Balance Sheet and Annexes

Federal Democratic Republic of Ethiopia check filling Status:

Ministry of Revenue Federal Inland schedule B Rental Income Tax
Revenue Authority
schedule C Business Income Tax
Mining Income Tax

Section 1-Tax payer Information

1.Tax payer's Name(Company Name or Name,Father's Name, 8.For the year of Pag 1 of _________
GrandFather's Name:- 3.Tax payer ____________________
Identification
Number(TIN)
______________________________________________________________________ xxxxxxxxxxxx Document Number(official use only)
2a.Region:___________________________ 2b. Zone/K.ketema:-_______________ 4.Tax Acount
2C. Woreda 2d.kebele/farmer association 2e. Hous________________
____________________ ________________________ 5.Tax Center
6. Telephone Number 7. Fax Number
_____________________ or______________________________ _______________
_____________________ or ____________________________

Section 2 -Business Assets,Liabilities and Capital

Instruction: prior to completing this portion of the Balance sheet you will need to complete the individual Annexes on the following three pages. Be sure and
check your filling status at the top of this form.
Assets
1 Cash 10
2 Accounts Receivable (Transfer Total from Annex 1, Line 4) 20 -
3 Allowance for Bad Debts 30
4 Net Accounts Receivable (Subtract Line 3 from Line 2 and Enter Total) 40 -
5 Pre Paid Expenses 50
6 Inventories (Transfer Total from Annex 2, Line 7) 60 -
7 Operating Supplies 70
8 Other Current Assets (Transfer Total from Annex 3) 80 -
9 Loans to Shareholders 90
10 Mortgage & Real Estate Loans Receivable 100
11 Other Investments (Transfer Total from Annex 4) 110 -

12 Building, Cost of Improvements & Reconstruction -

Transfer from

120
Annex 5A,
Column f

13 Computers, Software Products & Related Equipment 130 -

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Transfer fr

Column
Annex 5
14 Plant, Machinery, Tools & Other Equipment 140 -
15 Motor Vehicles 150 -
16 Office Equipment and Furniture 160 -
17 Add Lines 12 through 16 and Enter Total 165 -
18 Accumulated Depreciation (Transfer from Annex 5B, Column d) 170 -
19 Net Book Value (Subtract Line 18 from Line 17 and Enter Total) 180 -
20 Intangible Assets (Transfer Total from Annex 6A, Column f) 190 -
21 Accumulated Amortization (Transfer from Annex 6B, Column f) 200 -
22 Net Book Value / Intangible Assets (Subtract Line 21 from Line 20 and Enter Total) 210 -
23 Other Assets (Transfer Total from Annex 7) 220 -
24 Total Assets (Add Lines 1, 4 through 11, 19, 22 and 23) 230 -
Liabilities
25 Accounts Payable 240
26 Interest Payable 250
27 Loans Payable less than 1 Year (Transfer Total from Annex 8) 260 -
28 Tax Payable (Transfer Total from Annex 9) 270 -
29 Other Current Liabilities (Transfer Total from Annex 10) 280 -
30 Loans from Shareholders 290
31 Loans Payable More than 1 Year (Transfer Total from Annex 11) 300 -
32 Other Long-Term Liabilities (Transfer Total from Annex 12) 310 -
33 Total Liabilities (Add Lines 25 through 32 and Enter Total) 320 -
Capital
34 Capital 330
35 Legal Reserve 340
36 Retained Earnings 350
37 Total Capital (Add Lines 34 through 36 and Enter Total) 360 -
38 Total Liabilities and Capital (Add Lines 33 and 37 and Enter Total) 370 -
Name and Signature of Taxpayer/agent
Ministry of Revenue Date Seal

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 Balance Sheet Annexes
Annex 1 – Accounts Receivable
Seq. Num b. Item Description C. Amount
1 Trade Debtors
2 Sundry Debtors
3 Staff Debtors
4 Total of Lines 1 through 3 (Enter Total amount on Line 2 of Balance Sheet) -

Annex 2 – Inventories(Applies to Business/Mining income only,not Rental income)

Seq. Num b. Item Description C. Amount
1 Merchandise Stock
Manufacturing Business
2 finished/processed product
3 Working in process
4 Raw Material
5 Reject,by product and other Related Items
6 Spare parts,Supplies,packing and other materials
7 Total of Line 1 through 6 (Enter Total amount on Line 6 of Balance sheet) -

Annex 3 Other Current Assets

Seq. Num b. Item Description C. Amount
1
2
3
4
5
6
7
8
9
10 Total(Enter amount on Line 8 of Balance Sheet) -

Annex 4 Other Investments

Seq. Num b. Item Description C. Amount
1
2
3
4

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 5
6 Total(Enter Total amount on Line 11 of Balance Sheet) -

Annex 5 – Fixed Assets

a c. Beginning e. Disposal/
b. Item Description d. Addition f. Ending Balance
Seq. Num Balance Transfer
A. Cost of Fixed Assets (Transfer Column "f" Totals to Lines 12 through 17 on Balance Sheet)
1 Building, Cost of Improvements & Reconstruction -
2 Computers, Software & Related Equipment -
3 Plant, Machinery, Tools & Other Equipment -
4 Motor Vehicles -
5 Office Equipment and Furniture -
6 Total of Lines 1 through 5 - - -
B. Depreciation of Fixed Assets (Transfer Column “d” Total to Line 18 of Balance Sheet)
5% 7 Building, Cost of Improvements & Reconstruction - -
25% 8 Computers, Software & Related Equipment - -
20% 9 Plant, Machinery, Tools & Other Equipment - -
20% 10 Motor Vehicles - -
20% 11 Office Equipment and Furniture - -
12 Total of Lines 7 through 11 - - -
13 Net Book Value (Line 6 – Line 12) - -

Annex 6 – Intangible Assets

a c. Beginning e. Disposal/
b. Item Description d. Addition f. Ending Balance
Seq. Num Balance Transfer
A. Intangible Assets (Transfer from Column "f" to Line 20 of Balance Sheet)
1 GoodWill -
2 Patent -
3 Leasehold Land -
4 -
5 Other Intangible Assets -
6 Total of Lines 1 Through 5 - -
B.Amortization (Transfer from Column "f" to Line 21 of Balance Sheet)
7 GoodWill -
8 Patent -
9 Leasehold Land -
10 -
11 Other Intangible Assets -

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12 Total of Lines 7 through 11 - - - -
13 Net Book Value(Lines 6 minus 12) -

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 Annex 7 - Other Assets
Seq. Num b. Item Description C. Amount
1
2
3
4
5
6
Total(Enter Total amount on Line 23 of Balance sheet) -

Annex 8 -Loans payable in less than one year

Seq. Num b.Name of Loan provider(financed by) C. Amount
1
2
3
4
5
6
Total Loans payable in Less than 1 year (Enter Total amount on Line 27 of Balance sheet) -

Annex 9 - Tax Payable

Seq. Num b. Type Tax Payable C. Amount
1 Employee income Tax payable
2 Business income Tax payable
3 Rental Tax payable
4 Withholding Tax payable
5 VAT payable
6 Turnover Tax payable
7 Excise Tax Payable
8 Dividend Tax payable
9 Other Tax Payable
10 Total(Enter Total amount on Line 28 of Balance Sheet) -

Annex 10 - Other Current Liabilities

Seq. Num b. Account Description C. Amount
1
2
3

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 4
5
6
7
8 Total(Enter Total amount on Line 29 of Balance Sheet) -

Annex 11 - Loans payable in more than 1 year

Seq. Num b.Name of Loan provider(financed by) C. Amount
1
2
3
4
5
6
7
8 Total(Enter Total amount on Line 31 of Balance Sheet) -

Annex 12 - Loans payable in more than 1 year

Seq. Num b.Name of Loan provider(financed by) C. Amount
1
2
3
4
5
6
7
8 Total(Enter Total amount on Line 31 of Balance Sheet) -

Taxpayer Certefication
I declare that the above declaration and all information provided here with is correct and complete. I understand that any
misrepresentations is punishable as per the law and the penal code.
Taxpayer/Authorized Agent: Taxpayer/Authorized Agent:
Name: ____________________________ Name: ____________________________
Signature:__________________________ seal Signature:__________________________
Date: ______________________________ Date: ______________________________

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 Federal Democratic Republic of Ethiopia Business Income Tax Declaration
Ministry of Revenue Federal Inland (With Annex)
Revenue Authority
schedule C Business Income Tax
Mining Income Tax
Section 1-Tax payer Information
8.For the year of Pag 1 of _________
3.Tax payer ____________________
Identification
1.Tax payer's Name(Company Name or Name,Father's Name,GrandFather's Name Number(TIN)
____________________________________________________________________________________ ________________ Document Number(official use only)
2a.Region:___________________________ 2b. Zone/K.ketema:-____________________________ 4.Tax Acount
2C. Woreda 2d.kebele/farmer association 2e. House Number ________________
____________________ ________________________ ____________________ 5.Tax Center
6. Telephone Number 7. Fax Number
_____________________ or______________________________ _____________________________
_____________________ or ____________________________

Income and Cost of Goods Sold

1 Business income or Sales/Turnover(Transfer from Annex 1) 5 -
2 None Operating and other Income 10
3 Total Gross Income (Add lines 1 and 2 and Enter Total at Right) 15 -
4 Cost of Goods Sold/ Direct Cost of Services (Transfer Total from Annex 2) 20 -
5 Gross Profit/Loss (Line 3 Minus Line 4) 25 -
Business Expenses
6 Selling and Distribution Expenses(Transfer from Annex 4) 30 -
7 Salary and Wages 35
8 Other Employee Benefits 40
9 Repair and Maintenance Expenses 45
10 Investment/Participation Expenses 50
11 Foreign Technical Service Expenses 55
12 Utilities Expenses 60
13 Travel Expenses 65
14 Rent Expenses 70
15 Interest Expenses 75
16 Depreciation Expenses 80
17 Amortization Expenses 85
18 Deductible Taxes and Licenses frees 90
19 Deductible Donations and Gifts 95
20 Other Deductions(Transfer Total from Annex 5) 100 -
21 Total Expenses(Add lines 6 through 20 and enter total) 105 -
Calculation of Tax Due
22 Net Income/Loss (Line 5 minus Line 21) 110 -
23 Loss Carry Forwarded from previous period(from Annex 6)(refer the instruction) 115 -
24 Carry Backward Loss Adjustment(Attach supporting Document and refer instruction) 120
25 Taxable Business Income(Line 22 Minus (Line 23 plus 24) 125 -
26 Income Tax Payable(Line 25 *Schedule C Tax Rate) 130 -
27 Foreign Tax Credit(Transfer Total from Annex 7) 135 -
28 Withholding Tax(Attach schedule on import and payments) 340
29 Total credits(Line 27 plus Line 28) 145 -
30 Net Tax Due/Refundaable Amount(Subtract Line 26 from Line 29) 150 -

Tax payer or Authorized Agent For Tax office use only Seal of Tax office
Name:-__________________________________ Seal Name:- ____________________________
Signature:-_______________________________ Signature:-____________________________
Date:-___________________________________ Date:- ____________________________

Ministry of Revenue

Ministry of Revenue 8 of 10 FIRA Form 1301(1/2006)

 Annex 1 - Business Income or Sales/Turnover
a. S/N b. Type of Income C. Amount
1 Local Sales
2 Export Sales
3 Service Income
4 Total(Add Line 1 through 3 -Enter total amount on Line 1 of Tax Declaration) -

Annex 2 - Cost of Goods Sold/Direct cost of Service

a. S/N b. Type of Income C. Amount
1 Beginning Invetory
2 Cost of purchase/cost of finished Goods/Direct cost of Services
( from line 19 of Annex 3 Below)

3 Goods Available for sales Direct cost of service(Add line 1 and 2) -

4 Ending Invertory
Cost of Goods Sold/direct cost of services(Line 3 minus Line 4)- Enter this amount
5
on Line 4 of Tax Declaration -

Annex 3 - Cost of Finished Goods/Direct cost of Service

a. S/N b. Type of Income C. Amount
1 Beginning work in process
2 Cost of Direct Material
3 Cost of Direct Labor
4 Cost of Indirect Materials
5 Cost of Indirect Labor
6 Power
7 Depreciation Expenses
8 Supplies
9 Employee Benefits
10 Repair and Maintenance Expenses
11 Insurance Expenses
12 Airfare,Transport and Freight Expenses
13 Accommodation and Hotel Expenses
14 Excise Tax
15 Other Expenses
16 Total Over Head Costs(Add Line 4 throgh 15) -
17 Total Cost of Manufacturing/Direct cost of Services(Add line 1,2,3 and 16) -
18 Ending Work in process
Total Cost of Finished Goods/Direct Cost of Services(Line 17 Minus Line 18 -
19 Enter the amount on Line 3 Annex 2 Above

Annex 4 - Selling & Distribution Expenses

a. S/N b. Type of Income C. Amount
1 Salaries,wages and Related Benefits
2 Repairs and maintenance Expenses
3 fule and lubricants Expenses
4 Travel , Accomodation and Transport Expenses
5 Advertiment Expenses
6 Commission Expenses
7 Insurance Expenses
8 Clearing ,Transit & other Related Expenses
9 Other Expenses
10 Total(Add Line 1 through 9- Enter Total amount on Line 6 of the Tax Declaration -

Ministry of Revenue 9 of 10 FIRA Form 1301(1/2006)

 Annex 5 - Other Deductions
a. S/N b. Acount Description C. Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15 -

Annex 6 - Loss Carry Forward from previous Tax peiod

a. year b. profit/Loss Amount C. Loss Apllied D.Loss Carry Forward e. Remark
1
2
3
4
5
6 Transfer Total of Column "D"to Line 23 of Tax Declaration -

Annex 7 - Foreign Tax Credit

D. Amount of Foreign
a. S/N b. Name of Foreign Country C. Foreign Income Tax paid /Payable e. Remark
1
2
3
4
5
6
Total(Enter Total amount on Line 28 of Tax Declaration) - -

Section 4-Attachements
- Balance Sheet
- Profit and Loss Statement
- Source & Application of Fund
- Fixe Asset & Depriation Schedule
- General & Administration Expenses
- Selling & Distribution Expenses
- Provision & Reserves
- Gross Profit & the manner in which it is computed
-Statement of Goods Manufactured and /or Cost of Goods Sold

Section 5 -Taxpayer Certefication

I declare that the above declaration and all information provided here with is correct and complete. I understand that any
misrepresentations is punishable as per the law and the penal code.

Taxpayer/Authorized Agent Authorized Tax officer

Name: ____________________________ Name: ____________________________
Signature:__________________________ seal Signature:__________________________
Date: ______________________________ Date: ______________________________

Ministry of Revenue 10 of 10 FIRA Form 1301(1/2006)