Application for Taxpayer Official Use Only

Form DT-1001
Identification Number
for all Individuals
This Form may be used by all individuals
who are applying for a TIN.Individuals BW0121011110797
who are ONLY employed, orRegistering/ transfering
(Toll Free Number
a Motor Vehicleor carrying out a Land transfer are not
required to complete section D and Schedule 3 of this form.) 0800117000

Section A-Name and Address

Title Surname First Name Middle Name Mother's Maiden Marital Status
Name
MR. ODONGO LEO NA SINGLE

Postal address where notices and correspondences should be sent

Post Box Number/PrivateBag District/City where box is
located

Home Address in Uganda (This must be a permanent physical address)

Plot Number Street Name Building Name Trading Center District/City County/Municipalit
y
KASANA LUWEERO KATIKAMU
NORTH
Village Parish Mobile Number Landline Number Email Address
KALONGO LUWERO SOUTH 256775364347 odongo.leo@yahoo.c
EAST WARD om

Section B - Birth and Citizenship and Purpose of Registration

Country of Birth Place of Birth State District/City County/Municipality
UGANDA LIRA LIRA
Sub- Parish Village Gender Date of Birth If you are NOT a Citizen of
County/TownCouncil/ Uganda, enter country where
Division you are a citizen
BARR AYAMO ODANO MALE 05/03/1999 UGANDA
Are you a Minor Have you been known by another name
NO NO

Purpose of TIN Registration

Income Tax VAT(Complete Form DT-1011) Stamp Duty Imports/Exports
YES NO NO NO
Local Excise and Duty(Complete Gaming TaxRegistration(Complete Form DT- Motor Vehicle
FormDT-1012) 1013) Registration/Transfer
NO NO

Section C-Identification Documents

Section D - Partnership, corporate and Trusts Information
Indicate below your additional business interests or investments in any Partnerships, Companies or Trusts

Entity Type Business Name of Partnership, Registration Number TIN

Corporation or Trust

Section E-Sources of Income and Type of Business Activity

Are you in employment Is the employer resident Principal Employers Name Employer's TIN
of Uganda
YES YES UGANDA NATIONAL ROADS 1000132401
AUTHORITY
Property Income Rental Income Business Income from a Sole Date Business
Proprietorship orFamily Run Started(dd/mm/yyyy)
Business
NO NO NO
Business Name Business Registration Certificate Number

Business Address Infomation

Plot Number Street Name Building Name Trading Center District/City
County/Municipality Sub-County/TownCouncil/Division Parish Village
Activity Code Description of Activity

Schedule 3 - Registration for Pay As You Earn and Withholding of Tax

WHT from Salary WHT from WHT from WHT from WHT from WHT from
Contract Supplier Foreign Gaming Commence Date
NO