PRIVATE EMPL.

ETHIOPIAN REVENUES AND CUSTOMS

PENSION
AUTHORITY
CONTRIBUTION

Section 1 - Taxpayer Information

Taxpayer's Name: TIN: Tax Period:

Asterio Stionery Computer And Orinting 0050009824 Jan, 2022

Registration Addresse: Tax Account Number: (Official Use Only)

House No.: new/101 17507241429

Kebele: WOREDA 01 Po.Box: Tax Centre:
Woreda: NO WOREDA-139 Document Number: 1634883310010
Zone/Sub-City: ARADA MOR- NORTH
Document Date: 07/03/2022
Region: ADDIS ABABA Ethiopia WEST SMALL TAX
Telephone Number: Fax Number:
PAYERS OFFICE
(STO) Submission Number: 13912661429
- Submission Date: 07/03/2022

Section 2 - Electronic Tax Declaration

Total Number of Employees 10 1.00

Total Taxable Amount 20 2,000.00

Employee Contribution Rate 30 0.07

Employee Contribution 35 140.00

Employer Contribution Rate 40 0.11

Employer Contribution 45 220.00

Total Tax to Pay 50 360.00

Section 3 - 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 Law and the Penal Code. Declaration of preparer (other than the taxpayer) is based on all information of
which the preparer has any knowledge.
Printed Taxpayer Name or Authorized Date Company Seal For Official Use Only
Representative

Date of Payment Receipt Number

Signature of Taxpayer or Authorized
Representative

Amount of Payment Check Number

Printed Name of Preparer Date

Cashier's Signature
Signature of Preparer

Page 1 of 1