Federal Democratic Republic of Ethiopia Schedule A The National Regional Government of Oromia

Employment Income Tax Declaration

Ethiopian Revenues &
Custom Authority Bureau of Revenues

1. Taxpayer’s Name (Company Name or Your Name, Father’s Name, Grandfathers 3. Taxpayer Identification Number 4. Tax Account Number 8. Tax Period:
Name) Month- Mazia Year-2023 Page 1
0039125875 of 1
Planet Acadeny
2a. Region 2b. Zone/K-Ketema Sheger 5. Tax Center Document Number (Official Use Only)
Burrayu 32
oromia
2c. 2d. Kebele/Farmers Association 2e. House Number 6. Telephone Number 7. Fax Number
Woreda G/ Buurayu 0923015487

c) Employee Additional Benefits

Name j) Taxable
a) b) (Name, d) Start Date f) Total Income
e) Basic g) Taxable k) Tax m) Net n) Employee
Seq Employ Father’s Name of Transportatio h) Over i) Other Taxable (Sum l) Cost Sharing
Salary Transportation Withheld Pay Signature
Num ee TIN and Employment n Allowance Time Benefits Columns e,
Grandfather’s Allowance g, h, and i)
Name)
25 Tadalu Baraja 3500.00 0 3500.00 397.5 2347.50
26 Bonsa File 3500.00 800.00 3500.00 397.5 3392.5
27 Dame Hunde 3500.00 0 3500.00 397.5

Transfer Totals from All Continuation Sheets to this Line >>

Total 94,500.00 10,732.5
(line 20) (line 30)
Number of Employees on Your Payroll 27 Seq Employee’s Name
10 Employee TIN Date of Payment
for this Tax Period Num (Name, Father’s Name,Grandfather’s Name)
Total Taxable Income 94,500.00
20 Receipt Number
(From Column j Above)
Total Tax Withheld
30 Amount of Payment
(From Column k Above) 10,732.5.00

Cheque Number

Cashier’s Signature

Section 1 - Taxpayer Information

Section 2 – Calculation of Payments to Employees
Section 3 – Calculation of Tax Due this Period Section 4 – Employees Removed from Payroll as of this month For Official Use Only

Section 5 – Taxpayer Certification The National Regional Government of Oromia Revenue Authority

Section 1 - Taxpayer Information

I declare that the above declaration and all information provide here-with (including Printed Name Signature & Date of Authorized Employer Seal Preparers Printed Name, Signature & Date
continuation sheets) is correct and complete. I understand that any Officer
misrepresentation is punishable as per the tax Laws and the Penal code. Declaration
of preparer (other than the taxpayer) is based on all information of which the
preparer has any knowledge.
section-2 Calculation of Payments to Employees

Federal Democratic Republic of Ethiopia

Schedule A The National Regional Government of
Employment Income Tax Declaration Oromia
Ethiopian Revenues &
Custom Authority Bureau of Revenues


1. Taxpayer’s Name (Company Name or Your Name, Father’s Name, 3. Taxpayer Identification Number 4. Tax Account Number 8. Tax Period:
Grandfathers Name) Month-Mazia Year-2023 Page 1 of
0039125875 ___
Planet Academy
2a. Region 2b. Zone/K-Ketema Shegger 5. Tax Center Document Number (Official Use Only)
Oromia 32
2c. Woreda Burrayu 2d. Kebele/Farmers Association 2e. House Number 6. Telephone Number-0923015487 7. Fax Number

2
 f) Total Additional Benefits j) Taxable
d) Start
a) c) Employee Name (Name, Transpo g) Taxable Income
b) Employee Date of e) Basic h) i) Other k) Tax l) Cost n) Employee
S/ Father’s Name and Grandfather’s rtation Transportati (Sum m) Net Pay
TIN Employmen Salary Over Taxable Withheld Sharing Signature
N0 Name) Allowan on Columns e,
t Time Benefits
ce Allowance g, h, and I )
1 Dinkesh Olika 3500.00 800.00 3500.00 397.5 2867.5
2 Wude Birhanu 3500.00 800.00 3500.00 397.5 3662.5
3 Marta Aresa 3500.00 800.00 3500.00 397.5 3662.6
4 Emabet Dasalegn 3500.00 750.00 3500.00 397.5 3442.5
5 Milkesa Hambisa 3500.00 600.00 3500.00 397.5 2867.5
6 Samuel Ayana 3500.00 800.00 3500.00 397.5 3662.5
7 Yohanis Negasa 3500.00 750.00 3500.00 397.5 3442.5
8 Hana Solomon 3500.00 137.00 3500.00 397.5 2005.00
9 Hana Bayisa 3500.00 500.00 3500.00 397.5 2347.00
10 Elfinesh Hurisa 3500.00 700.00 3500.00 397.5 2967.00
11 Kibinesh Dhaba 3500.00 700.00 3500.00 397.5 2967.00
12 Jalale Tesfa 3500.00 700.00 3500.00 397.5 2967.00
13 Obse Tafari 3500.00 700.00 3500.00 397.5 2967.50
14 Misrak Efrem 3500.00 500.00 3500.00 397.5 2347.00
15 Walali Tamsgen 3500.00 500.00 3500.00 397.5 2347.00
16 Gizesh Tolera 3500.00 500.00 3500.00 397.5 2347.50
17 Bashatu Ebbaa 3500.00 300.00 3500.00 397.5 1710.00
18 Dame Hunde 3500.00 3000.00 3500.00 397.5 2147.00
19 Daniel Buraka 3500.00 800.00 3500.00 397.5 3667.5
20 Obse Alemu 3500.00 300.00 3500.00 397.5 1710.00
21 Fikedu Cimedasa 3500.00 700.00 3500.00 397.5 3392.50
22 Gurmesa Abara 3500.00 700.00 3500.00 397.5 3392.50
23 Simegni Abdala 3500.00 700.00 3500.00 397.5 3392.50
24 Meti Indalu 3500.00 500.00 3500.00 397.5 2347.00
Transfer Totals from All Continuation Sheets to this Line >>
Total 84,000.00 9,540.00 68,628.00
(line 20) (line 30)