ZIMBABWE REVENUE AUTHORITY INCOME TAX. Return of employment income by an individual for the year ended 31 st December.. BP No

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1 I.T.F. 1 ZIMBABWE REVENUE AUTHORITY INCOME TAX Return of employment income by an individual for the year ended 31 st December.. For official use only Issued by To BP No All sections must be completed. Please state all your employment income for the year ended 31 st December,... on this form. When you have completed and signed this return, please deliver it or post it to your nearest Regional Office. It is important that you return the form to your nearest Regional Office within 30 days from the date it was issued or within any extended period allowed by your Commissioner. If you do not do so, your tax will be estimated and you may have to pay penalties. Please make sure that you sign the declaration on page 4. Ensure that your National Registration Number is correct and attach the copy of your NRN Card. National Identity No. Date of Birth Name (in capital letters) and address Surname First Names Title (Mr., Mrs., etc.) Residential Address Postal Address Spouse s full names Daytime phone number (only if convenient) Name and address of spouse s employer Please write your name and address in block letters. Receipt for your Tax Return Do not detach this slip. The slip will be sent to you as a receipt. Title, name (initials and surname) Address

2 Nature of income 1. Employment 2 Period(s) of employment (indicate Name(s) and address (es) of employer(s) Position held periods of unemployment). Details of earnings Salary, Wages, Overtime Office use only Bonus Fees, commission Cash-in-lieu of leave Gratuity or compensation on ceasation of employment Commutation of amount due under a contract of employment Lump-sum payment from pension, benefit or unapproved fund Other earnings (specify) Benefits (Please specify type of benefit and state amount) Total from employment Deductions claimed Membership subscriptions to a trade, technical or professional association State name of association. Cost of tools renewed or replaced (artisans and tradesmen only)... Contributions to registered pension or retirement annuity funds (attach receipt(s) for the latter contribution(s) State name(s) of fund(s).. Donations to a charitable trust administered by the Minister responsible for Social Welfare, or Health and Chid Welfare. Total deductions claimed = - Net earnings = 2. Pensions and annuities (Income).. 3. Income of minor children (Please attach statement) Zimbabwe Revenue Authority Office of issue Your employment income Tax Return for the year ended 31 st December has been received. Please do not Please advise your Commissioner as soon detach this receipt as you change your address. Date-stamp

3 3 Sub total from page 2 Office use only 4. Any other income (Please attach statement) Total Income 5. P.A.Y.E. deducted Please attach your employee s tax certificate (Forms P6) Serial No. Amount Serial No. Amount Credits claimed A. Medical expenses Medicines on prescription and Purchase of Payment from other Total Office use only hospital fees appliances sources B. Medical aid contributions - = Name of person covered Name of Society Total medical expenses C. Blind person s credit Claim relates to.. self spouse Office use only D. Disabled person s credit If you or your spouse or one or more of your children is/are disabled state Self or Spouse or name of disabled child Nature of disability 7. Details of bank or Savings accounts Name of banker(s) Branch (es) Type of account Account number Rent paid Do you own the house or flat you live in? Yes No If No give the following details Name and address of person to whom Address of property Period Amount paid Office use only rent was paid covered... Indicate whether Amount paid covers Full board Partial board Nil board

4 9. Other information 4 Is this your first return? Yes No If No state tax Tax year Year for last return.. If yes, please explain why this is your Regional office to which you sent it first return in Zimbabwe Office use only Name and business address of your previous employer, if any and period of employment.. If you were a student before the year covered by this return, please state name of college or university.. If you moved here from another country Date of arrival please state date of arrival in Zimbabwe 10. Remarks You can use the space below for any remarks or to state details in support of any item in the return. 11. Declaration I declare that the information I have given on this form is correct and complete in every particular. Signature.. Date.. Please make sure that you send or deliver your form to your nearest ZIMRA office. The addresses are stated on the next page. Giving false information and making false statements in the return or concealing any part of the taxable income may lead to prosecution.

5 12. REGIONAL TAX OFFICES REGION 1 REGION 2 REGION 3 Harare 3 rd Floor, Kurima House 89 Nelson Mandela Ave. Between 3 rd and 4 th Street P.O. Box CY 693 Causeway Harare Tel.: Fax: Chirundu Border Post P.Bag 6, Chirundu Tel: Fax: Kariba Border Post P.O Box 97, Kariba Tel: Fax: Nyamapanda Border Post P. Bag 510 Mutoko Tel: Fax: CHINHOYI 76 Beleveiw Road P.O.Box 164 Chinhoyi Tel: Bindura 846 Matuka Inve Centre York Road P.O.Box 723 Bindura Tel: Kanyemba Border Post (Please use Nyamapanda Office) Mukumbura Border Post (Please use Chirundu Office Block E Mhlahlandlela Building 10 Ave./Basch St P.O. Box 601 Tel: Fax: Region 2 Audits Block C Mhlahlandlela Building 10 Ave./Basch St P.O. Box 601 Tel: Beitbridge Border Post P. Bag 5746 Beitbridge Tel: /22303/22366/22259 Fax : Plumtree Border Post P.O. Box 7, Plumtree Tel: Victoria Falls Border Post P. Bag 5917, Victoria Falls Tel: / Kazungula Border Post c/o P. Bag 5917 Victoria Falls Tel: / Fax: Hwange 12 Southgate Road P.O. Box 145 Hwange Tel /76/77 Mphoengs Border Post (Please contact Plumtree Office) Maitengwe Border Post (Please contact Plumtree Office) Pandamatenga Border Post (Please contact Victoria Falls Office) Masvingo ZIMRE Centre Cnr. Hughes Street/Simon Mazorodze Road P.O. Box 828 Masvingo Tel: / Fax Gweru Government Composite Office 10 th street P.O.Box 350 Gweru Tel: /3 Fax: Mutare ZIMRE Centre 109, Herbert Chitepo Street P.O.Box 890, Mutare Tel: Fax: Kwekwe 2 nd Floor, CAIPF COMPLEX, Stand 5662 Robert Mugabe Way P. Bag 8146, Kwekwe Tel; Fax: Forbes Border Post P.O.Box 90, Mutare Tel: /67532 Fax: Mt. Selinda Border Post P. Bag 2062, Chipinge Tel: Fax: Chiredzi 609, Baobab Road P.O. Box 208, Chiredzi Tel; /2866/2836 Fax: Zimbabwe Revenue Authority Chipinge Office Room st Floor Eastern Block Government Complex CHIPINGE Tel No Rusape Shop 2 22 Chimurenga Street P O Box 244 Rusape Tel Fax Kadoma 20 Union Avenue PO Box 603 Kadoma Tel Fax Zvishavane 889 Israel rd P Bag 652 Zvishavane Tel: /4389 Fax: