MINISTRY OF REVENUES WITH TAX ON PAYM

Section 1 - Taxpayer Information

Taxpayer's Name: TIN: Tax Period:

Ethiopian Economic Association 0001291121 Jun, 2023

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

House No.: new 51150

Kebele: WOREDA 13 Po.Box: Tax Centre:
Woreda: WOREDA 13 Document Number: 1732164260010
Zone/Sub-City: LEMI KURA SUB CITY MOR-EAST ADDIS
Document Date: 31/07/2023
Region: ADDIS ABABA Ethiopia ABEBA SMALL TAX
Telephone Number: Fax Number:
PAYERS BRANCH
Submission Number: 24340320010
Submission Date: 31/07/2023

Section 2 - Electronic Tax Declaration

Total Number of Withholdees' 10 18.00

Total Taxable Amount for this Tax Period 20 384,820.76

Total Tax Withheld for this Tax Period 30 13,696.33

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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