Federal Democratic Republic of Ethiopia Pension Contribution Declaration Form The National Regional Government

Ethiopian Revenues & Proclamation No. 715/2011 Bureau of Revenues

Custom Authority (Private Organization Employees Pension Proclamation)

Section 1 – Taxpayer Information

8. Tax Period:

1. Taxpayer Name.(Company Name Your Name ,Father’s Name, Grandfather’s Name 3. Taxpayer Identification Number Page 1 of 1
Month Meskerem Year 2015 E.C
HOE Trading PLC 0078842912

g) Pension
f) Pension Contribution of h) Total Amount of the
c) Employee Name(Name, Father’s Name and d) Start Date of Employment Contribution of Employer _11_% contribution _18_%
a)Seq Num b) Employee TIN Grandfather’s Name) (DD/MM/YY) e) Basic Salary /Birr/ Employee _7_% /Birr/ /Birr/ /Birr/ (f + g )
1 Workinesh Wondu Afework 5,000.00 350.00 550.00 900.00
2 Naser Kemal 5,000.00 350.00 550.00 900.00
3 Mesfin Kasay 5,000.00 350.00 550.00 900.00

Transfer Totals from All

Continuation Sheets to this Line >
Taxpayer name & Seal Total 15,000.00 1,050.00 1,650.00 2,700.00

(line 20) (line 30) (line 40) (line 50)

Taxpayer/Authorized Agent name __________________________________________ Signature ___________________________________ Date _____________ Seal _____________

The National Regional Government Bureau of Revenue (as of /5/2011) OBR Form _____ (1/2011)
 Federal Democratic Republic of Ethiopia

Ethiopian Revenues &

Custom Authority

Section 1 – Taxpayer Inform

1. Taxpayer Name.(Company Name Your Name ,Father’s Name, Grandfather’s Name
HOE Trading PLC
Section 2 – Declaration De
c) Employee Name(Name, Father’s Name and
a)Seq Num b) Employee TIN Grandfather’s Name)
1 Workinesh Wondu Afework
2 Naser Kemal
3 Mesfin Kasay

Taxpayer name & Seal

Taxpayer/Authorized Agent name __________________________________________ Signature ___________________________________ Date __

The National Regional Government of Oromia Bureau of Revenue (as of /5/2011)

 Pension Contribution Declaration Form The National Regional Government of Oromia

Proclamation No. 715/2011 Bureau of Revenues

(Private Organization Employees Pension Proclamation)

Section 1 – Taxpayer Information

8. Tax Period:
3. Taxpayer Identification Number
0078842912 Month Tikemet Year 2015 E.C

Section 2 – Declaration Detail

f) Pension Contribution of
d) Start Date of Employment Contribution of Employer _11_%
(DD/MM/YY) e) Basic Salary /Birr/ Employee _7_% /Birr/ /Birr/
5,000.00 350.00 550.00
5,000.00 350.00 550.00
5,000.00 350.00 550.00

Transfer Totals from All

Continuation Sheets to this Line >
Total 15,000.00 1,050.00 1,650.00

(line 20) (line 30) (line 40)

e ___________________________________ Date _____________ Seal _____________

Revenue (as of /5/2011) OBR Form _____ (1/2011)

Page 1 of 1

h) Total Amount of the

contribution _18_%
/Birr/ (f + g )
900.00
900.00
900.00

2,700.00

(line 50)
 Federal Democratic Republic of Ethiopia

Ethiopian Revenues &

Custom Authority

Section 1 – Taxpayer Inform

1. Taxpayer Name.(Company Name Your Name ,Father’s Name, Grandfather’s Name
HOE Trading PLC
Section 2 – Declaration De
c) Employee Name(Name, Father’s Name and
a)Seq Num b) Employee TIN Grandfather’s Name)
1 Workinesh Wondu Afework
2 Naser Kemal
3 Mesfin Kasay

Taxpayer name & Seal

Taxpayer/Authorized Agent name __________________________________________ Signature ___________________________________ Date __

The National Regional Government of Oromia Bureau of Revenue (as of /5/2011)

 Pension Contribution Declaration Form The National Regional Government of Oromia

Proclamation No. 715/2011 Bureau of Revenues

(Private Organization Employees Pension Proclamation)

Section 1 – Taxpayer Information

8. Tax Period:
3. Taxpayer Identification Number
0078842912 Month Hidar Year 2015 E.C

Section 2 – Declaration Detail

f) Pension Contribution of
d) Start Date of Employment Contribution of Employer _11_%
(DD/MM/YY) e) Basic Salary /Birr/ Employee _7_% /Birr/ /Birr/
5,000.00 350.00 550.00
5,000.00 350.00 550.00
5,000.00 350.00 550.00

Transfer Totals from All

Continuation Sheets to this Line >
Total 15,000.00 1,050.00 1,650.00

(line 20) (line 30) (line 40)

e ___________________________________ Date _____________ Seal _____________

Revenue (as of /5/2011) OBR Form _____ (1/2011)

Page 1 of 1

h) Total Amount of the

contribution _18_%
/Birr/ (f + g )
900.00
900.00
900.00

2,700.00

(line 50)
 Federal Democratic Republic of Ethiopia

Ethiopian Revenues &

Custom Authority

Section 1 – Taxpayer Inform

1. Taxpayer Name.(Company Name Your Name ,Father’s Name, Grandfather’s Name
HOE Trading PLC
Section 2 – Declaration De
c) Employee Name(Name, Father’s Name and
a)Seq Num b) Employee TIN Grandfather’s Name)
1 Workinesh Wondu Afework
2 Naser Kemal
3 Mesfin Kasay

Taxpayer name & Seal

Taxpayer/Authorized Agent name __________________________________________ Signature ___________________________________ Date __

The National Regional Government of Oromia Bureau of Revenue (as of /5/2011)

 Pension Contribution Declaration Form The National Regional Government of Oromia

Proclamation No. 715/2011 Bureau of Revenues

(Private Organization Employees Pension Proclamation)

Section 1 – Taxpayer Information

8. Tax Period:
3. Taxpayer Identification Number
0078842912 Month Tahisase Year 2015 E.C

Section 2 – Declaration Detail

f) Pension Contribution of
d) Start Date of Employment Contribution of Employer _11_%
(DD/MM/YY) e) Basic Salary /Birr/ Employee _7_% /Birr/ /Birr/
5,000.00 350.00 550.00
5,000.00 350.00 550.00
5,000.00 350.00 550.00

Transfer Totals from All

Continuation Sheets to this Line >
Total 15,000.00 1,050.00 1,650.00

(line 20) (line 30) (line 40)

e ___________________________________ Date _____________ Seal _____________

Revenue (as of /5/2011) OBR Form _____ (1/2011)

Page 1 of 1

h) Total Amount of the

contribution _18_%
/Birr/ (f + g )
900.00
900.00
900.00

2,700.00

(line 50)
 Federal Democratic Republic of Ethiopia Pension Contribution Declaration Form
Ethiopian Revenues & Proclamation No. 715/2011
Custom Authority (Private Organization Employees Pension Proclamation)

Section 1 – Taxpayer Information

1. Taxpayer Name.(Company Name Your Name ,Father’s Name, Grandfather’s Name 8. Tax Period: Page 1 of 1
3. Taxpayer Identification Number
HOE Trading PLC 0078842912 Month Tire Year 2015 E.C

Section 2 – Declaration Detail

f) Pension Contribution of h) Total Amount of the
c) Employee Name(Name, Father’s Name and d) Start Date of Employment Contribution of Employer _11_% contribution _18_%
a)Seq Num b) Employee TIN Grandfather’s Name) (DD/MM/YY) e) Basic Salary /Birr/ Employee _7_% /Birr/ /Birr/ /Birr/ (f + g )
1 Workinesh Wondu Afework 5,000.00 350.00 550.00 900.00
2 Naser Kemal 5,000.00 350.00 550.00 900.00
3 Mesfin Kasay 5,000.00 350.00 550.00 900.00

Transfer Totals from All

Continuation Sheets to this Line >
Taxpayer name & Seal Total 15,000.00 1,050.00 1,650.00 2,700.00

(line 20) (line 30) (line 40) (line 50)

Taxpayer/Authorized Agent name __________________________________________ Signature ___________________________________ Date _____________ Seal _____________

The National Regional Government of Oromia Bureau of Revenue (as of /5/2011) OBR Form _____ (1/2011)
 Federal Democratic Republic of Ethiopia Pension Contribution Declaration Form
Ethiopian Revenues & Proclamation No. 715/2011
Custom Authority (Private Organization Employees Pension Proclamation)

Section 1 – Taxpayer Information

1. Taxpayer Name.(Company Name Your Name ,Father’s Name, Grandfather’s Name 8. Tax Period: Page 1 of 1
3. Taxpayer Identification Number
HOE Trading PLC 0078842912 Month Yekatit Year 2015 E.C

Section 2 – Declaration Detail

f) Pension Contribution of h) Total Amount of the
c) Employee Name(Name, Father’s Name and d) Start Date of Employment Contribution of Employer _11_% contribution _18_%
a)Seq Num b) Employee TIN Grandfather’s Name) (DD/MM/YY) e) Basic Salary /Birr/ Employee _7_% /Birr/ /Birr/ /Birr/ (f + g )
1 Workinesh Wondu Afework 5,000.00 350.00 550.00 900.00
2 Naser Kemal 5,000.00 350.00 550.00 900.00
3 Mesfin Kasay 5,000.00 350.00 550.00 900.00

Transfer Totals from All

Continuation Sheets to this Line >
Taxpayer name & Seal Total 15,000.00 1,050.00 1,650.00 2,700.00

(line 20) (line 30) (line 40) (line 50)

Taxpayer/Authorized Agent name __________________________________________ Signature ___________________________________ Date _____________ Seal _____________

The National Regional Government of Oromia Bureau of Revenue (as of /5/2011) OBR Form _____ (1/2011)
 Federal Democratic Republic of Ethiopia
Ethiopian Revenues &
Custom Authority

Section 1 – Taxpayer Inform

1. Taxpayer Name.(Company Name Your Name ,Father’s Name, Grandfather’s Name
HOE Trading PLC
Section 2 – Declaration De
c) Employee Name(Name, Father’s Name and
a)Seq Num b) Employee TIN Grandfather’s Name)
1 Workinesh Wondu Afework
2 Mesfin Kasay

Taxpayer name & Seal

Taxpayer/Authorized Agent name __________________________________________ Signature ___________________________________ Date __

The National Regional Government of Oromia Bureau of Revenue (as of /5/2011)

 Pension Contribution Declaration Form
Proclamation No. 715/2011
(Private Organization Employees Pension Proclamation)

Section 1 – Taxpayer Information

8. Tax Period:
3. Taxpayer Identification Number
0078842912 Month Megabit Year 2015 E.C

Section 2 – Declaration Detail

f) Pension Contribution of
d) Start Date of Employment Contribution of Employer _11_%
(DD/MM/YY) e) Basic Salary /Birr/ Employee _7_% /Birr/ /Birr/
5,000.00 350.00 550.00
5,000.00 350.00 550.00

Transfer Totals from All

Continuation Sheets to this Line >
Total 10,000.00 700.00 1,100.00

(line 20) (line 30) (line 40)

e ___________________________________ Date _____________ Seal _____________

Revenue (as of /5/2011) OBR Form _____ (1/2011)

Page 1 of 1

h) Total Amount of the

contribution _18_%
/Birr/ (f + g )
900.00
900.00

1,800.00

(line 50)
 Federal Democratic Republic of Ethiopia Pension Contribution Declaration Form
Ethiopian Revenues & Proclamation No. 715/2011
Custom Authority (Private Organization Employees Pension Proclamation)

Section 1 – Taxpayer Information

1. Taxpayer Name.(Company Name Your Name ,Father’s Name, Grandfather’s Name 8. Tax Period: Page 1 of 1
3. Taxpayer Identification Number
HOE Trading PLC 0078842912 Month Miyazia Year 2015 E.C

Section 2 – Declaration Detail

d) Start Date of Employment
g) Pension
f) Pension Contribution of h) Total Amount of the
c) Employee Name(Name, Father’s Name and Contribution of Employer _11_% contribution _18_%
a)Seq Num b) Employee TIN Grandfather’s Name) (DD/MM/YY) e) Basic Salary /Birr/ Employee _7_% /Birr/ /Birr/ /Birr/ (f + g )
1 Worknesh Wondu 1/1/2015 5,000.00 350.00 550.00 900.00
2 Mesfin Kasaye 1/1/2015 5,000.00 350.00 550.00 900.00

Transfer Totals from All

Continuation Sheets to this Line >
Taxpayer name & Seal Total 10,000.00 700.00 1,100.00 1,800.00

(line 20) (line 30) (line 40) (line 50)

Taxpayer/Authorized Agent name __________________________________________ Signature ___________________________________ Date _____________ Seal _____________

The National Regional Government of Oromia Bureau of Revenue (as of /5/2011) OBR Form _____ (1/2011)
 Federal Democratic Republic of Ethiopia Pension Contribution Declaration Form
Ethiopian Revenues & Proclamation No. 715/2011
Custom Authority (Private Organization Employees Pension Proclamation)

Section 1 – Taxpayer Information

1. Taxpayer Name.(Company Name Your Name ,Father’s Name, Grandfather’s Name 8. Tax Period: Page 1 of 1
3. Taxpayer Identification Number
HOE Trading PLC 0078842912 Month Ginbot Year 2015 E.C

Section 2 – Declaration Detail

d) Start Date of Employment
g) Pension
f) Pension Contribution of h) Total Amount of the
c) Employee Name(Name, Father’s Name and Contribution of Employer _11_% contribution _18_%
a)Seq Num b) Employee TIN Grandfather’s Name) (DD/MM/YY) e) Basic Salary /Birr/ Employee _7_% /Birr/ /Birr/ /Birr/ (f + g )
1 Worknesh Wondu 1/1/2015 5,000.00 350.00 550.00 900.00
2 Mesfin Kasaye 1/1/2015 5,000.00 350.00 550.00 900.00
3 Mussie Kebede 8/9/2015 3,666.67 256.67 403.33 660.00
4 Kaleab Mola 21/9/2015 1,666.67 116.67 183.33 300.00

Transfer Totals from All

Continuation Sheets to this Line >
Taxpayer name & Seal Total 15,333.33 1,073.33 1,686.67 2,760.00

(line 20) (line 30) (line 40) (line 50)

Taxpayer/Authorized Agent name __________________________________________ Signature ___________________________________ Date _____________ Seal _____________

The National Regional Government of Oromia Bureau of Revenue (as of /5/2011) OBR Form _____ (1/2011)
 Federal Democratic Republic of Ethiopia
Ethiopian Revenues &
Custom Authority

Section 1 – Taxpayer Inform

1. Taxpayer Name.(Company Name Your Name ,Father’s Name, Grandfather’s Name
HOE Trading PLC
Section 2 – Declaration De

c) Employee Name(Name, Father’s Name and

a)Seq Num b) Employee TIN Grandfather’s Name)
1 Worknesh Wondu
2 Mesfin Kasaye
3 Mussie Kebede
4 Kaleab Mola
5 Amanuel Tefer

Taxpayer name & Seal

Taxpayer/Authorized Agent name __________________________________________ Signature ___________________________________ Date __

The National Regional Government of Oromia Bureau of Revenue (as of /5/2011)

 Pension Contribution Declaration Form
Proclamation No. 715/2011
(Private Organization Employees Pension Proclamation)

Section 1 – Taxpayer Information

8. Tax Period:
3. Taxpayer Identification Number
0078842912 Month Sene Year 2015 E.C

Section 2 – Declaration Detail

d) Start Date of Employment g) Pension
f) Pension Contribution of
Contribution of Employer _11_%
(DD/MM/YY) e) Basic Salary /Birr/ Employee _7_% /Birr/ /Birr/
1/1/2015 5,000.00 350.00 550.00
1/1/2015 8,000.00 560.00 880.00
8/9/2015 5,000.00 350.00 550.00
21/9/2015 5,000.00 350.00 550.00
1/10/2015 5,000.00 350.00 550.00

Transfer Totals from All

Continuation Sheets to this Line >
Total 28,000.00 1,960.00 3,080.00

(line 20) (line 30) (line 40)

e ___________________________________ Date _____________ Seal _____________

Revenue (as of /5/2011) OBR Form _____ (1/2011)

Page 1 of 1

h) Total Amount of the

contribution _18_%
/Birr/ (f + g )
900.00
1,440.00
900.00
900.00
900.00

5,040.00

(line 50)
 Federal Democratic Republic of Ethiopia
Ethiopian Revenues &
Custom Authority

Section 1 – Taxpayer Inform

1. Taxpayer Name.(Company Name Your Name ,Father’s Name, Grandfather’s Name
HOE Trading PLC
Section 2 – Declaration De

c) Employee Name(Name, Father’s Name and

a)Seq Num b) Employee TIN Grandfather’s Name)
1 Worknesh Wondu
2 Mesfin Kasaye
3 Mussie Kebede
4 Kaleab Mola
5 Amanuel Tefer
6 Helen Girma

Taxpayer name & Seal

Taxpayer/Authorized Agent name __________________________________________ Signature ___________________________________ Date __

The National Regional Government of Oromia Bureau of Revenue (as of /5/2011)

 Pension Contribution Declaration Form
Proclamation No. 715/2011
(Private Organization Employees Pension Proclamation)

Section 1 – Taxpayer Information

8. Tax Period:
3. Taxpayer Identification Number
0078842912 Month Hamlie Year 2015 E.C

Section 2 – Declaration Detail

d) Start Date of Employment g) Pension
f) Pension Contribution of
Contribution of Employer _11_%
(DD/MM/YY) e) Basic Salary /Birr/ Employee _7_% /Birr/ /Birr/
1/1/2015 5,000.00 350.00 550.00
1/1/2015 8,000.00 560.00 880.00
8/9/2015 5,000.00 350.00 550.00
21/9/2015 5,000.00 350.00 550.00
1/10/2015 5,000.00 350.00 550.00
1/10/2015 5,000.00 350.00 550.00

Transfer Totals from All

Continuation Sheets to this Line >
Total 33,000.00 2,310.00 3,630.00

(line 20) (line 30) (line 40)

e ___________________________________ Date _____________ Seal _____________

Revenue (as of /5/2011) OBR Form _____ (1/2011)

Page 1 of 1

h) Total Amount of the

contribution _18_%
/Birr/ (f + g )
900.00
1,440.00
900.00
900.00
900.00
900.00

5,940.00

(line 50)
 Federal Democratic Republic of Ethiopia
Ethiopian Revenues &
Custom Authority

Section 1 – Taxpayer Inform

1. Taxpayer Name.(Company Name Your Name ,Father’s Name, Grandfather’s Name
HOE Trading PLC
Section 2 – Declaration De

c) Employee Name(Name, Father’s Name and

a)Seq Num b) Employee TIN Grandfather’s Name)
1 Worknesh Wondu
2 Mesfin Kasaye
3 Mussie Kebede
4 Kaleab Mola
5 Amanuel Tefer

Taxpayer name & Seal

Taxpayer/Authorized Agent name __________________________________________ Signature ___________________________________ Date __

The National Regional Government of Oromia Bureau of Revenue (as of /5/2011)

 Pension Contribution Declaration Form
Proclamation No. 715/2011
(Private Organization Employees Pension Proclamation)

Section 1 – Taxpayer Information

8. Tax Period:
3. Taxpayer Identification Number
0078842912 Month Nehasie Year 2015 E.C

Section 2 – Declaration Detail

d) Start Date of Employment g) Pension
f) Pension Contribution of
Contribution of Employer _11_%
(DD/MM/YY) e) Basic Salary /Birr/ Employee _7_% /Birr/ /Birr/
1/1/2015 5,000.00 350.00 550.00
1/1/2015 8,000.00 560.00 880.00
8/9/2015 5,000.00 350.00 550.00
21/9/2015 5,000.00 350.00 550.00
1/10/2015 5,000.00 350.00 550.00

Transfer Totals from All

Continuation Sheets to this Line >
Total 28,000.00 1,960.00 3,080.00

(line 20) (line 30) (line 40)

e ___________________________________ Date _____________ Seal _____________

Revenue (as of /5/2011) OBR Form _____ (1/2011)

Page 1 of 1

h) Total Amount of the

contribution _18_%
/Birr/ (f + g )
900.00
1,440.00
900.00
900.00
900.00

5,040.00

(line 50)