Ministry of Finance Form No

Ministry of Finance Form No. General Commission for Taxes Fiscal Year / 200 Direct Deduction Section (page 1) Form (Dhad/4 A) concerning taxpayers who are subject to Direct Deduction 1. Full name: Date of birth: Nationality: Employee’s Nationality ID No.: Employee’s Address: 2. a. Marital status: b. Date of marriage: 3. a. Occupation: b. Employer’s Name: c. Employer’s Address: d. Business Registration No.: 4. fill the table below with the information about your children (males and females) who are under 18 years old , and those who are above 18 years old and still pursuing the high or secondary study mentioning the name of their school or their college and the amount of their incomes and their ages according to their ID. Full name of children (males and females) Date of birth Day-month-year Children annual income (ID) notes 1. 2. 3. 4. 5. 6. Signature Name of taxpayer Date / / Accountant Head of office Dhad.D/4A page 2 Computation of the tax to be filled in by the accountant Dinar A. Incomes (ID ) The nominal monthly salaries or wages from / / to / / Lodging allowance or free lodging consideration Food allowance or free meals consideration Other allowances (to be mentioned) Sum of incomes B. Deductions Legal allowance for a period of ( ) months Pension deductions Life insurance premiums Other insurance premiums Other deductions Sum of deductions Taxable income(A minus B) Accountant signature director signature Ministry of Finance Employer’s Name: __________ General Commission for Taxes Business Registration No.:_____ Direct Deduction Section Withheld amounts from employees salaries for the period of three months (the amounts in ID) NO. Name of employee Employee ID No. Monthly salary Monthly withholding Three- month withholding Sum of withhold amounts A copy to: _________________ (Mentioned the name of the office) / Financial dep. For auditing at the end of the year with the coordination of wage withholding dep. / the General Commission for Taxes. Ministry of Finance General Commission for Taxes Direct Deduction Section Tax amounts withheld by the employer / /200 Ministry._____________ Directorate.______________ Name of Employer (if private sector):_________________ Business Registration No: _______________ Tax installments Dinar Installment no. Receipt no. Date of receipt Sum We certify the information mentioned in the table above Accountant signature Director signature Name Name Date Date Important note This table must be organized correctly according to the instructions of General Commission for Taxes Employer’s Name: ____________ Ministry of Finance General Commission for Taxes Business Registration No.:_______ Direct Deduction Section INCOME TAX DEDUCTION SCHEDULE FOR THE FISCAL YEAR 200 123456789101112Form No.Employee name and his I.D. No.Income Lodging and food Sum of columns (3+4) Allowances and deductions Taxable income (5-6) Tax due Tax paid Remained tax Excess tax Work period From/toSum To be filled at the beginning of every year . 2 If you have a daughter with no independent income that exceeds ID 200,000, and non married, register that in the field of children no matter what is her age. Notes: a. This form must be handed over to the wage withholding dep. In the first three months that follow the fiscal year. b. The items 56, 57, 58, 59, of the tax low (113) for 1982 have to be taken into consideration. c. If the information in (2) and (4) are not filled correctly, the allowances corresponding each case will be eliminated. Revised : April 2004 PAGE PAGE Accountant’s signature Accountant's name