OAAPHE BLEAR LPHEALE 6TOAN LPF LLAEC The Federal Democratic Republic of Ethiopia Ministry of Revenues PAL &PC/Document Number. 1.1 PING UH? PrePAt: HCHC HPF Tax Period Details Paros $7/Date of filing (LI IO) Praha serene 4err/VAT return type __ 7 /Original erhad/Revised tne /Taxeeriod/ = n/from COIOOIOO) mnvto COIOOIOO 1.2 PANIC HAL TICHC oA /Taxpayer Details Pn geen ecerograncneeer (\ | \) Name of registered Organization or Taxpayer (| | | | \_\_\ PAC he. cPns dC /Taxpayer Identification Number (TIN) (J | "0-0 oMA8 denc(hA) Sub TIN, Ifany (_ ) PTAC Ee erate Nive Sho Pin derc/Vat Registration Nol {| |_| 1.3. PFN Ohl UCC 22% / Details of Tax Agent PTAC -hOCO- AAT ALAT(EHA OA) POE WU Parte LOY HCMC CAPE mre Ifthe return has been prepared by Tex Intermediary (Tax Agent), then please provide the aoe details PMC NEL OHA PIC NEL OAL dec /Agent TIN/, epeqseeans Paha Ona Mune? /CRFF/ Aad hur /If you are a part of any Tax Agent aszociation/Organi tion/ ni AAn@U-P/No- irs \.t/Computation of Output Tax aban mm?/Total amount PPC ora rhd/Output Vat Pha eeUnZan teem/APcor e2 : Fa Value of Taxable Sales /Supplies pI pi} PHC PON CAFO. Tike /APCO? PD 15 Value Of Zero Rated Sales/Supplies * ’ ' hon 7a eu em/ACO 2.9 20 Value Of Tax Exempt Sales/Supplies PH Arce. RE RANA FIP /RAPCO .9 Value Of Services or Supplies subjectto 25 DU }s0 reverse Taxation PHO GHAPANAMT LAT ML NLT I-AA, lao Tax adjustment with debit note for Suppliers pt, PhO PPA hes AS AR PD-AREA, so Tax adjustment with credit note for suppliers ptt cada tieen/adco #2 Total Sales/Supplies 5. co (Line 5415+20+25+35-45) WU Uf ‘eisaion HhoERR eae Ae cee cured amPAd ovm3/Total amount e097 Jha/ Inputs VAT RHIC OT HLA IPE TM I eg Pa Local Purchase of Capital Assets J J J J I Ff J I Poop hic WEI OSPF ame ea | 5 Value of imported Capital Assets hanes hiv Ahn karrhaAN Ne pp room Pere EVTEO-104 72 — |g Value of purchase with no VAT b , > of unclaimed inputs PA PFA OSPF MC PO Value of Total purchase of Capital (90 95 Assets [Line 63475485) : , , ptt, 5.2 HTAA SAU 69 PT 1£/Non-Capital Asset: ‘mbAd o%mn3/Total amount #104 *hd/ Inputs VAT PIG ORT IPE ne PD Value of local purchase of inputs 100) JJ }t05 | pA Pop KIC OPH MC Value of imported inputs fe JA) fA) t AR AR OPT 104A FI General expense inputs purchase _*79) 5 * + SS) J Ceseebeseel! Phare Mur Fh Loran Ne BP -bamnt eILANEHRO- AH PD | | Value of purchase without VAT , : ’ or unclaimed inputs Ono FEN ehPAA Paver AOA ANN 36 aol Deductiable on VAT reverse Taxation 4 : 4 pI hn eT SA e-AMe-#2 -€NE |g] 4150 Tax Adjustment with debit note for buyer J J eeeee: Sha pee hnan hese me ee Anta | ‘160 ‘axAdjustment withCredit note for buyer : : I pt enPaa ern PD Total Inputs Lines ‘165| 170 (100+110+120+130+135+145-155) z u d : ir ze , 175) arc heehdse LH AS, Serban ehaayeté hiv Z+hQ/VAT on government Voucher 1g9| iF 104. ant ROLAAM NEE # NOE 8A 03 Other credit for the Month (Payment, goods on hand) } 5 t 1g5/PO% AMIAe Crate hor hi TEL. \VAT due for the month (line 60-95-170-175-180) 5 . , 190] Pe PraneTs Nie Fha Feet VAT Credit for the month (Line 95+170+175+180-60) + . * 4 195| MALO wc Fie Ae HEP Credit Carried forward from previous month/ > > , : 200| nbn thse ‘Amount to be paid/ (Line 185-195) > : , 205] AMIE, OC PAM Ti toma Credit Available for carry forward (Line 190+195-185) > . : u Penne CUNT OTIC “THE "HIG AE APA HEPC PE HIG NEE OAR HPCE RRLNY HRC? TOS NE (AIO FEIT: COLE FL fire: #9 Witt.) Annex A - Detailed break down of all purchases made (including reciept number, date of sale ,type of goods/services Vat paid, TIN of Supplier e.t.c.) Ua ed ae VAs SCO UL PR AL. Caer OIE HOC RPE AMAT LEIA OUT LIMA: I here by certify that the information given in this form is true and complete. understand that any mis-representation is punishable by law o1y19"/seal ag/Name/_ 4C1/Signature, EWE ae mee PAH LD: 49? ACO LAL OODLE HTC. we Officer Name Signature Employee ID Date eaha emha/Tax Center. ‘Tato Eo