1 2 3

EMPLOYEE'S PARTICULARS

SEQUENCE
NO. Employee's TIN SURNAME FIRST NAME

1 599937819 ROBERTS MAGDALEN

2 334669910 HANSEN JALEN
 R

3 4
EMPLOYEE'S PARTICULARS

MONTHS
EMPLOYED
ADDRESSES

27556 DACH MOUNTAIN

SOLEDADSHIRE, NV 04503-8272
1157 MIA DAM SUITE 198 2
TODCHESTER, MN 44186 2
 RETURN OF EMPLOYERS OF PERSONS EMPLOYED BY THEM

5 6
IN THE CASE OF PERSONS: (a) REMUNERA
EMPLOYED DURING THE YEAR NAME & ADDRESS OF
PREVIOUS EMPLOYER (IF ANY)

STATE WHETHER (A)

WHOLY (W) OR PARTLY AMOUNT OF
EMPLOYEDWHOLLY/PAR SALARIES, WAGES,
TLY COMMISSIONS OVERTIME
OR OTHER EMOLUMENTS
FOR THE YEAR ENDED
31ST DECEMBER 2015
(b)LEAVING DURING THE YEAR, GIVEN NAME & ADDRESS
OF NEW EMPLOYER
P $320,000
P $349,468
 7 8
REMUNERATION TOTAL (D) DEDUCTIONS ALLOWED

('C)
(B) ANNUAL
VALUE OF ANY OTHER (E ) (F) EMPLOYEES'S NATIONAL
ALLOWANCES IN (A+B+C) STATUTORY INSURANCE SCHEME
RESIDENCE QUARTERS CONTRIBUTION
KIND RECEIVED BY DEDUCTION
BORD AND LODGING
EMPLOYEE

$320,000 $150,000 $0
$349,468 $150,000 $19,570
 9 10
TOTAL DEDUCTION (G)

FOR OFFICAL
INCOME TAX USE
DEDUCTED (H)
E+F

$150,000 $47,600
$169,570 $50,372
 SUBMIT THIS PART TO THE GUYANA REVENUE AUTHORITY SUBMIT THIS PART TO THE GUYANA REVENUE AUTHORITY
ATTACHED TO YOUR INCOME TAX RETURN ATTACHED TO YOUR INCOME TAX RETURN

ORIGINAL DUPLICATE

Dear Sir/Madam, Dear Sir/Madam,

Please note that we (I) have advised the Commissioner-General of Please note that we (I) have advised the Commissioner-General of
Salary etc., paid to and Tax Deducted from you for the period Salary etc., paid to and Tax Deducted from you for the period
…….….….……. to..……..….…………20……… as follows:- …….….….……. to..……..….…………20……… as follows:-
Salary or Wages (Basic) Salary or Wages (Basic)
Rent Free Quarters or Rent Free Quarters or
House Allowance House Allowance
Bonus and Profit Share Bonus and Profit Share
(Other than Incentive Payments) (Other than Incentive Payments)
Overtime Overtime
Board and Lodge Board and Lodge
Fees Fees
Other Emoluments and Allowances: Other Emoluments and Allowances:
All other Allowances paid must be All other Allowances paid must be
stated and separately listed.) stated and separately listed.)
Total Income Total Income

National Insurance Scheme (NIS) National Insurance Scheme (NIS)

(Employee Contributions)
Statutory Deduction
INCOME TAX DEDUCTED TOTAL
If your total income from all sources including the above is
over $720,000, you are required under penalty to make a Return on
the Form 1 attached to the Commissioner-General, Georgetown, on
or before 30th April, ……………….
Attach the original of this Notice to your Income Tax Return
and retain the duplicate for your records.
If you are not liable to Income Tax, you should claim
repayment from the Commissioner-General submitting at the same
time the original of this Notice.
* State the earning period of income.
Yours co-operatively,
(Employee Contributions)
Statutory Deduction
INCOME TAX DEDUCTED TOTAL
If your total income from all sources including the above is
over $720,000, you are required under penalty to make a Return on
the Form 1 attached to the Commissioner-General, Georgetown, on
or before 30th April, ……………….
Attach the original of this Notice to your Income Tax Return
and retain the duplicate for your records.
If you are not liable to Income Tax, you should claim
repayment from the Commissioner-General submitting at the same
time the original of this Notice.
* State the earning period of income.
Yours co-operatively,

…………………….. ……………………..
Employer Signature Employer Signature

Employee’s Employee’s National Employer’s Employee’s Employee’s National Employer’s

Sequential # TIN Registration # TIN Sequential # TIN Registration # TIN

Name: ………………………………………………………………. Name: ……………………………………………………………….

Address:………………………………………………………… Address:…………………………………………………………
I.R.D 7B2 I.R.D 7B2
 SUBMIT THIS PART TO THE GUYANA REVENUE AUTHORITY SUBMIT THIS PART TO THE GUYANA REVENUE AUTHORITY
ATTACHED TO YOUR INCOME TAX RETURN ATTACHED TO YOUR INCOME TAX RETURN

ORIGINAL DUPLICATE

Dear Sir/Madam, Dear Sir/Madam,

Please note that we (I) have advised the Commissioner-General of Please note that we (I) have advised the Commissioner-General of
Salary etc., paid to and Tax Deducted from you for the period Salary etc., paid to and Tax Deducted from you for the period
…….….….……. to..……..….…………20……… as follows:- …….….….……. to..……..….…………20……… as follows:-
Salary or Wages (Basic) Salary or Wages (Basic)
Rent Free Quarters or Rent Free Quarters or
House Allowance House Allowance
Bonus and Profit Share Bonus and Profit Share
(Other than Incentive Payments) (Other than Incentive Payments)
Overtime Overtime
Board and Lodge Board and Lodge
Fees Fees
Other Emoluments and Allowances: Other Emoluments and Allowances:
All other Allowances paid must be All other Allowances paid must be
stated and separately listed.) stated and separately listed.)
Total Income Total Income

National Insurance Scheme (NIS) National Insurance Scheme (NIS)

(Employee Contributions) (Employee Contributions)
Statutory Deduction Statutory Deduction
INCOME TAX DEDUCTED TOTAL INCOME TAX DEDUCTED TOTAL
If your total income from all sources including the above is If your total income from all sources including the above is
over $780,000, you are required under penalty to make a Return on over $780,000, you are required under penalty to make a Return on
the Form 1 attached to the Commissioner-General, Georgetown, on the Form 1 attached to the Commissioner-General, Georgetown, on
or before 30th April, ………………. or before 30th April, ……………….
Attach the original of this Notice to your Income Tax Return Attach the original of this Notice to your Income Tax Return
and retain the duplicate for your records. and retain the duplicate for your records.
If you are not liable to Income Tax, you should claim If you are not liable to Income Tax, you should claim
repayment from the Commissioner-General submitting at the same repayment from the Commissioner-General submitting at the same
time the original of this Notice. time the original of this Notice.
* State the earning period of income. * State the earning period of income.
Yours co-operatively, Yours co-operatively,

……………………………….. ………………………………..
Employer Signature Employer Signature

Employee’s Employee’s National Employer’s Employee’s Employee’s National Employer’s

Sequential # TIN Registration # TIN Sequential # TIN Registration # TIN

I.R.D 7B2 I.R.D 7B2

 SUBMIT THIS PART TO THE GUYANA REVENUE AUTHORITY SUBMIT THIS PART TO THE GUYANA REVENUE AUTHORITY
ATTACHED TO YOUR INCOME TAX RETURN ATTACHED TO YOUR INCOME TAX RETURN

ORIGINAL DUPLICATE

Demo Payroll Inc Demo Payroll Inc

Lamaha St Lamaha St
Georgetown, Guyana Georgetown, Guyana

Dear Sir/Madam, Dear Sir/Madam,

Please note that we (I) have advised the Commissioner-General of Please note that we (I) have advised the Commissioner-General of
Salary etc., paid to and Tax Deducted from you for the period Salary etc., paid to and Tax Deducted from you for the period
…….….….……. to..……..….…………20……… as follows:- …….….….……. to..……..….…………20……… as follows:-
Salary or Wages (Basic) $320,000 Salary or Wages (Basic) $320,000
Rent Free Quarters or Rent Free Quarters or
House Allowance House Allowance
Bonus and Profit Share Bonus and Profit Share
(Other than Incentive Payments) (Other than Incentive Payments)
Overtime $0 Overtime $0
Board and Lodge Board and Lodge
Fees Fees
Other Emoluments and Allowances: $0 Other Emoluments and Allowances: $0
All other Allowances paid must be All other Allowances paid must be
stated and separately listed.) stated and separately listed.)
Total Income $320,000 Total Income $320,000

National Insurance Scheme (NIS) $0 National Insurance Scheme (NIS) $0

(Employee Contributions) (Employee Contributions)
Statutory Deduction $150,000 Statutory Deduction $150,000
INCOME TAX DEDUCTED TOTAL $47,600 INCOME TAX DEDUCTED TOTAL $47,600
If your total income from all sources including the above is If your total income from all sources including the above is
over $780,000, you are required under penalty to make a Return on over $780,000, you are required under penalty to make a Return on
the Form 1 attached to the Commissioner-General, Georgetown, on the Form 1 attached to the Commissioner-General, Georgetown, on
or before 30th April, ………………. or before 30th April, ……………….
Attach the original of this Notice to your Income Tax Return Attach the original of this Notice to your Income Tax Return
and retain the duplicate for your records. and retain the duplicate for your records.
If you are not liable to Income Tax, you should claim If you are not liable to Income Tax, you should claim
repayment from the Commissioner-General submitting at the same repayment from the Commissioner-General submitting at the same
time the original of this Notice. time the original of this Notice.
* State the earning period of income. * State the earning period of income.
Yours co-operatively, Yours co-operatively,

……………………………….. ………………………………..
Employer Signature Employer Signature

Employee’s Employee’s National Employer’s Employee’s Employee’s National Employer’s

Sequential # TIN Registration # TIN Sequential # TIN Registration # TIN
1 599937819 050006661 1 599937819 050006661

Name: MAGDALEN ROBERTS Name: MAGDALEN ROBERTS

Address: 27556 DACH MOUNTAIN Address: 27556 DACH MOUNTAIN
SOLEDADSHIRE, NV 04503-8272 SOLEDADSHIRE, NV 04503-8272
I.R.D 7B2 I.R.D 7B2
 DEMO PAYROLL INC
SUBMIT THIS PART TO THE GUYANA REVENUE AUTHORITY SUBMIT THIS PART TO THE GUYANA REVENUE AUTHORITY
ATTACHED TO YOUR INCOME TAX RETURN ATTACHED TO YOUR INCOME TAX RETURN

ORIGINAL DUPLICATE

Demo Payroll Inc Demo Payroll Inc

Lamaha St Lamaha St
Georgetown, Guyana Georgetown, Guyana

Dear Sir/Madam, Dear Sir/Madam,

Please note that we (I) have advised the Commissioner-General of Please note that we (I) have advised the Commissioner-General of
Salary etc., paid to and Tax Deducted from you for the period Salary etc., paid to and Tax Deducted from you for the period
…….….….……. to..……..….…………20……… as follows:- …….….….……. to..……..….…………20……… as follows:-
Salary or Wages (Basic) $340,937 Salary or Wages (Basic) $340,937
Rent Free Quarters or Rent Free Quarters or
House Allowance House Allowance
Bonus and Profit Share Bonus and Profit Share
(Other than Incentive Payments) (Other than Incentive Payments)
Overtime $8,531 Overtime $8,531
Board and Lodge Board and Lodge
Fees Fees
Other Emoluments and Allowances: $35,000 Other Emoluments and Allowances: $35,000
All other Allowances paid must be All other Allowances paid must be
stated and separately listed.) stated and separately listed.)
Total Income $384,468 Total Income $384,468

National Insurance Scheme (NIS) $19,570 National Insurance Scheme (NIS) $19,570
(Employee Contributions) (Employee Contributions)
Statutory Deduction $150,000 Statutory Deduction $150,000
INCOME TAX DEDUCTED TOTAL $50,372 INCOME TAX DEDUCTED TOTAL $50,372
If your total income from all sources including the above is If your total income from all sources including the above is
over $780,000, you are required under penalty to make a Return on over $780,000, you are required under penalty to make a Return on
the Form 1 attached to the Commissioner-General, Georgetown, on the Form 1 attached to the Commissioner-General, Georgetown, on
or before 30th April, ………………. or before 30th April, ……………….
Attach the original of this Notice to your Income Tax Return Attach the original of this Notice to your Income Tax Return
and retain the duplicate for your records. and retain the duplicate for your records.
If you are not liable to Income Tax, you should claim If you are not liable to Income Tax, you should claim
repayment from the Commissioner-General submitting at the same repayment from the Commissioner-General submitting at the same
time the original of this Notice. time the original of this Notice.
* State the earning period of income. * State the earning period of income.
Yours co-operatively, Yours co-operatively,

……………………………….. ………………………………..
Employer Signature Employer Signature

Employee’s Employee’s National Employer’s Employee’s Employee’s National Employer’s

Sequential # TIN Registration # TIN Sequential # TIN Registration # TIN
2 334669910 050006661 2 334669910 050006661

Name: JALEN HANSEN Name: JALEN HANSEN

Address: 1157 MIA DAM SUITE 198 Address: 1157 MIA DAM SUITE 198
TODCHESTER, MN 44186 TODCHESTER, MN 44186
I.R.D 7B2 I.R.D 7B2