1103 Employment Income Tax Dec Updated
1103 Employment Income Tax Dec Updated
1103 Employment Income Tax Dec Updated
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:
Month Year Page 1 of 1
2a. Region 2b. Zone/K-Ketema 5. Tax Center Document Number (Official Use Only)
2c. Woreda 2d. Kebele/Farmers Association 2e. House Number 6. Telephone Number 7. Fax Number
Additional Benefits
c) Employee Name j) Taxable
b) d) Start Date f) Total
a) Seq (Name, Father’s Name e) Basic g) Taxable i) Other Income l) Cost m) Net n) Employee
Employee of Transportation h) Over k) Tax Withheld
Num and Grandfather’s Salary Transportatio Taxable (Sum Columns Sharing Pay Signature
TIN Employment Allowance Time
Name) n Allowance Benefits e, g, h, and i)
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 correct and Taxpayer Signature & Date Employer Seal Preparers Printed Name, Signature & Date
complete. I understand that any misrepresentation is punishable as per the tax Laws and the Penal code. Declaration of
preparer (other than the taxpayer) is based on all information of which the preparer has any knowledge.
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
Month Year ___
2a. Region 2b. Zone/K-Ketema 5. Tax Center Document Number (Official Use Only)
2c. Woreda 2d. Kebele/Farmers Association 2e. House Number 6. Telephone Number 7. Fax Number
Additional Benefits
j) Taxable
c) Employee Name d) Start Date f) Total
a) Seq b) Employee e) Basic g) Taxable i) Other Income l) Cost m) Net n) Employee
(Name, Father’s Name and of Transportation h) Over k) Tax Withheld
Num TIN Salary Transportatio Taxable (Sum Columns Sharing Pay Signature
Grandfather’s Name) Employment Allowance Time
n Allowance Benefits e, g, h, and i)
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