ETHIOPIAN REVENUES AND CUSTOMS VALUE-ADDED

AUTHORITY TAX(VAT)

Section 1 - Taxpayer Information

Taxpayer's Name: TIN: Tax Period:

Walga Construction P.L.C 0004395178 Sep, 2017

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

House No.: 767 880030002

Kebele: 09 Po.Box: 59310 Tax Centre:
Woreda: NO WOREDA-148 Document Number: 1301125790821
Zone/Sub-City: GULLELE ADDIS ABABA LTO
Document Date: 28/10/2017
Region: ADDIS ABABA Ethiopia
Telephone Number: Fax Number:
Submission Number: 1625720003
Submission Date: 28/10/2017

Section 2 - Electronic Tax Declaration

Value of Taxable Goods and Supplies 5 927,020.47

VAT on Taxable Goods and Supplies (15% of line 5) 10 139,053.07

Value of Zero-Rated Goods 15

Value of Exempt Supplies/Sales 20

Value of Remitted Supplies 25

Total Supplies/Sales (lines 5 + 15 + 20 + 25) 30 927,020.47

VAT Charged for this Period (= line 10) 35 139,053.07

Value of Local Purchases Input 50 380,515.98

VAT on Local Purchases Input (15% of line 50) 55 57,077.40

Value of Imported Inputs 60

VAT on Imported Inputs (15% of line 60) 65

Value of General Expense Inputs 70

VAT on General Expense Inputs (15% of line 70) 75

Value of Purchases with no VAT or Unclaimed Inputs 80

Value of Total Inputs (lines 50 + 60 + 70 + 80) 85 380,515.98

Value of Taxable Inputs (lines 50 + 60 + 70) 90 380,515.98

Total Inputs Tax Credit (lines 55 + 65 + 75) 95 57,077.40

NET VAT DUE FOR MONTH (before carry-fwd calc) (line 35 - 95) 110 81,975.67

VAT CREDIT FOR MONTH (before carry-fwd calc) (line 95 - 35) 115

hidden line - for VT011RS reports 116

Other Credits for Month (Payments, Sales Tax, Goods On Hand) 120

Credits Carried Forward from Previous Month 125 3,519,656.00

Refund Given for Excess Credit 130

Refund Interest Adjustment 135

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 ETHIOPIAN REVENUES AND CUSTOMS VALUE-ADDED
AUTHORITY TAX(VAT)

Total Remaining Due for Period (line110-115-120-125+130+135) 150

Total Credit Available Carry-Forward=115+120+125-110-130-135 160 3,437,680.33

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

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