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On/t·r-AY �t-t\'e �'l°ht-oJ><e &Tilt\.


fn.1"\>'�f 'lOJPf'i" '1-9D�h 'lhilAlTJ1
The Federal Democratic Republic of Ethiopia
Ethiopian Revenues and Customs Authority

f+"1."'l& htb:,.. ;J-hil "'lltmtf


VALUE ADDED TAX DECLARATlON

\'MJ!' c/?'l'C ---------


Document No.

h�A 1 \1"1-0C h4-� ao(\f I Part 1 Taxpayer ldentification

1.1 \'''HlC h4-� ll'I°


I I
Name of Taxpayer
I I
1.2 \'"111C h4-,e UD(\f c/?'l'C / Taxpayer Identification Number (TIN)
I I
1.3 \'+m,"'lt, hl'bt ;rho c/?'l'C / VAT Registration Number
I I
\' UD;J(lt CDC 2013 �.'I° I For the month of


hctA 2 \1-f-Q;l."'16 ht'l.-l- ;J-ht'l t'll\.-l- / Part 2 Computation of Value Added Tax

2.1 fltW CDC \'D'l.ftiarc/?t hl\.l\ (✓) 'l°Aht YJ!'C'r I If the return for the period is NIL (✓) Here

2.2 \19°C-l- (Dem,:,. ;J-ht'l t'll\.-l- / Computation of Output Tax

;rhlt \'D'l.h.{.A<Vfar 6:J>�f h'i 11..e


Clh:J><; OMA"lflot 7if6J;b UD;r(l{l
\'MA"lflo.Y.f n:Pcnt /7if"};b 'f'.9/ f(\(lt v+m,"'lt nl'bt :rho
5 10
Value of Taxable Goods and VAT on Taxable Goods and
Supplies Supplier [15% of line 5]
\'H.C' '1°'1l� Yt\.:far 6:J>�f h'i
n1A"lflo.Y.f 7if6J;b 'P.9 15
Value of Zero-Rated Goods
hrm,"'lt, hl'bt ;rho �'l \'If� 7if6J;b/
n'PCCl.Y.f 'P.9 20
Value of Exempt Supplies/Sales
v;rho 'l°Vl:,. r1,-. n:Pcn.Y.f cp,9
25
Value of Remitted Supplies
m:Pt\.t\. h:Pcnt/7if6J;b \'CD�rh+.e \'rm,"'lt, hl'bt ;rho
Total Supplies/Sales 30 VAT Charge for this period 35
[lines 5+15+20+25] [=linel0]
2.3 Mil'¼-r ;l-hil ill\.T I Computation oflnput Tax

Oh7C (l}<O'l' "7lr9':f "1-<l°rr t\f, Y-f'ht.l'\


Yh7C (l}<O'l' "7lr9':f "1-<l°rr cp,'J Yrm"'lt. hn,r .+ho
50 55
Value ofLocal Purchases Input VAT on Local Purchases Input
[15% ofline 50]
{'(l}<");b U7C "llf' "1-<l°rr 'P,'J t\f, Y-f'ht.l'\
{'(l}<");b U7C "llf' "1-<lO,r 'P,'J Yrm"'lt. hn,r .+ho
60 65
Value ofImported Inputs VAT on Imported Inputs
[15% ofline 60]
Oh:J>'i' Oh7A"7f\o-r 71.P"V' t\f, OD_r(Hl
YAi Ai (l}<i;i;i_9':f, "1-<l°rr 'P,'J .rnot Yrm"'lt. hn,r .+ho
70 75
Value ofGeneral Expense Inputs VAT on General Expenses Inputs
[15% ofline 70]
Yrm"'lt. hn,r .+ho .PArht.not
"1lf' <Df-'l" ,f-ODt\11 Y"'lf,mYcpCVf(l}<
"1-<l°rr er., 80
Value ofPurchases with no VAT or
Unclaimed Inputs
m'Pt\t\ "],(10,r cp,')
Value ofTotal Inputs 85
[lines 50+60+70+80]
Y<D<r 1-h4-f- Yrm"'lt. h!\,r .+ho
Value of Taxable Inputs 90 Total Inputs Tax Credit 95
[lines 50+60+70] [lines 55+65+75]
Y<D<r YrflJt. 1-m"'lt. h!\,r .+ho 1-h4-f-
110
Net VAT Due for Month (before other credits) [line 35-95]
Y<D<r ,t-ODt\11 Yrm"'lt. hn,r .+ho
115
VAT Credit for Month (before other credits) [line 95-35]
t\,f\o:f, O<D<r (l}<O'l' Yotz..rl'lfr (hEj;f : 71.P"V' .rho : Oh� YI'\ 6:J>)
120
Other Credit for Month (Payments, Sales Tax, Goods On Hand)
lil'\t_(I}< <DC Yffl 1lA6fiJ. hEj;f
125
Credit Carried forward from Previous Month
m'Pt\t\ 1-h4-f-
150
Amount to be Paid [110-120-125]
nrh.+i mc Yotz..+1'1-<l ,t-ODt\7i 'l«'l-<l
160
Credits Available for carry forward [115+120+125]

h(i:A 3 \>-rhhh�-r U'/l.;J'l61i/. I Part 3 Commitment

mw 'P?. t\f, Yl'lt.<rr trt\-'l" ODl�9':f- -rhhA'i' Yra:J.t\ ODlf'fl hl,'J"]fl}(\rr:: I here by certify that the information given in this form is
true and complete.
' '

l---------���:.:_________;
I"' - - - - - - - - - - - - - - - - - - - - - - - - - - - - ,

&,C"'l I Signature <#>'}/Date

h(i:A 4 hTa.U'f& h(b-r ;J-hil UD'JD&f l'l'IA'?�-r il;r I Part 4 For VAT Department Use On1y

fl,'J7m(I}< I Checked By

YrP&,,f-f(I}< ii'!" I Officer's Name &,C"'l I Signature <#>'}/Date

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