COMPANY INCOME TAX RETURN

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1 COMPANY INCOME TAX RETURN C Revenue Division Derived during the year ended 31st December or the substituted year ended COMPANY Name of Company : Postal Address : Nature of Company's Business : Nature of Company's Structure : (Tick the appropriate box) REGISTERED OFFICE Exact Location : TAXPAYER IDENTIFICATION NO. (TIN) : Public Private Resident Non-resident Tick if it is a resident mutual or non-mutual insurance company? Do you have any investments and/or assets overseas? Yes No If yes complete line 104 on page Is the Company engaged in FAVP: Yes No If yes please complete the supplementary form IRS 204A. Is the Company a non-resident company claiming Film Tax Rebate: Yes No If yes please complete the supplementary Tax Rebate IRS 222. Postal Address : AUTHORISED OFFICER Name : Postal Address : Telephone No. : Address: If you would like your refund to be deposited in your bank account please complete the details below NOTE: The bank account nominated must belong to the Company Bank Name : Bank Branch : Account No. : OFFICE USE ONLY Stamp Here DATA ENTRY : ASSESSOR : CHECKER : BATCH NO. : RETURN NO. : FSIC :

2 2 1 NET PROFIT as shown in Profit and Loss Account Add: Items not allowable as deductions (attach details) 2 Depreciation charged in Accounts 3 Capital Expenditure 4 Income Taxes, SRT, CGT, FBT (Section 22(h)) 5 Donations and Subscriptions 6 Legal Expenses 7 Fines and Penalties 8 Unrealized Exchange Loss 9 Impairment Loss 10 Fair Value Losses on Assets and Liabilities 11 Additions to Provisions and Reserves 12 Losses on Disposal of Assets for accounting purposes 13 Gain on Disposal of fixed assets for Tax purposes 14 Preliminary Expenses 15 Audio Visual Production Income (Legal Notice 8) 16 FNPF (50% of 10% Employer Contribution)(Section 23(2)) 17 Debt Forgiveness 18 Forfeited Deposits 19 Other Items Less: Deductions/Concessions Sub Total a20 Depreciation Allowable (Legal Notice 1) 21 Accelerated Depreciation 22 Net Exempt Income (being gross income less expenses incurred) (LN2) 23 Commercial Agriculture & Agro- Processing-Vanua Levu(LN 2 Part 9 (2)) 24 Tax Concession- Small & Micro Enterprises (Legal Notice 2 Part 9 (4)) 25 Bio Fuel Production (10 year tax holiday) (Legal Notice 2 Part 9 (7)) 26 Dividend Deduction (Legal Notice 2 Part 5 (5)) 27 Renewable Energy Projects(5 year tax holiday)(legal Notice 2 Part 9 (8)) 28 Nausori to Ba Tax Free Region Exemption (Legal Notice 2 Part 9 (10)) 29 Hotel Aid Investment Allowance (Legal Notice 3) 30 Medical Investment Incentives (Legal Notice 4) 31 Residential Housing Development Incentive (Legal Notice 6) 32 Maritime Vessel Investment Allowance (Legal Notice 7) 33 Film Making & Audio Visual Production - exempt income(legal Notice 8) 34 F 1 - Contribution to Audio Visual Production(150% of expenditure)(ln8) 35 F 2 - Contribution to Audio Visual Production (125% of expenditure)(ln8) 36 TFF/TFZ/TFR Concession (Legal Notice 10) 37 Decrease in Provisions 38 Amortization of Deferred Grant Revenue 39 Unrealized Exchange Gain 40 Reversal of Impairment loss 41 Share of Gain from Investment in Associates 42 Losses on Disposal of Assets for Tax purposes Office Use Only

3 3 OFFICE USE ONLY 43 Gain on Disposal of Assets for accounting purposes 44 Fuel Concession 45 Investment Allowances 46 Employee Share Scheme (Section 16) 47 Cash Donations to Approved Organisations/Charities (Section 24 (1) & (2)) Donation to Sports fund (Section 24 (3)) Donation to Fiji Heritage Foundation (Section 24 (4)) 50 Donation-Poverty Relief Fund for Education (Section 24(5)) Donation of Computers to Schools (Section 24 (6) & (7)) Disaster Rehabilitation Fund (Section 24 (8)) Donation to Farmers Emergency Fund Acc (Section 24 (11)) Listing on Stock Exchange 150% Deduction (Section 25 (2)) 55 Vanua Levu Incentive- 40% Deduction on capital expenditure(section 25 (4)&(5) % Deduction - Rural Banking Programming (Section 25 (6)) 57 Commercial Agriculture & Agro-Processing (Section 25 (7)) 58 Export Profit (Section 25 (8)) 59 ICT Development - 150% Deductions (Section 25 (12)) 60 ICT Training Institutions 150% Deductions (Section 25 (13)) 61 Uniform made in Fiji 50% Deductions (Section 25 (14)) 62 Cyclone Reserve Fund (Section 28) 63 Amortization of Business Intangibles (Section 35) 64 ETS (Section 143 (3)) 150% Deductions for Professional Qualification Fees 65 ETS 200% Deductions for First Full Time Employees, Student Employees 66 ETS 300% Deduction for employment of Disabled People 67 Electric Vehicle Charging Station % Sponsoring 2019 ADB Annual Meeting % Renovation & Redevelopment (Modernisation) 70 25% Extension Or Redevelopment (Modernisation) % For R&D in ICT & Renewable Energy Industries 72 55% Tax Deduction for Investments in Electric Buses % Staff training cost Accredited training providers 74 CGT & Income Tax Exemption for SPSE Listing % Deduction Paternity & Family Care Leave 76 Other Items (attach details) Sub Total 77 Taxable Business Income/Loss for Current Year 78 Losses brought forward from prior years 79 CHARGEABLE INCOME/LOSS 80 Film Tax Rebate

4 Opening Stock plus: Purchases less: Closing Stock INFORMATION REQUIRED continued Office use Only Total Sales less: Cost of Goods Sold = COST OF GOODS SOLD = GROSS TRADING INCOME 86 Gross Trading Income 87 plus: Interest Income 88 plus: Dividend Income 89 plus: Other Income = TOTAL GROSS INCOME Total Expenses 92 Interest Expenses 93 Net Income 94 Total Assets 95 Total Liabilities ICT Incentives Current Year Previous Year No. of Employees Total Sales Gross Wages and Salaries paid for the year 101 DETAILS OF DIRECTOR S/MANAGEMENT FEES PAID Name of Director T.I.N. of Director Director's/Mgt Fees Continue on a separate sheet if necessary Total Fees: 102 DETAILS OF DIVIDEND PAID (Include Directors Advance/Deemed Dividend) Name of Recipient T.I.N. of Recipient Gross Dividends Continue on a separate sheet if necessary Total Dividends:

5 5 103 INTEREST INCOME INFORMATION REQUIRED continued Office use Only Name of Financial Institution Gross Interest NOTE: Continue on a separate sheet if necessary Total Interest Income: 104 OVERSEAS INCOME Name of Company W/ Gross Income Total W/ Total Gross Income: 105 DETAILS OF CONTRACTUAL PAYMENTS RECEIVED Name of Contractor T.I.N. of Contractor Gross Payment NOTE: Continue on a separate sheet if necessary Total Payments: 106 SHARE OF JOINT VENTURE/TRUST/PARTNERSHIP INCOME RECEIVED Name of Joint Venture/Trust/Partnership T.I.N. Income NOTE: Continue on a separate sheet if necessary Total Income: IRS204 [Revised:30-Jul-2018]

6 6 INFORMATION REQUIRED continued 107 DETAILS OF MANAGEMENT FEES RECEIVED Name of Paying Company T.I.N. Gross Payment Office Use Only Total Payments 108 DIRECTOR'S FEES RECEIVED Name of Director T.I.N. Gross Payment Total Payments: DECLARATION BY AUTHORISED OFFICER I, declare that this tax return is true and complete. Signature: Date: IT IS A SERIOUS OFFENCE TO MAKE A FALSE INCOME TAX RETURN DECLARATION BY TAX AGENT I, declare that this tax return has been prepared in accordance with information supplied by the taxpayer. Signature: Date: Tax Agent's No.: NOTE: All attachments to this return must be signed by the person authorised to make the return.

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