Federal Democratic

Republic of Ethiopia
Schedule C - Business Income
Ministry of Revenues Tax Declaration (With Annex)
Check Status:
 Schedule C Business Income Tax  Mining Income
Tax
Section 1 – Taxpayer Information
1.Taxpayer’s Name Tiya Tekel Dinegay PLC 3. Taxpayer Identification Number 8. For the Year of: Page 1
0004925308 30/10/2011
of ___
2a. Region soouth 2b. Zone/K-Ketema 4. Tax Account Number Document Number (Official Use Only)
GURAGE ZONE

2c. Woreda 2d. Kebele/Farmers Association 2e. House Number 5. Tax Center
SODO

6. Telephone Number 7. Fax Number

Section 2 – Tax Declaration

Income and Cost of Goods Sold
1 Business Income or Sales/Turnover (Transfer from Annex 1) 5 17,990,103.61
2 Non Operating and Other Income 10
3 Total Gross Income (Add lines 1 and 2 and Enter Total at Right) 15 17,990,103.61
4 Cost of Goods Sold (Transfer Total from Annex 2) 20 17,965,369.64
5 Gross Profit/Lost (Line 3 minus Line 4) 25 24,733.97
Business Expenses
6 Selling and Distribution Expenses (Transfer from Annex 4) 30
7 Salary and Wages 35
8 Other Employee Benefits 40
9 Repair and Maintenance Expenses 45
10 Investment/Participation Expenses 50
11 Foreign Technical Services Expenses 55
12 Utilities Expenses 60
13 Travel Expenses 65
14 Rent Expenses 70
15 Interest Expenses 75
16 Depreciation Expenses 80
17 Amortization Expenses 85
18 Deductible Taxes and License Fees 90
19 Deductible Donations and Gifts 95
20 Other Deductions (Transfer Total from Annex 5) 100
21 Total Expenses (Add Lines 6 through 20 and enter total) 105

22 Net Income/Loss (Line 5 minus Line 21) 110 24,733.97

23 Loss Carry Forward from Previous Period (From Annex 6) 115
24 Carry Backward Loss Adjustment (Attach Supporting Document) (See Instructions) 120
25 Taxable Business Income (Line 22 minus (Line 23 + 24) 125 24,733.97
26 Income Tax Payable (Line 25 X Schedule C Tax Rate) 130 7,420.20
27 Foreign Tax Credit (Transfer Total from Annex 7) 135
28 Withholding Tax (Attach Schedule Import and Payments) 140
29 Total Credits (Line 27 plus Line 28) 145
30 If line 26 is greater than Line 28, Subtract Line 28 from Line 26. This is Net Tax Due 150
31 If line 28 is greater than Line 26, Subtract Line 26 from Line 28. This is Refund Amount 160

Section 3- Attachments
- Balance Sheet
- Profit & Loss Statement
- Source & Application of Fund
- Fixed Asset & Depreciation Schedule
- Statement of Goods Manufactured and/or Cost of Goods Sold
- Gross Profit & the Manner in which it is Computed
- General & Administrative Expenses
- Selling & Distribution Expenses
- Provisions & Reserves
Ethiopian Revenues and Customs Authority Page 1 of 3 (As of 7/8/2011) ERCA Form 1301 (5/2006)
 Business Income Tax Annexes
Taxpayer Information
1. Taxpayer’s Name (Company or Individual) 2. Taxpayer Identification Number 3. Statement as of
TIYA TEKEL DINEGAY. PLC 30/10/11

Section 4 - Annexes for Business Income Tax

Annex 1 – Business Income or Sales/Turnover
a. Seq
Num b. Type of Income c. Amount
1 Local Sales 17,990,103.61
2 Export Sales
3 Service Income
4 Total (Add Line 1 through 3 - Enter total amount on Line 1 of Tax Declaration (Form 1301)) 17,990,103.61
Annex 2 – Cost of Goods Sold
a. Seq
Num b. Type of Cost c. Amount
1 Beginning Inventory 33,900.00
2 Purchases 17,959,508.54
3 Cost of Finished Goods/Direct Cost of Services (From Line 17 of Annex 3 below)
4 Goods Available for Sale (Add Lines 1, 2 & 3) 17,993,408.54
5 Ending Inventory 28,038.90
Cost of Goods Sold (Line 4 minus Line 5 - Enter Total amount on Line 4 of Tax Declaration 17,965,369.64
6
(Form 1301))

Annex 3 – Cost of Finished Goods/Direct Cost of Services

a. Seq
Num b. Type of Cost c. Amount
1 Beginning Work in Process
2 Cost of Direct & Indirect Materials
3 Cost of Direct & Indirect labor
4 Power/WATER
5 Depreciation Expense
6 Other Supplies (Fuel, Chemicals, etc.)
7 Employee Benefits
8 Repair & Maintenance
9 Insurance
10 Airfare, Transportation & Freight
11 Accommodation & Hotel Expense
12 Excise Tax
13 Other Expenses
14 Total Over Head Costs (Add Lines 4 through 13)
15 Total Cost of Manufacturing/Processed Product (Add Lines 1, 2, 3 and 14)
16 Ending Work in Process
17 Total Cost of Finished Goods/Direct Cost of Services (Line 15 minus Line 16 - Enter
Total amount on Line 3 of Annex 2 Above)

Annex 4 – Selling & Distribution Expenses

a. Seq
Num b. Type of Expense c. Amount
1 Salaries, Wages and Related Benefits
2 Repairs and Maintenance
3 Fuel and Lubricants
4 Travel, Accommodation & Transport
5 Advertisement
6 Commission
7 Insurance
8 Clearing, Transit & Other Related Expenses
9 Other Expenses
10 Total (Add Line 1 through 9 - Enter Total amount on Line 6 of the Tax Declaration (Form 1301))
Ethiopian Revenues and Customs Authority Page 2 of 3 (As of 7/8/2011)
ERCA Form 1301 (5/2006)
 Business Income Tax
(Section 3 – Annexes continued)
Taxpayer Information
1. Taxpayer’s Name (Company or Individual) 2. Taxpayer Identification Number 3. Statement as of
Tired flour factory 0016797905 30/10/11

Annex 5-Other Deductions

a. Seq
Num b. Account Description c. Amount

Total (Enter Total amount on Line 20 of Tax Declaration (Form 1301))

Annex 6 – Loss Carry Forward from Previous Tax Period

(Validity of Loss for Schedule C Normal is 3 Years; for Schedule C Mining it is 10 Years)
b. Profit / Loss c. Loss d. Loss Carry-
a. Year
Amount Forward
e. Remarks
Applied

Transfer Total of Column d to Line 23 of Tax Declaration, Form 1301

Annex 7 – Foreign Tax Credit
d. Amount of
a. c. Foreign
Seq b. Name of Foreign Country Foreign Tax e. Remarks
Num Income
Paid/Payable

Total (Enter Total amount on Line 28 of Tax Declaration

(Form 1301))

Section 4 - Taxpayer Certification

I declare that the above declaration and all information provided here-with is correct and complete. I understand that any
misrepresentations is punishable as per the tax Law and the Penal Code. Declaration of preparer (other than the taxpayer) is
based on all information of which the preparer has any knowledge.
Printed Name of Taxpayer or Authorized Representative Date For Official Use Only

Signature of Taxpayer or Authorized Representative Date of Payment Receipt Number

Company Seal
Printed Name of Preparer Date Amount of Payment Cheque Number

Signature of Preparer Cashier’s Signature

Ethiopian Revenues and Customs Authority Page 3 of 3 (As of 7/8/2011) ERCA Form 1301 (5/2006)
 Instructions for Business Tax Declaration In the Business Expenses section, enter your
and Annexes (Form 1301) documented expenses since the beginning of the period.
In order to do this you will also have to complete Annexes
This form complies with the regulations established in the 4 and 5. Then enter the total from the sheet you are
Income Tax Proclamation No. 286/2002. Specific attaching on the line provided in the annex. In case of an
references to business income are included in Section IV of audit, you will be required to provide receipts or other
the Proclamation, Schedule ‘C’ Income/Business written and verifiable documentation to prove your actual
Income Tax. Paragraph 18 states, “Taxable business expenses.
income shall be determined per tax period on the basis of
the profit and loss account or income statement, which The Calculation of Tax Due section requires information
shall be drawn in compliance with the General Accepted from Annexes 6 and 7. After this data is entered, follow
Accounting Standards, subject to the provisions of this the calculations specified on the form. Use the Schedule
proclamation and the directives issued by the Tax C tax table below to calculate the tax on line 26.
Authority.” Line 24, Carry Backward Loss Adjustment, should
This form may be used for most normal business NEVER be filled in when this form is filed. If in future
enterprises. If you are in the mining business, you may years a carry back loss is approved, a Ministry of
use this form but you must check the “Mining” box at the Revenue representative will make the appropriate
top of the form. Non-mining business enterprises should entries and recalculations.
check the “Normal” box. If you are in the “rental” Tax Rate on Income of bodies is thirty percent (30%) of
business, you are required to complete the Rental taxable income. Tax rate on income of persons is
Income Tax Declaration, Form 1201. Rental Income is according to the schedule below.
covered under Schedule B of the Proclamation.
Schedule “C” Tax Rate on Persons
In addition to the Business Tax Declaration, you must Taxable Business Income Income Tax
complete and file a Balance Sheet, Form 1303. (Per Year) Payable
Complete the Balance Sheet prior to the Tax Over Birr To Birr (Percent)
Declaration, as some of the information on the Balance 0 1,800 Exempt Threshold
Sheet will have to be transferred to the Declaration form. 1,801 7,800 10
At the top of the Balance Sheet mark whether you are 7,801 16,800 15
filing it for a Normal, Mining or Rental enterprise. If you 16,801 28,200 20
are involved in more than one of these enterprises, you 28,201 42,600 25
42,601 60,000 30
will need to file separate Balances sheets with each
Over 60,000 35
Declaration.
Calculation Table – Determine which range bracket
Should there be any discrepancy between these
your taxable income on Line 25 falls within, multiply by
instructions and the Proclamation, the language of the
the percentage shown in the Tax Rate column and then
Proclamation shall take precedence.
deduct the amount in the “Deduction” column. For
example, if your taxable Business Income on Line 25
Section 1 – Taxpayer Information for the year is 45,000 birr, you would go to the 6 th row
1 Name – Enter the name of individual taxpayer (42,601 to 60,000 birr) and multiply your taxable
including given name, father’s name and grandfather’s income of 45,000 birr by the tax rate of 30% and then
name.
subtract the 2,820 birr shown in the Deduction column.
2 Address – Enter all information necessary to identify the (45,000 birr x 30% minus 4,950 birr equals 8,550 birr).
location of your residence. If your address has changed
since your last filing, contact your Registration Office. Over Birr To Birr Tax Rate Deduction
3 Taxpayer Identification Number (TIN) – Every 0 1,800 Exempted threshold
person having a tax responsibility is required to have a  1,801 7,800 10 % 180
TIN and to enter it with each filing. See Income Tax 7,801 16,800 15 % 570
Proclamation no. 286/2002, paragraphs 43, 44 and 90. 16,801 28,200 20 % 1,410
4 Tax Account Number (TAN) – This number is 28,201 42,600 25 % 2,820
provided by the Federal Inland Revenue Authority 42,601 60,000 30 % 4,950
(FIRA) and must be entered each time a Personal Over 60,000 35% 7,950
Income Tax Return is filed. If you have not been issued
this number, contact your local central registration Section 3 – Annexes
office. The Annexes should be complete prior to completing the
5 Filing Month and Year – Enter month and year for tax declaration section. If additional lines are needed to
which you are filing this return. complete any Annex, attach an additional sheet with that
6 Tax Cheque – Enter name of Tax Cheque where you contains the same information as required in the Annex.
are registered. Be sure to enter your name or company name and
7/8 Telephone and Fax Numbers – If more than one, Taxpayer Identification Number and identify the number
enter contact numbers for person authorized to sign this and name of the annex at the top. Enter totals from the
form. annexes on the next to last line (just before the TOTAL
line) in the appropriate annex. Be sure to attach your
Section 2 - Tax Declaration extra sheets to the Tax Declaration.
Income and Cost of Goods Sold – Prior to completing
this section, complete Annexes 1, 2 and 3. Enter the Section 4 – Taxpayer Certification
totals from these annexes 1 and 2 on lines 1 and 4. The form must be signed and dated by the taxpayer or
Then complete the required calculations. the authorized representative at the bottom of page 3.
The signature and name of the preparer, if other than
the taxpayer is also required. If payment is made in
person, the cashier will record this information and the
Ministry of Revenue will retain the original form. If you
need a copy of the Declaration, you should make this
before meeting with the cashier.