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ZAMBIA REVENUE AUTHORITY

DIRECT TAXES DIVISION


TAX CLEARANCE CERTIFICATE APPLICATION FORM FOR INDIVIDUALS
AND COMPANIES
(Complete this form in block letters)
NAME:_________________________________________________________________________________
TPIN:

NRC: _________________________________

(If you are not registered for TPIN, kindly complete TPIN registration form before this application can be considered)

INCOME TAX ACCOUNT NUMBER:________________________


(If you are not registered for Income tax, kindly complete Income tax registration form before this application can be considered)

BUSINESS SECTOR:____________________________________
PHYSICAL ADDRESS (PLOT/STAND/ROOM)
________________________________________
________________________________________
________________________________________
________________________________________
__________________________________

POSTAL ADDRESS
__________________________________
__________________________________
__________________________________

CONTACT PERSON:______________________________________________________________________
TITLE:______________________________________ EMAIL ADDRESS:________________________
TEL:________________________

CELL:______________________

REASON FOR APPLICATION:__________________________________________________________


___________________________________________________________________________________
__________________________________________________________________________________________
____________________________________________________________________________

DECLARATION
I .. DECLARE THAT THE INFORMATION
PROVIDED IS CORRECT.
SIGNATURE:_______________________ CAPACITY:_____________________________________
DATE:________________

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