VALUE-ADDED

MINISTRY OF REVENUES
TAX(VAT)

Section 1 - Taxpayer Information

Taxpayer's Name: TIN: Tax Period:

M Two A Custom Clearing And Trading 0002181096 Sep, 2024

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

House No.: 1115/57 28503

Kebele: WOREDA 05 Po.Box: Tax Centre:
Woreda: NO WOREDA-145 Document Number: 1840845470010
Zone/Sub-City: AKAKI KALITI MOR-WEST ADDIS
Document Date: 20/10/2024
Region: ADDIS ABABA Ethiopia ABABA SMALL TAX
Telephone Number: Fax Number:
PAYERS BRANCH
Submission Number: 35714960002
251911515149 Submission Date: 20/10/2024

Section 2 - Electronic Tax Declaration

TAXABLE SALES/ SUPPLIES 5 170,000.00

VAT ON TAXABLE SALES/ SUPPLIES 10 25,500.00

ZERO-RATED SALES/ SUPPLIES 15 0.00

TAX-EXEMPT SALES/ SUPPLIES 20 0.00

SERVICES OR SUPPLIES SUBJECT TO REVERSE TAXATION 25 0.00

VAT ON SERVICES OR SUPPLIES SUBJECT TO REVERSE TAXATION 30 0.00

TAX ADJUSTMENT WITH DEBIT NOTE 35 0.00

VAT ON TAX ADJUSTMENT WITH DEBIT NOTE 40 0.00

TAX ADJUSTMENT WITH CREDIT NOTE 45 0.00

VAT ON TAX ADJUSTMENT WITH CREDIT NOTE 50 0.00

TOTAL SALES/ SUPPLIES (5+15+20+25+35)-45) 55 170,000.00

VAT ON TOTAL SALES/ SUPPLIES(10+30+40)-50) 60 25,500.00

LOCAL PURCHASE CAPITAL ASSETS 65 0.00

VAT ON LOCAL PURCHASE CAPITAL ASSETS 70 0.00

IMPORTED CAPITAL ASSETS 75 0.00

VAT ON IMPORTED CAPITAL ASSETS 80 0.00

PURCHASE WITH NO VAT OR UNCLAIMED INPUTS 85 0.00

TOTAL CAPITAL ASSETS (65+75+85) 90 0.00

VAT ON TOTAL ASSETS 95 0.00

LOCAL PURCHASE INPUTS 100 43,176.58

VAT ON LOCAL PURCHASE INPUTS 105 6,476.49

IMPORTED INPUTS 110 0.00

VAT ON IMPORTED INPUTS 115 0.00

GENERAL EXPENSE INPUTS PURCHASE 120 0.00

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VALUE-ADDED
MINISTRY OF REVENUES
TAX(VAT)

VAT ON GENERAL EXPENSE INPUTS 125 0.00

PURCHASE WITH NO VAT OR UNCLAIMED INPUTS 130 18,925.00

DEDUCTIBLE ON VAT REVERSE TAXATION 135 0.00

VAT ON DEDUCTIBLE ON VAT REVERSE TAXATION 140 0.00

TAX ADJUSTMENTS WITH DEBIT NOTE 145 0.00

VAT ON TAX ADJUSTMENTS WITH DEBIT NOTE 150 0.00

TAX ADJUSTMENTS WITH CREDIT NOTE 155 0.00

VAT ON TAX ADJUSTMENTS WITH CREDIT NOTE 160 0.00

TOTAL NON CAPITAL INPUTS ((100+110+120+130+135+145)-155) 165 62,101.58

VAT ON TOTAL INPUTS (105+115+125+140+150)-160 170 6,476.49

VAT ON GOVERNMENT VOUCHER 175 0.00

OTHER CREDITS FOR THE MONTH(PAYMENTS, SALES TAX,GOODS ON HAND) 180 0.00

VAT DUE FOR THE MONTH (BEFORE PREVIOUS MONTH CREDIT) 185 19,023.51

VAT CREDIT FOR THE MONTH (BEFORE PREVIOUS MONTH CREDIT) 190 0.00

CREDIT CARRIED FORWARD FROM PREVIOUS MONTH 195 0.00

Refund Given for Excess Credit 196 0.00

Refund Interest Adjustment 197 0.00

AMOUNT TO BE PAID 200 19,023.51

VAT CREDIT AVAILABLE FOR CREDIT CARRY FORWARD 205 0.00

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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