Federal Democratic Republic of Ethiopia

Schedule B
Ministry of Revenue
Federal Inland Revenue Rental Income Lessee
Authority Details Declaration
Section 1 – Taxpayer Information
1. Taxpayer’s Name (Company Name or Name, Father’s Name, Grandfather’s name) 2. Taxpayer Identification Number 3. For the Year of: Page 1 of
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Section 2 – Declaration of Lessee Payments Made
d) Address of Property Being Leased e) End
g)
Total Rent i) If Sub-
a) b) Lessee c) Name of Lessee Organization or h)
Monthly f) Date of lease Enter
Seq TIN (If Person (Name, Father’s Name and Zone/ K- Kebel House For Year
Num Available) Region Woreda Rent Leased Contract Amount
Grandfather’s Name) Ketema e Number (Birr) Paid
(Birr) Date

Enter Totals From All Continuation Sheets Here if used >>

Gross Rental Income (Enter Totals Here and on Lines 1 and 2 of Rental Income Tax Declaration, Form 1201 )
Section 3 – Taxpayer Certification
I declare that the above declaration and all information provide here-with (including continuation sheets) is correct and
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
Signature of Taxpayer or Authorized Representative Date Signature of Preparer Date

Company
Printed Name of Taxpayer or Authorized Representative Seal Printed Name of
Preparer

Ministry of Revenue (Draft as of 465/2006) FIRA Form 1202 (5/2006)