GAMBIA REVENUE AUTHORITY
APPLICATION FOR TAXPAYER IDENTIFICATION NUMBER
(Complete this form in BLOCK letters - see reverse for instructions)
The completed form should be mailed or delivered to any Gambia Revenue Authority Office
1 TAX OFFICE:
2 CATEGORY OF APPLICANT (Please tick appropriate box)
COMPANY (RESIDENT) COMPANY (NON-RESIDENT) PARTNERSHIP (RESIDENT)
INDIVIDUAL (RESIDENT) INDIVIDUAL( NON-RESIDENT) PARTNERSHIP (NON-RESIDENT)
TRUSTS GOV. MINISTRY, LOCAL AUTHORITY OR OTHER GOV. INSTITUTION
CLUB,ASSOCIATION, ETC INDIVIDUAL/ORGANISATION ENTITLED TO DIPLOMATIC PRIVILEGES
PART A - PERSONAL DETAILS
3 SURNAME FIRST NAME MIDDLE NAME(S
4 MOTHER'S FIRST NAME LAST NAME:
GAMBIAN 6. COUNTRY OF RESIDENCE
5 CITIZENSHIP
NON-GAMBIAN 7. PASSPORT NUMBER
(for individual citizens and residents) (for non-citizens and non-residents, attach photocopy of passport)
8 ID CARD NUMBER MALE 10 DATE OF BIRTH
9. GENDER
FEMALE
(ATTACH COPY OF BIRTH CERT. & ID)
…........../…............./….. ….. …..
MARRIED SINGLE D D M M Y Y Y
11 MARITAL STATUS: WIDOWED DIVORCED
SEPERATED OTHER
SELF-EMPLOYED EMPLOYEE NOT EMPLOYED
12 EMPLOYMENT STATUS:
EMPLOYER NON-EMPLOYER OTHER
PART B: BUSINESS DETAILS
13 BUSINESS NAME
14 TRADING NAME
15 BUSINESS REGISTRATION NO : BUSINESS REGISTRATION DATE:
16 PREVIOUS YEAR TURNOVER (GMD) 17.IMPORTER ID NO.
18 CERTIFICATE OF INCORPORATION NO. 19. BUSINESS START DATE:
20 ACCOUNTING PERIOD: START DATE ….. ….. …………...…....END DATE ….. ………………………..……….
21 NATURE OF BUSINESS
22 DETAILS OF TAX AGENT (If any)
AGENT NAME TIN
AGENT ADDRESS TEL. NO.
23 ARE YOU EXEMPTED FROM INCOME TAX? YES [ ] NO [ ]
If Yes, indicate granting Authority………………………………………………
PART C - GENERAL DETAILS
24 PHYSICAL ADDRESS 25 POSTAL ADDRESS
BUILDING NAME( IF ANY) P.O. BOX
LAND REGISTER NO. TOWN
STREET PROVINCE
AREA
TOWN/PROVINCE
26 CONTACT INFORMATION (Non Business Applicants should provide BOTH their personal and Employer Contacts)
INDIVIDUAL CONTACT INFORMATION
TELEPHONE 1: TELEPHONE 2: MOBILE:
FAX: EMAIL:
BUSINESS/EMPLOYER CONTACT INFORMATION
TELEPHONE 1: TELEPHONE 2: MOBILE:
FAX: EMAIL:
EMPLOYER CONTACT INFORMATION (To be completed by employees only)
EMPLOYER NAME AND ADDRESS:
EMPLOYER TIN
PLEASE CONTACT THE NEAREST GAMBIA REVENUE AUTHORITY OFFICE IF YOU NEED ANY ASSISSTANCE IN COMPLETING THIS FORM
27 INCOME TAX FILE NO (if known) PAYE FILE NO. (if known)
28 HAVE YOU EVER HAD A TAX FILE IN AN INCOME TAX BRANCH OTHER THAN THE ONE THAT HANDLES YOUR TAX
FILE NOW? YES [ ] NO [ ]. If Yes, provide the following information:
PREVIOUS NAME(S) IF ANY………………………………………………………………………………………………
PREVIOUS INCOME TAX FILE NUMBER(S) IF ANY…………………………………………………………..………
PREVIOUS PAYE FILE NUMBER(S) IF ANY…………………………………………………………………………….
29 DO YOU NOW EMPLOY OR INTEND IN THE NEXT 12 MONTHS TO EMPLOY OTHERS, ANY OF WHOM WILL EARN
MORE THAN GMD 625 OR MORE PER MONTH? YES [ ], NO [ ]
30 DO YOU NOW EMPLOY OR INTEND IN THE NEXT 12 MONTHS TO EMPLOY ANY NON-GAMBIANS? YES [ ], NO [ ]
PART D - DECLARATION (To be completed by the person filling the form)
31 I (FULL NAME IN BLOCK LETTERS) DECLARE THAT THE
INFORMATION GIVEN IN THIS APPLICATION IS TRUE AND COMPLETE. I UNDERSTAND THAT IF ANY INFORMATION
GIVEN ABOVE IS MISLEADING OR INCORRECT I COULD BE SUBJECT TO ANY AND ALL PENALTIES OR FINES
THAT THE LAW MAY ALLOW TO BE IMPOSED.
32 SIGNATURE……………………………………………………. DATE………………………………….
33 CAPACITY OF SIGNATORY………………………………………………………………..
PART E - FOR OFFICIAL USE
34 TO BE COMPLETED BY RECEIVING OFFICER
ATTACHMENTS (Tick copies of what has been attatched)
NATIONAL/ALIEN ID CARD BUSINESS REGISTRATION CERTIFICATE DATE
PASSPORT CERTIFICATE OF INCORPORATION STAMP
BIRTH CERTIFICATE TAX EXEMPTION CERTIFICATE
MEMORANDUM & ART. ASSOCIATION CONSTITUION OF ASSOCIATION
PARTNERSHIP DEED OTHER
SIGNATURE NAME
35 TO BE COMPLETED BY DATA ENTRY CLERK
DATE INPUT ON COMPUTER:
SIGNATURE: NAME
36 TO BE COMPLETED BY REGISTRATION OFFICER
I HAVE CROSS CHECKED THE FORM AGAINST THE KEYED IN DATA.
REGISTRATION: APPROVED NOT APPROVED
APPROVED BY DATE
SIGNATURE: STAMP
FULL NAME:
CONFIRMATION OF REGISTRATION
TIN
PART F: OTHER PERSONS ASSOCIATED WITH THE APPLICANT
37 LIST BELOW ANY SPOUSES ASSOCIATED WITH THIS APPLICANT
NO. NAME ADDRESS TIN RELATIONSHIP
38. LIST BELOW ANY OTHER BUSINESSES ASSOCIATED WITH THIS APPLICANT
NO. NAME ADDRESS TIN RELATIONSHIP
version 7.0
GRA REG 1
s)
Authority Office
RSHIP (RESIDENT)
RSHIP (NON-RESIDENT)
R GOV. INSTITUTION
LOMATIC PRIVILEGES
DATE OF BIRTH
........../…............./….. ….. ….. ….
D M M Y Y Y Y
OT EMPLOYED
OTHER
S START DATE:
MPLETING THIS FORM
LES YOUR TAX
M WILL EARN
ES [ ], NO [ ]
ARE THAT THE
Y INFORMATION
………………………….
DATE
STAMP
DATE
STAMP
RELATIONSHIP
RELATIONSHIP
GAMBIA REVENUE AUTHORITY
REPUBLIC OF GAMBIA
SUPPLEMENTARY FORM
(FOR COMPLETION BY COMPANIES,PARTNERSHIPS,CLUBS,ASSOCIATIONS,ETC)
PART G: OTHER PERSONS ASSOCIATED WITH THE APPLICANT
39. LIST BELOW ANY OTHER BUSINESSES ASSOCIATED WITH THIS APPLICANT
NO NAME ADDRESS TIN RELATIONSHIP
40. LIST THE MAJOR SHAREHOLDERS
NO. OF SHARES % OF TOTAL
NO. NAME TIN
HELD SHARES HELD
41. LIST OF DIRECTORS
NO NAME TIN
42. LIST OF PARTNERS & SHARE OF CAPITAL
SHARE OF
NO NAME TIN CAPITAL SHARE OF PROFIT
43. LIST OF PRINCIPAL OFFICERS OF CLUBS, ASSOCIATIONS, ETC.
NO NAME TIN DESIGNATION
