GOVERNMENT OF THE PEOPLE'S REPUBLIC OF BANGLADESH

NATIONAL BOARD OF REVENUE

VALUE ADDED TAX RETURN

[See rule 47(1)]
Mushak-9.1
[Please read the instruction before filling up this form]
PART - 1: TAXPAYER'S INFORMATION
1. BIN 001125057-0401

2. Name of Taxpayer THE IBN SINA TRUST

3. Address of Taxpayer 1/1/B KALLYANPUR,; Mirpur PS; Dhaka - 1216; Bangladesh

4. Type of Ownership Others (TRUST)

5. Economic Activity Services, Imports

PART - 2: RETURN SUBMISSION DATA

1. Tax Period May, 2022
2. Type of Return A) Main/Original Return (Section 64)
[Please select your desired option]
Reason for Amendment

Yes No
3. Any activities in this Tax Period?

[If Selected “No” Please Fill Only the Relevant Part]

4. Date of Submission 13/06/2022

5. Last Amendment Date

 PART - 3: SUPPLY - OUTPUT TAX

Value SD VAT
Nature of Supply Note
(a) (b) (c)

Zero Rated Direct Export 1

Goods/Service Deemed Export 2
Exempted Goods/Service 3
Standard Rated Goods/Service 4
Goods Based on MRP 5

Goods/Service Based on Specific VAT 6

Goods/Service Other than Standard

7 7,43,220.00 37,161.00
Rate
Retail/Wholesale/Trade Based
8
Supply

Total Sales Value & Total Payable Taxes 9 7,43,220.00 37,161.00

PART - 4: PURCHASE - INPUT TAX

Value VAT
Nature of Purchase Note
(a) (b)
Local Purchase 10
Zero Rated Goods/Service
Import 11
Local Purchase 12
Exempted Goods/Service
Import 13 2,20,49,212.81
Local Purchase 14
Standard Rated Goods/Service
Import 15
Goods/Service Local Purchase 16
Other than
Standard Rate Import 17

Goods/Service Based on Specific VAT Local Purchase 18

From Turnover
19
Tax Units
Goods/Service Not Admissible for Credit
From
(Local Purchase)
Unregistered 20
Entities
Goods/Service
Not Admissible for
Credit (Taxpayers
Local Purchase 21
who sell only
Exempted/
Specific VAT and
Goods/Service
Other than
Standard Rate/
Import 22
Credits not taken
within stipulated
time)
Total Input Tax Credit 23 2,20,49,212.81
 PART - 5: INCREASING ADJUSTMENTS (VAT)
Adjustment Details Note VAT Amount
Due to VAT Deducted at Source by the Supply
24 43,20,904.00
Receiver

Payment Not Made Through Banking Channel 25

Issuance of Debit Note 26

Any Other Adjustments 27 36,45,564.00

Total Increasing Adjustment 28 79,66,468.00

PART - 6: DECREASING ADJUSTMENTS (VAT)

Adjustment Details Note VAT Amount
Due to VAT Deducted at Source from the Supplies
29
Delivered
Advance Tax Paid at Import Stage 30 11,02,460.64

Issuance of Credit Note 31

Any Other Adjustments 32

Total Decreasing Adjustment 33 11,02,460.64

 PART - 7: NET TAX CALCULATION
Items Note Amount (Tax)

Net Payable VAT for the Tax Period (Section- 45)

34 69,01,168.36
(9c-23b+28-33)

Net Payable VAT for the Tax Period after Adjustment

with Closing Balance and balance of form 18.6 [34- 35 -32,16,929.60
(52+56)]

Net Payable Supplementary Duty for the Tax Period

36
(Before adjustment with Closing Balance) [9b+38- (39+40)]

Net Payable Supplementary Duty for the Tax Period

after Adjusted with Closing Balance and balance of 37
form 18.6 [36-(53+57)]
Supplementary Duty Against Issuance of Debit Note 38
Supplementary Duty Against Issuance of Credit Note 39
Supplementary Duty Paid on Inputs Against Exports 40

Interest on Overdue VAT (Based on note 35) 41

Interest on Overdue SD (Based on note 37) 42

Fine/Penalty for Non-submission of Return 43
Other Fine/Penalty/Interest 44
Payable Excise Duty 45
Payable Development Surcharge 46
Payable ICT Development Surcharge 47
Payable Health Care Surcharge 48
Payable Environmental Protection Surcharge 49
Net Payable VAT for Treasury Deposit
50 -32,16,929.60
(35+41+43+44)
Net Payable SD for Treasury Deposit (37+42) 51

Closing Balance of Last Tax Period (VAT) 52 1,01,18,097.96

Closing Balance of Last Tax Period (SD) 53

PART - 8: ADJUSTMENT FOR OLD ACCOUNT CURRENT BALANCE

Items Note Amount
Remaining Balance (VAT) from Mushak-18.6, [Rule
54
118(5)]

Remaining Balance (SD) from Mushak-18.6, [Rule

55
118(5)]

Decreasing Adjustment for Note 54 (up to 30% of

56
Note 34)

Decreasing Adjustment for Note 55 (up to 30% of

57
Note 36)
 PART - 9: ACCOUNTS CODE WISE PAYMENT SCHEDULE (TREASURY DEPOSIT)
Items Note Account Code Amount
VAT Deposit for the Current Tax
58 1 / 1133 / 0035 / 0311 79,66,468.00
Period
SD Deposit for the Current Tax Period 59 1 / 1133 / 0035 / 0711
Excise Duty 60 1 / 1133 / 0035 / 0601
Development Surcharge 61 1 / 1103 / 0000 / 2225
ICT Development Surcharge 62 1 / 1103 / 0000 / 2214
Health Care Surcharge 63 1 / 1103 / 0000 / 2212
Environmental Protection Surcharge 64 1 / 1103 / 0000 / 2213

PART - 10: CLOSING BALANCE

Items Note Amount
Closing Balance (VAT) (58-50-67+Not
Approved 65 1,11,83,397.60
Amount of VAT in Refund Module (If any))
Closing Balance (SD) [59-51-68+Not
Approved 66
Amount of SD in Refund Module (If any)]

PART - 11: REFUND

I am interested to get refund of my Closing Balance Yes No

Items Note Amount

Requested Amount
67
for Refund (VAT)

Requested Amount 68
for Refund (SD)

PART - 12: DECLARATION

Name: ABUL KALAM MOHAMMAD SADRUL ISLAM

Designation: Managing Director

Mobile Number: 01716452465

National ID/Passport Number: 19552691649420615
Email: ist@ibnsinatrust.com
I hereby declare that all information provided in this Return Form are complete, true & accurate. In case
✔ of any untrue/incomplete statement, I may be subjected to penal action under The Value Added Tax and
Supplementary Duty Act, 2012 or any other applicable Act prevailing at present.

Signature
[Not required for electronic submission]
 Sub-form of Part - 3.7: Goods/Service Based on Minimum Value Addition/Other Rates

Goods / Service
Goods / Service Value* SD VAT
Commercial Goods / Service Name Notes
Code* (a) (b) (c)
Description*

0 0 0

Restaurant: not air conditioned

Canteen VAT S001.20 4,86,620.00 0 24,331.00 Hospital
without bar &floor show
Restaurant: not air conditioned
Canteen VAT S001.20 2,56,600.00 0 12,830.00 MCH
without bar &floor show

TOTAL 7,43,220.00 0 37,161.00

Sub-form of Part - 4.13: Exempted Goods/Service - Import

BoE
Office
Code Goods /
Goods / Goods /
BoE BoE (Custom BoE Item CPC Service Assessable Base Value of SD* VAT*
Data Source * Service Service AT Notes
Number Date s No Code Commercial Value VAT* (a) (b) (c)
Code* Name
House / Description*
Station
Code)
BoE Data 426488 30/05/2022 101 3 4000 TABLE 9403.90.00 Parts Of Furniture 43,987.07 76,537.50 12,756.25 11,480.63 3,826.88 MCH-09/06

4D
ULTRASOUND Ultrasonic
Hospital
BoE Data 383024 16/05/2022 101 1 4000 MACHINE 9018.12.00 Scanning 47,01,798.98 47,48,816.97 0 0 2,37,440.85
23-05
MODEL: Apparatus
VOLUSON E8''
Parts And
Accessories,
Nes, For
BoE Data 426488 30/05/2022 101 2 4000 ACC 9033.00.00 3,95,883.62 4,35,471.98 0 65,320.80 21,773.60 MCH-09/06
Machines,
Appliances, Etc,
Of Chapter 90
Processing units
CT other than those
WORKSTATIO of subheading
BoE Data 426488 30/05/2022 101 1 4000 8471.50.00 32,99,030.18 34,63,981.69 0 0 1,73,199.08 MCH-09/06
N M : SYNGO. 8471.41 or
VIA 8471.49, whether
or
Parts And
Accessories,
Mirpur-
Nes, For
BoE Data 383749 16/05/2022 101 2 4000 ACC 9033.00.00 97,534.21 1,07,287.63 0 16,093.14 5,364.38 Malibagh-02
Machines,
/06
Appliances, Etc,
Of Chapter 90

Page 6 of 13
 BoE
Office
Code Goods /
Goods / Goods /
BoE BoE (Custom BoE Item CPC Service Assessable Base Value of SD* VAT*
Data Source * Service Service AT Notes
Number Date s No Code Commercial Value VAT* (a) (b) (c)
Code* Name
House / Description*
Station
Code)
MEDICAL
EQUIPMENT: Other Electro- Mirpur-
BoE Data 383749 16/05/2022 101 1 4000 VIDEO 9018.19.90 Diagnostic 20,61,222.96 20,81,835.19 0 0 1,04,091.76 Malibagh-02
LARYNGOSCO Apparatus Nes /06
PE
Parts And
Accessories,
Nes, For
BoE Data 375667 12/05/2022 101 2 4000 ACC 9033.00.00 3,25,114.03 3,57,625.43 0 53,643.81 17,881.27 D-Lab-19/05
Machines,
Appliances, Etc,
Of Chapter 90
VIDEO Other Electro-
BoE Data 375667 12/05/2022 101 1 4000 ENDOSCOPE 9018.19.90 Diagnostic 1,05,21,665.92 1,06,26,882.58 0 0 5,31,344.13 D-Lab-19/05
SYSTEM Apparatus Nes
Optical media:
Incorporating Hospital
BoE Data 383024 16/05/2022 101 3 4000 CD 8523.49.29 4,398.28 5,629.80 0 844.47 281.49
computer 23-05
software
Parts And
Accessories,
Nes, For Hospital
BoE Data 383024 16/05/2022 101 2 4000 ACC 9033.00.00 1,31,949.13 1,45,144.04 0 21,771.61 7,257.20
Machines, 23-05
Appliances, Etc,
Of Chapter 90

TOTAL 2,20,49,212.81 12,756.25 1,69,154.

Sub-form of Part - 5.24: Due to VAT Deducted at Source by the Supply Receiver

VAT VAT Tax

Invoice Tax
Deduction at Deduction at Deposited Tax
Supplier’s Supplier’s Supplier’s Deducted No./ Invoice/Bill Deposited
Value* Source, Source, Serial no. Deposited Notes
BIN Name* Address* VAT* Challan/Bill Date Account
Certificate Certificate of Book Date
No. etc. Code
No. Date Transfer

OTHER
DHAKA 47,94,363 3,57,245.00
SUPPLIER
Globex
00025544 Marketing
DHAKA 3,520.00 264.00
4-0 Company
Ltd.
00123120 Genetic
DHAKA 17,79,800 1,33,485.00
5-0 Trading.
Resources -
DHAKA 5,19,067.0 38,930.00
21

Page 7 of 13
 VAT VAT Tax
Invoice Tax
Deduction at Deduction at Deposited Tax
Supplier’s Supplier’s Supplier’s Deducted No./ Invoice/Bill Deposited
Value* Source, Source, Serial no. Deposited Notes
BIN Name* Address* VAT* Challan/Bill Date Account
Certificate Certificate of Book Date
No. etc. Code
No. Date Transfer

GE
00027111 Healthcare
DHAKA 1,85,813.0 13,936.00
1-0 Bangladesh
Ltd.
Fann
00233039
Industries DHAKA 15,613.00 1,171.00
7-0
Ltd
Diganta
00202021
Printing & DHAKA 37,72,826 2,82,962.00
1-0
Packaging
00028312
Diamed DHAKA 2,22,040.0 16,653.00
4-0
00197603 Biotech
DHAKA 27,24,241 2,04,318.00
1-0 Services
Bio-Trade
00192953
Internation DHAKA 2,06,23,38 15,46,754.0
9-0
al
Bio
00100725 Resource
DHAKA 10,200.00 765.00
7-0 Internation
al
Siemens
00025702
Healthcare Dhaka 15,77,693 1,18,327.00
8-0
Limited
BDCOM
00000121
Online DHAKA 6,960.00 522.00
6-0
Limited
00112505 Anifco
DHAKA 85,720.00 6,429.00
7-0 Healthcare
ADN
00033362
Telecom DHAKA 40,586.00 3,044.00
1-0
Ltd.
GE
Healthcare
DHAKA 12,41,827 93,137.00
Bangladesh
Ltd.

Page 8 of 13
 VAT VAT Tax
Invoice Tax
Deduction at Deduction at Deposited Tax
Supplier’s Supplier’s Supplier’s Deducted No./ Invoice/Bill Deposited
Value* Source, Source, Serial no. Deposited Notes
BIN Name* Address* VAT* Challan/Bill Date Account
Certificate Certificate of Book Date
No. etc. Code
No. Date Transfer

00285571 ABC
DHAKA 10,74,479 80,586.00
2-0 Corporation
Taiwan-
Bangla
Medical DHAKA 13,67,813 1,02,586.00
Equipment
Co.Ltd.
Siemens
Healthcare DHAKA 23,02,734 1,72,705.00
Ltd.
Ibn Sina
DHAKA 26,10,801 1,95,810.00
Trust
00017397 Unimed
Dhaka 1,81,934.0 13,645.00
5-0 Limited
00200960 Unihealth
Dhaka 63,03,225 4,72,742.00
7-0 Limited.
RACE
00070484
ONLINE Dhaka 5,080.00 381.00
4-0
LIMITED
Telnet
00038242
Communic Dhaka 20,920.00 1,569.00
1-0
ation Ltd.
Overseas
00048291 Marketing
Dhaka 11,27,921 84,594.00
6-0 Corporatio
n (Pvt.) Ltd.
Nissho
Koeki
00027453
Tissue Dhaka 4,26,653.0 31,999.00
8-0
Papers Co.
Ltd.
Nipro JMI
00076116
Marketing Dhaka 1,00,120.0 7,509.00
5-0
Ltd

Page 9 of 13
 VAT VAT Tax
Invoice Tax
Deduction at Deduction at Deposited Tax
Supplier’s Supplier’s Supplier’s Deducted No./ Invoice/Bill Deposited
Value* Source, Source, Serial no. Deposited Notes
BIN Name* Address* VAT* Challan/Bill Date Account
Certificate Certificate of Book Date
No. etc. Code
No. Date Transfer

Meghna
00008893 Pulp &
Dhaka 2,34,200.0 17,565.00
6-0 Paper Mills
Ltd.
Meditech
00185875
Imaging Dhaka 38,52,184 2,88,914.00
2-0
Ltd.
Medi
00078367
Graphic DHAKA 4,31,426.0 32,357.00
7-0
Trading Ltd.

TOTAL 5,76,43,14 43,20,904.0

Sub-form of Part - 5.27: Any Other Adjustments

Challan Number Date Amount VAT* Notes*

T1 08/06/2022 3,29,320.00 49,398.00 Office rent - Trust

T-34 08/06/2022 25,17,727.00 3,77,659.00 Office rent - Uttara

T-2 07/06/2022 8,69,333.00 1,30,400.00 Office rent - Malibagh

2122-00059207591 05/06/2022 4,10,500.00 61,575.00 Office rent - Bogura

553 05/06/2022 1,40,473.00 21,071.00 Office rent - Jashore

T-18 07/06/2022 3,35,747.00 50,362.00 Office rent - Savar

116 08/06/2022 12,00,000.00 1,80,000.00 Office rent - hattogram

105 12/06/2022 3,96,000.00 59,400.00 Office rent - Mirpur

T1 05/06/2022 11,51,247.00 1,72,687.00 Office rent - D-Lab

Page 10 of 13
 Challan Number Date Amount VAT* Notes*

Office rent - Hospital,

1,36,79,460.00 20,51,919.00
Dhanmondi

T2 09/06/2022 9,79,800.00 1,46,970.00 Office rent - IMIC

T-1 09/06/2022 3,11,400.00 46,710.00 Office rent - ISMCH

T-12 09/06/2022 2,20,000.00 33,000.00 Office rent - Nursing

2122-0006196858 12/06/2022 6,18,007.00 92,701.00 Office rent - Doyagonj

T-23 06/06/2022 9,97,787.00 1,49,668.00 Office rent - Badda

T-99 06/06/2022 1,46,960.00 22,044.00 Office rent - MCU

TOTAL 2,43,03,761.00 36,45,564.00

Sub-form of Part - 8.58: VAT Deposit for The Tax Period

Treasury Challan
Tax Deposited Account
Number/ Token Bank/ CGA* Branch/CAFO/DCA* Date* Amount* Notes
Code
Number*
T-2 Sonali Bank Ltd. Hazaribagh 09/06/2022 1 / 1133 / 0035 / 0311 1,46,970.00 Rent-IMIC

T-22 Sonali Bank Ltd. Badda 06/06/2022 1 / 1133 / 0035 / 0311 3,13,454.00 Badda Expesns
Krishi Bazar
T-1 Sonali Bank Ltd. 08/06/2022 1 / 1133 / 0035 / 0311 49,398.00 Rent-Trust
Mohammadpur
T-99 Sonali Bank Ltd. Badda 06/06/2022 1 / 1133 / 0035 / 0311 22,044.00 MCU-Rent

VDS on expenditure
T-40 Sonali Bank Ltd. Badda 06/06/2022 1 / 1133 / 0035 / 0311 30,425.00
MCU

T-33 Sonali Bank Ltd. Custom House 08/06/2022 1 / 1133 / 0035 / 0311 5,96,466.00 Expenditur-Uttara

VDS on Office Rent

T-34 Sonali Bank Ltd. Custom House 08/06/2022 1 / 1133 / 0035 / 0311 3,77,659.00
Uttara
VDS on Expenditure
T-1 Sonali Bank Ltd. Malibagh 07/06/2022 1 / 1133 / 0035 / 0311 1,97,230.00
Malibagh
VDS on Office Rent
T-2 Sonali Bank Ltd. Malibagh 07/06/2022 1 / 1133 / 0035 / 0311 1,30,400.00
Malibagh

Page 11 of 13
 Treasury Challan
Tax Deposited Account
Number/ Token Bank/ CGA* Branch/CAFO/DCA* Date* Amount* Notes
Code
Number*
Islami Bank
2122-00059207591 Bogra 05/06/2022 1 / 1133 / 0035 / 0311 61,575.00 Rent- Bogura
Bangldesh Ltd.
Islami Bank
2122-00059190131 Bogra 05/06/2022 1 / 1133 / 0035 / 0311 2,73,542.00 Expenses-Bogura
Bangldesh Ltd.
Expenses-Medical
T-3 Sonali Bank Ltd. Kalyan Pur 09/06/2022 1 / 1133 / 0035 / 0311 10,923.00
College

552 Sonali Bank Ltd. Jessore Corporate 05/06/2022 1 / 1133 / 0035 / 0311 2,31,441.00 Expen-Jesshore

553 Sonali Bank Ltd. Jessore Corporate 05/06/2022 1 / 1133 / 0035 / 0311 21,071.00 Rent-Jesshore
Krishi Bazar
T-2 Sonali Bank Ltd. 08/06/2022 1 / 1133 / 0035 / 0311 28,248.00 Expenditure-Trust
Mohammadpur
T-17 Sonali Bank Ltd. Savar 07/06/2022 1 / 1133 / 0035 / 0311 1,28,381.00 Expens-Savar

T-18 Sonali Bank Ltd. Savar 07/06/2022 1 / 1133 / 0035 / 0311 50,362.00 Rent-Savar

House Rent
116 Sonali Bank Ltd. Panchlaish 08/06/2022 1 / 1133 / 0035 / 0311 1,80,000.00
Chattogram
Vds on Expenditure
115 Sonali Bank Ltd. Panchlaish 08/06/2022 1 / 1133 / 0035 / 0311 1,56,698.00
Chattogram
Islami Bank Expenditure-
2122-0060945641 Comilla 08/06/2022 1 / 1133 / 0035 / 0311 1,26,965.00
Bangldesh Ltd. Cumilla

105 Sonali Bank Ltd. Kalyan Pur 12/06/2022 1 / 1133 / 0035 / 0311 59,400.00 Mirpur-Rent

97 Sonali Bank Ltd. Kalyan Pur 12/06/2022 1 / 1133 / 0035 / 0311 65,767.00 Mirpur-Expenses

T-2 Sonali Bank Ltd. Kalyan Pur 09/06/2022 1 / 1133 / 0035 / 0311 3,95,619.00 Expense-ISMCH

T1 Sonali Bank Ltd. Hazaribagh 13/06/2022 1 / 1133 / 0035 / 0311 10,90,791.00 Expenditure-D-Lab

T-1 Sonali Bank Ltd. Hazaribagh 05/06/2022 1 / 1133 / 0035 / 0311 1,72,687.00 Rent-Lab

Krishi Bazar VDS on expenditure

T-1 Sonali Bank Ltd. 12/06/2022 1 / 1133 / 0035 / 0311 2,88,451.00
Mohammadpur Hospital,Dhan.
Krishi Bazar House Rent
T-7 Sonali Bank Ltd. 12/06/2022 1 / 1133 / 0035 / 0311 20,51,919.00
Mohammadpur Hospital,Dhan.

T-1 Sonali Bank Ltd. Hazaribagh 09/06/2022 1 / 1133 / 0035 / 0311 59,319.00 Expen-IMIC

T-1 Sonali Bank Ltd. Kalyan Pur 09/06/2022 1 / 1133 / 0035 / 0311 46,710.00 Rent-ISMCH

Page 12 of 13
 Treasury Challan
Tax Deposited Account
Number/ Token Bank/ CGA* Branch/CAFO/DCA* Date* Amount* Notes
Code
Number*
T-13 Sonali Bank Ltd. Kalyan Pur 09/06/2022 1 / 1133 / 0035 / 0311 2,487.00 Expenses-Nursing

T-12 Sonali Bank Ltd. Kalyan Pur 09/06/2022 1 / 1133 / 0035 / 0311 33,000.00 Rent-Nursing
Islami Bank
2122-0006196858 Gandaria 12/06/2022 1 / 1133 / 0035 / 0311 92,701.00 Rent-Doyagonj
Bangldesh Ltd.
Islami Bank
2122-0006199207 Gandaria 12/06/2022 1 / 1133 / 0035 / 0311 3,24,697.00 Expense-Doyagonj
Bangldesh Ltd.
T-23 Sonali Bank Ltd. Badda 06/06/2022 1 / 1133 / 0035 / 0311 1,49,668.00 Badda Rent

TOTAL 79,66,468.00

Page 13 of 13