Line 3 and Enter Total) 40 -
5 Prepaid expenses 50 -
6 Inventories (transfer Total from Annex2, Line7) 60 -
7 Operating Supplies 70 -
8 Other Current Assets (Transfer Total from Annex 3) 80 -
9 Loans to Shareholders 90 -
10 Mortgage & Real Estate Loans Receivable 100 -
11 Other Investment Transfer Total from Annex 4) 110 -
12. Building, cost of improvement & reconstruction 120 -
13. Computers, Software products & Related Equipment 130 -
Transfer from
Annex 5A

140 -
column f

14. Plant, Machinery, Tools & other Equipment

15. Motor Vehicles 150 -
16. office Equipment and Furniture 160 -
17. Add Lines 12 through 16 and Enter Total 165 -
18 Accumulated Depreciation (transfer from Annex 5B, column d) 170 -
19 Net book Value ( Subtract Line 18 from Line 17 and enter Total 180 -
20 Intangible Assets (Transfer Total From Annex 6A, Column d) 190 -
21 Accumulated amortization (Transfer from Annex 6B, column f) 200 -
22 Net book Value /intangible asset( Subtract Line 21 from Line 20 and Enter Total 210 -
23 Other Assets (transfer Total from Annex 7) 220 -
24 Total Assets (add Lines 1, 4 through 11, 19, 22 and 23) 230 -
Liabilities
25 Accounts payable 240 -
26 Interest payable 250 -
27 Loans payable less than 1 Year (Transfer Total from Annex 8) 260 -
28 Tax payable (Transfer Total from Annex 9) 270 -
29 Other current liabilities (transfer Total from Annex 10) 280 -
30 Loans from Share holders 290 -
31 Loans payable more than 1 year ( transfer total from Annex 11) 300 -
32 Other Long-Term Liabilities (Transfer Total from Annex 12) 310 -
33 Total Liabilities (add lines 25 through 32 and Enter Total) 320 -
Capital
34 Capital 330 -
35 Legal Reserve 340 -
36 Retained Earnings 350 -
37 Total Capital (add lines 34 through 36 and Enter Total 360 -
38 Total liabilities and Capital (add lines 33 and 37 and Enter Total 370 -
Name & signature of taxpayer/agent- _______________ Date ______________ Seal
 Schedule B &C - Business /Rental Income Tax
Balance Sheet Annexes
Tax Payer information
1. Taxpayer's Name (company or individual) 2. Taxpayer identification Number 3. For the year ended

Annex 1- Accounts Receivable

a. Seq
Num b. Item Description C. Amount
1 VAT receivable -
2 -
3 -
4 Total of lines 1 through 3 (Enter Total amount on Line 2 of Balance Sheet) -
Annex 2- Inventories (Applies to Business/Mining Income Only, Not Rental Income)
a. Seq
Num b. Item Description C. Amount
1 Merchandise Stock
Manufacturing Business
2 Finished /processed product
3 Work in Process
4 Raw Materials
5 Reject, By Product and Other related items
6 Spare Parts, supplies Packing and other Materials
7 Total of Line 1 Through 6, (Enter total amount on Line 6 of balance Sheet) -
Annex 3- Other Current Assets
a. Seq
Num b. Item Description C. Amount
1

Total (enter total amount on Line 8 of Balance Sheet (include Total from continuation sheet if used)] -
Annex 4- Other Investment
a. Seq
Num b. Item Description c. Taxpayer Name d. description of Investment e. Amount

Total (enter total amount on Line 11 of Balance Sheet (include Total from continuation sheet if used)]
Annex 5- Fixed Assets f.
Endin
g
a. Seq c. Beginning e. disposal Balanc
Num b. Item Description Balance d. Addition Transfer e
A. Cost of Fixed Assets ( Transfer Column f Totals to Lines 12 through 17 on Balance sheet.
1 Building, cost of improvement & reconstructio - - -
2 Computers, Software & Related Equipment - - -
3 Plant, Machinery, Tools & Other Equipment - - -
4 Motor Vehicles - - -
5 Office Equipment and Furniture - - -
6 Total Lines 1 through 5 - - - -
B. Depreciation of Fixed Assets (Transfer Column "d" Total to Line 18 of Balance sheet)
7 Building, cost of improvements & Reconstruct - - -
8 Computers, Software & Related Equipment - - -
9 Plant, Machinery, Tools & other - - -
10 Motor Vehicles - - -
11 Office Equipment and furniture - - -
12 Total lines 7 through 11 - - -
13 Net book Value (Lines 6 - Line 12) - -
 Schedule B &C - Business /Rental Income Tax
Balance Sheet Annexes
Tax Payer information
1. Taxpayer's Name (company or individual) 2. Taxpayer identification Number 3. For the year ended

a. Seq
Num b. Item Description c. Beginning Balance d. Addition e. disposal Transf. Ending Balance
B. Intangible Assets (Transfer from Column "f" to Line 20 of Balance Sheet
1 Goodwill
2 Patent
3 Leasehold Land - -
4 - -
5 Other intangible Assets - -
6 Total of Lines 1 through 5 - -
B. Amortization (Transfer from Column "f" to Line 21 of Balance Sheet
7 Goodwill - -
8 Patent - -
9 Leasehold Land - - -
10 - - -
11 Other Intangible Assets - - -
12 Total of Lines 7 through 11 - - -
13 Net Book Value (Lines 6 minus 12) - - -
Annex 7- Other Assets
a. Seq
Num b. Item Description C. Amount
1 Deferred expenditures -
2 -
3 -
4
5
6
Total (Enter Total amount on Line 23 of Balance Sheet) -
Annex 8- Loans Payable in less than One Year
a. Seq
Num b. Name of Loan Provider (Financed by) C. Amount

Total Loans Payables in Less than 1 Year (Enter Total amount on Line 27 of Balance Sheet) -
Annex 9- Tax Payable
a. Seq
Num b. Name of Loan Provider (Financed by) C. Amount
1 Employment income tax payable -
2 Business income Tax payable -
3 Rental tax payable -
4 Withholding tax payable -
5 VAT payable -
6 Turnover Tax payable -
7 Excise Tax payable -
8 Dividend Tax payable -
9 Other Tax payable -
10 Total (Enter Total amount on line 28 of Balance Sheet (include Total from Continuation Sheet if Used -
 Schedule B &C - Business /Rental Income Tax
Balance Sheet Annexes
Tax Payer information
1. Taxpayer's Name (company or individual) 2. Taxpayer identification Number 3. For the year ended

a. Seq
Num b. Account Description C. Amount
1 -
2 -

Total (Enter Total amount on Line 28 of Balance Sheet (include Total from Continuation Sheet -
Annex 11- Loans Payable I More than 1 Year
a. Seq
Num b. Account Description C. Amount

Total (Enter Total amount on Line 30 of Balance Sheet (include Total from Continuation Sheet if used) -
Annex 12- Other Long - Term Liabilities
a. Seq
Num b. Name of Loan Provide (Financed by) C. Amount
-

Total (Enter Total amount on Line 31 of Balance Sheet (include Total from Continuation Sheet if used) -
Taxpayer Certification

I declare that the above declaration and all information provided here-with is correct and complete. I understand that any misrepresentation is
punishable as per the tax laws and the penal code.
Taxpayer/Authorized Agent Authorized Tax Officer
Name ___________________
Name: ____________________ Seal
Signature ______________________ Date : _______________ Signature __________Date____________
 Federal Democratic Business Income Tax declaration
Republic of Ethiopia
Ministry of Revenue
(with Annex)
Check Status:
Federal Inland
Schedule C Business income Tax
Revenue Authority Mingling income Tax

Section 1 -Taxpayer Information

1. Taxpayer's Name (company Name or Name, Father's Name, 3. Taxpayer identification Number 8. For the year ended
Grandfather's Name)

2a. Region: 2b. Zone/k-Ketema 4. Tax Account Number Document Number (official Use only)

2c.woreda 2d. Kebele/Farmers Association 2e. House Number 5. Tax center

6. Telephone Number 7. Fax Number

-----------

Section 2 - Income Tax

Income and Cost Goods Sold
1 Business income or Sales /Transfer from Annex 1) 5 -
2 Non Operating and other Income 10 -
3 Total Gross income (Add lines 1 and 2 and Enter Total at Right) 15 -
4 Cost of goods Sold / Direct Cost of Services (Transfer Total from Annex 2) 20 -
5 Gross Profit /Loss (Line 3 minus Line4) 25 -
Business Expenses
6 Selling and Distribution Expenses (Transfer from Anex4) 30 -
7 Salary and Wages 35 -
8 Other Employee benefits 40 -
9 Repair and Maintenance Expenses 45 -
10 Investment / participation expense 50 -
11 Foreign Technical Services Expenses 55 -
12 Utilities Expenses 60 -
13 Travel Expenses 65 -
14 Rent Expenses 70 -
15 Interest Expenses 75 -
16 Deprecation Expenses 80 -
17 Amortization Expenses 85 -
18 Deductible Expenses 90 -
19 Deductible Donations and Gifts 95 -
20 Other deductions (Transfer Total from Annex5) 100 -
21 Total Expenses (Add Lines 6 Through 20 and Enter Total) 105 -
Calculation of Tax Due
22 Net income/loss (Line 5 minus Line 21) 110 -
23 Loss Carry forward from Previous Period (From Annex 6) refer the instruction) 115 -
24 Carry Backward loss Adjustment (Attach supporting Document & refer instruction) 120 *************
25 Taxable Business Income (Line 22 minus( Line 23 plus 24)) 125 -
26 Income Tax payable (Line 25 x Schedule C Tax Rate) 130 -
27 Foreign tax Credit (Transfer Total From Annex 7) 135 -
28 Withholding Tax (Attach Schedule on import and payments 140 -
29 Total Credits (Line 27 plus line 28) 145 -
30 Net Tax due /Refundable Amount (subtract Line 26 from Line 19) 150 -
Taxpayer/Authorized Agent For Tax office use only
Name : ____________________ Name ___________________
Signature __________________ Signature ___________ Seal of tax
Seal office
Date: _____________________ Date________________
Taxpayer/Authorized Agent For Tax office use only
Name : ____________________ Name ___________________
Signature __________________ Signature ___________ Seal of tax
Seal office
Date: _____________________ Date________________
 Section 3- Annexes for Business Income Tax
Taxpayer information
1. Taxpayer's Name (company or individual) 2. Taxpayer identification Number 3. For the year ended

Annex1- Business Income or Sales / Turnover

a. Seq
Num b. Type of income C. Amount
1 Local Sales -
2 Export Sales
3 Service Income -
4 Total (Add Line 1 through 3- Enter total amount on line 1 of tax declaration (form 1301) -
Annex 2- Cost of Goods Sold /Direct cost of Services
a. Seq
Num b. Type of cost C. Amount
1 Beginning inventory -
2 Cost of Purchase/ Cost of Finished goods/Direct Cost of Services (From Line 19 of Annex 3 below) -
3 Goods available for Sale Direct cost of Services (Add Lines 1&2) -
4 Ending inventory -
Cost of Goods Sold /Direct cost of services (line3 minus line 4)- Enter this amount on line 4 of Tax
5 declaration (from 1301) -
Annex 3- Cost of Finished Goods/Direct cost of Services
a. Seq
Num b. Type of cost C. Amount
1 Beginning Work in Process -
2 Cost of Direct Materials -
3 Cost of Direct labor -
4 Cost of indirect materials
5 Cost of indirect labor
6 Power
7 Depreciation Expenses -
8 Supplies
9 Employee benefits
10 Repair & Maintenance expense
11 Insurance expenses
12 Airfare, Transportation & Freight expenses
13 Accommodation & Hotel Expenses
14 Excise Tax
15 Other Expenses
16 Total Over Head Costs (add lines 4 through 15) -
17 Total cost of Manufacturing / direct cost of services (add lines 1,2,3 and16)
18 Ending Work in Process -
Total cost of finished goods / direct cost of services (line 17minu line 18)- Enter Total amount on Line 3 of Annex 2
19 Above) -
Annex 4- Selling & distribution Expenses
a. Seq
Num b. Type of Expenses C. Amount
1 Salaries, Wages And Related Benefits
2 Repairs and maintenance expenses
3 Fuel and Lubricants expenses
4 Travel, Accommodation & Transport expenses
5 Advertisement expenses
6 Commission expenses
7 Insurance expenses
8 Clearing, Transit & other Related Expenses
9 Other expenses
10 Total (Add Line 1 through 9- Enter total amount on line 6 of Tax Declaration (form 1301) -
 Business Income Tax (Section 3 - Annexes Continued)
Taxpayer Information
1. Taxpayer's Name (company or individual) 2. Taxpayer identification Number 3. For the year ended

Annex 5- Other Deductions

a. Seq a. Seq
Num b. Account description C. Amount Num C. Amount
1 Stationary and printings -
2 Air ticket cost -
3 Licence and registration -
4 Lregal fee -
5 Insurance -
6 Internet and telephone -
7 Miscellaneous -

Declaration
Sub -Total
Annex - (Form
6-Loss Carry Forward from1301)
Previous Tax period -
(Validity of Loss for Schedule C Normal is 3 Years; for C mining it is 10 Years)
a. Year b. Profit/ Loss Amount c. Loss Applied d. Loss Carry - Forward e. Remark
-

23 of Tax
- Declaration, form 1301
Annex 7 - Foreign Tax Credit

a. Seq d. Amount of Foreign Tax

Num b. Name of Foreign Country C. Foreign Income paid /Payable e. Remark

Total (Enter total amount on line 28 of tax

declaration (Form 1301))
Section 4 Attachments
Balance Sheet - Selling & Distribution Expenses
Section 5 Taxpayer Certification
I declare that the above declaration and all information provided here-with is correct and complete. I understand that any
misrepresentation
Name of Taxpayer/isAuthorized
punishable agent
as per the tax law and the penal code. For Official Used Only
________________________ Seal Date of payment Receipt Number
Signature _______________ Date: _________________ (Taxpayer)

Authorized Tax officer

_______________________________________
Seal Amount of payment Cheque Number
Signature _______________ Date_____________
(Taxpayer)
Cashier's signature