QUARTERLY STATEMENT OF TAX AND CONTRIBUTIONS

IS FOR INDIVIDUAL SMALL BUSSINESES UNIREF

[1] Period of declaration: Q4 2021 MFA2F50060075013

[3] Fiscal number: 602646385 [3a] Personal number:
[4] Business/individual name: ISLAMSKA ZAJEDNICA-REGIJA GORA

[5]Business/individual address: DRAGASH KOSOVA

[6] Name of contact person: MIRALEM MISINI Telephone: 044629851
[7] Mark with ‘X’ in the appropriate box if not filing for the first time during this period
Addition Correction Only payment

TAX
Tax payment part Income Tax

[8] Gross income for the quarter by: retail, manufacturing, trade, transport, agriculture and other
commercial activities........................................................................................................................................................[8]
[9] Gross income for the quarter by: services, professional activities, craft, entertainment and
similar.....................................................................................................................................................................................[9]

[10] Tax on quarterly income [10]=[8] x 3%..................................................................................................................................................[10]

[11] Tax on quarterly income [11]=[9] x 9%..................................................................................................................................................[11]

[12] Amount for payment in this statement [10]+[11] , but not less than 37.50 euro...................................................................[12]

BANK PART
Signature and Stamp Account number: 1000420070000373 [13] Amount of Tax paid

Text:
€
Date: ___/____/___________
UNIREF

MFAKP5006007502Z
CONTRIBUTION
Part of pension contributions Income Contributions

[16] Gross income for the quarter [16]=[8]+[9]............................................................................................[16]

[19] Pension Contributions: put 1/3rd of the sum from the box [12] (max. =box [12]; min. 30% of the minimum wage of Kosovo)...[19]

[20] Amount for payment from column [19]...............................................................................................................................................[20]

[21] I declare that reporter facts in this Tax Statement are true.
Name/Last name/Signature/ Stamp
(______________________________________) Data:

BANK PART
Signature and Stamp Account number: 1000430110000214
[22] Amount of paid contribution
Text:
€
Date: ___/____/___________
Form No.IL-E6-; Revised 15.09.2012
 Instructions for completing the form for Quarterly Statement of Tax and
Contributions for Individual Small Businesses

Box [1] Enter tax period to which the statement is filed, for example, Q3-2012
(January, February, March)=TM1, (April, May, June)=TM2, (July, August, September)=TM3, (October, November, December)=TM4

Box [2] UNIREF Serial number will be pre-printed so do not tick the box [2]
Box [3] Enter Fiscal number, for example: 6000XXXXX
Box [3a.] Enter Personal number, for example: 1234573789
Box [4] Enter the name of individual business, for example, ‘Barber- Te Blerimi’’
Box [5] Enter the address of the individual business, for example: ‘Rruga e Barrikadave’ No-87, Gjakova, as well the
business phone number
Box [6] Enter contact person name and phone number of this person
Box [7] In box [7], if you are not filing this statement for the first time for that quarter, you can tick with „X“in one of three
boxes:
Addition - means additional statement in the same quarter.
Correction- means when you want to change the data reported earlier for that quarter.
Only payment - means that you want to make additional payment without changing any of the previous data.
that are reported for the same quarter.

Tax Payment section

Box [8] Enter gross income for the quarter of retail sales, manufacturing, trade, transport, agriculture and other
commercial activities
Box [9] Enter gross income for the quarter from services, professional activities, craft, entertainment and similar
Box [10] Enter 3%, of the amount from Box [8]
Box [11] Enter 9 % of the amount from Box [9]
Box [12] Enter the amount of tax to be paid with this statement, [12] = [10] + [11], but not less than 37.5 Euros
Box [13] Bank official will place the amount of tax paid, so do not write in this box
Box [14] UNIREF serial number of this statement will be pre-printed, so do not write in this box [14]

Pension Contribution section

Box [16] Enter gross income for the quarter [16] = [8] + [9]
Box [19] Enter 1/3 of the amount Box [12] (max.= Box [12] but not less than 30% of the minimal wage in Kosovo). For the
age up to 35, minimal wage is 130€, so 130€x30% =39€, whole for the age over 35, minimal wage is 170€, so 170
€ x 30% = 51€.
Box [20] Enter the amount of contribution to be paid with this statement
Box [21] Statement must be signed and dated by the individual or a person authorized by him and to be delivered to
the bank until the 15-th of the month after completion of a calendar quarter.
Box [22] Bank official will place the amount of pension contributions paid, so do not write in this box.