Ministry Of Finance Form Number AR/3

Income And Sales Tax Department

Certificate of withheld Salary, Wages and Tax

Issued in accordance with the provisions of paragraph (f) of Article (12) of the Income Tax Law No. (34) for
the year 2014 and its updates

Employee Information

Employee Name

Name Father Grand Father Last Name / Family

Sufian Yousef Ahmad AlSalem

National Code /
Tax Code Post Box Zip Code
Passport

9861045756

Address Contactable

Work period during of Date To Begin Work End Date

Tax Period
the tax period (Appointment) (Employee Termination)

2019 1 Months 10/06/2019

Amount Amount
Tax Deduction From
Total Salaries
Overall
Dinar Fils Dinar Fils

Salaries And Wages 1680 000 Salaries And Wages 1 000

Salaries And Wages Is Salaries And Wages Is

0 000 0 000
Not The Monthly Not The Monthly

Directors' Remuneration Directors' Remuneration

STB For Service Up To 0 000 STB For Service Up To 0 000

STB For Service From STB For Service From

0 000 0 000
Untill Untill

STB For Service From STB For Service From

0 000 0 000
Until Service Ends Until Service Ends

Exempted Deductions 0 000

Other Amounts 0 000 Other Amounts 0 000

Exempted Amounts
National Contribution 0 000
Deducted From STB

Total 1680 000 Total 1 000

I certify that the information listed above are true, real and uncompromised. and I've withheld payment of income tax described and listed above to the
Department of Income and Sales Tax.
 Company Name OMCO Stamp and
Signature
Of the
Tax Code 129280569 Company

Date: 29/07/2019