Registered ame Trade ame PARTICULARS OF PUBLIC OFFICER Domicilium Citandi Et Executandi (Address for legal purposes) PARTICULARS OF COMPA / CLOSE CORPORATIO Surname Cell no. contact telephone no. I declare that: I am the duly appointed Public Officer / Representative Taxpayer of the company / close corporation; and The information furnished in this return is true and correct in every respect; and I have disclosed all gross amounts of all income received and / or accrued to this company / close corporation during the period covered by this return; and I have the necessary financial records to support all the declarations on this form which I will retain for audit purposes. Initials SIGATURE PAE / SDL / UIF Reference o. Address Registered Address Physical Address TAX REFERECE O. Company / CC registration no. Date VAT Reference o. Financial year end Please consult the SARS guide prior to completing this tax return. ear of Assessment Rate the preference as to how you would like to be contacted (Scale of 1 to 5) Email M M D D RETUR OF ICOME: Companies and Close Corporations (Income Tax Act, o. 58 of 1962, as amended) SMS Post Fax / / / Through Tax Practitioner 2008 M M D D Email address Date of appointment M M D D ID o.
BAK ACCOUT DETAILS Account o. Branch o. Cheque ame of Account Holder Did a tax practitioner complete this form? Tax Practitioner Registration o. Tax Practitioner's Tel o. Savings / Transmission TAX PRACTITIOER DETAILS PR - ASSESSMET, AUDIT AD OTHER IFORMATIO Mark the applicable block with an X Listed Public Company Unlisted Public Private Close 01 Company 02 Company 03 Corp. 04 05 Is the Auditor s / Accounting officer s report qualified? Is the company dormant? If dormant does the company have any assets, liabilities and / or reserves? Is the company resident outside South Africa due to: Foreign incorporation (and not effectively managed in SA)? By virtue of a treaty to avoid double taxation? Is this return in respect of a branch or agency of a foreign company? Is this company an international headquarter company (applicable only to financial years ended on or prior to 31/5/2004)? Does the company have participation rights and / or voting rights in a controlled foreign company (CFC)? Is the company a small business corporation? ASSESSMET, AUDIT AD OTHER IFORMATIO Is the company a labour broker? If ES - state the IRP30 o. Province where main industry is carried on (refer to guide). Source code of main industry (refer to guide). State the profit code of your main source of income (refer to the source code booklet available on the SARS website). BALACE SHEET IFORMATIO O-CURRET ASSETS Fixed property Fixed assets (plant and equipment) Fixed assets - other Goodwill and intellectual property Investments in subsidiaries free bearing Deferred tax assets non-current assets Tax o: Tax ear: Reg ame: Page o: 0 0 4609 4611 4632 4610 4645 4613 4614 4634 4636 BALACE SHEET IFORMATIO continued... CURRET ASSETS Inventory and work in progress (net after provisions) Trade and other receivables (net after provisions) Prepayments Group companies current accounts Short-term investments SA Revenue Service Cash and cash equivalents current assets CAPITAL AD RESERVES Credit balances Share capital Share premium on-distributable reserves Distributable reserves (excl. retained profit / accumulated loss) Retained profit 02/06 capital and reserves Debit Balances Accumulated loss capital and reserves 4615 4637 4617 4619 4621 4620 4638 4622 4639 4640 4601 4602 4603 4641 4604 4642 If ES - state the gross income of the company Is the company a personal service company? If ES - how many employees are in the company s service that are non-connected persons? R
BALACE SHEET IFORMATIO continued... O-CURRET LIABILITIES bearing free Deferred tax liability non-current liabilities CURRET LIABILITIES Trade and other payables (including accruals) Provisions excluding inventory and trade receivables Deposits and funds received in advance Group companies current accounts Contract progress payments received in advance Current portion of interest bearing borrowings Current portion of interest free borrowings Overdraft and interest bearing short-term borrowings SA Revenue Service Shareholders for dividend / proposed dividend current liabilities ICOME STATEMET IFORMATIO GROSS PROFIT / LOSS (THE SHADED AREAS I THIS PART REFER TO DEBITS) Sales (Turnover) Cost of sales (excl. inventory adjustments) Inventory adjustments (writeoff reversed) Inventory adj. (write-off of obsolete / slow-moving stock) 4607 4608 4605 4643 4623 4624 4625 4646 4626 4627 4644 4628 4629 4630 4631 4501 4502 4545 4560 ICOME STATEMET IFORMATIO continued... Admin., management, secretarial, rentals - other persons Bad and doubtful debts recovered Dividends local Dividends foreign Foreign exchange gain Interest financial institutions Interest connected persons Interest - other Accounting profit on disposal of fixed assets and / or other assets Gross royalties and license fees income EXPESE ITEMS (OL DEBIT AMOUTS) Admin., mng., secretarial fees, rentals - connected persons Admin., mng., secretarial fees, rentals - other persons Alterations and improvements (excluding repairs and maintenance) Compensation for loss of office Consulting, legal and professional fees Provision of doubtful debts Bad debts written off 4561 4508 4509 4546 4510 4511 4512 4513 4514 4563 4515 4516 4564 4565 4566 4518 4567 ICOME STATEMET IFORMATIO continued... Depreciation Directors / members remuneration Donations Foreign exchange loss Interest financial institutions Interest connected persons Interest other Insurance premiums unrelated to assets of company Accounting loss on disposal of fixed assets/other assets Medical, pension and provident fund contributions Research and development costs Restraint of trade Repairs and maintenance Royalties and license fees (gross) Salaries and wages (excl. medical, pension, provident fund contributions) Foreign travelling ET PROFIT / LOSS et profit subtotal 03/06 et loss subtotal Tax o: 4547 Tax ear: Reg ame: Page o: 4519 4569 4576 4520 4521 4522 4523 4580 4524 4581 4570 4571 4528 4572 4529 4574 4599 4532 4533 Gross profit subtotal 4503 Gross loss subtotal 4504 ICOME ITEMS (OL CREDIT AMOUTS) Admin., management, secretarial, rentals connected persons 4507
TAX COMPUTATIO DEBIT ADJUSTMETS (DECREASE ET PROFIT / ICREASE ET LOSS) on-taxable Amounts Credited to the Income Statement Accounting interest received (s 24J) Accounting profit on disposal of fixed and / or other assets Amounts previously taxed as received in advance Local dividends excl. dividends mentioned in s 8E and 103(5) Exempt foreign dividends (s 10(1)(k)(ii)) Income (other than foreign dividends) exempt from tax (s 10) Receipts and / or accruals of a capital nature Reversal of provisions Accounting adjustments to Fair value adjustments to Special Allowances ot Claimed in the Income Statement Allowance for future expenditure (s 24C) Amortisation of lump sum contr. to retirement / benefit funds (s 11(/)) Broad-based employee share plan (deduction this year) (s 11(/A) All building allowances Credit agreement and debtors allowance (hirepurchase) (s 24) Doubtful debt allowance (s 11(j)) Economic development area allowance Film allowance (s 24F) Improvement to leasehold premises (s 11(g)) 6902 6914 6905 6907 6908 4401 6911 6996 6903 6909 6912 4414 6915 69A4 4494 4408 4410 TAX COMPUTATIO continued... Lease premium allowance (s 11(f)) Machinery, ship or aircraft allowance (s 12B and 12C) Plant and machinery of small business corporations Industrial assets used for qualifying strategic industrial projects (s 12G) Learnership agreements registered in current year Learnership agreements completed in current year Restraint of trade (s 11(cA)) Reversal of closing values consumable stock and spare parts (previous year) Reversal closing values of work in progress (s 22(2A) previous year) Depreciable asset allowance (s 11(o)) UDZ (s 13 quat ) improvements this year UDZ (s 13 quat ) erection of a new building this year Transfer pricing adjustment Wear and tear allowance (s 11(e)) deductible items 4411 Tax o: Tax ear: 4413 Reg ame: 4417 Prepaid expenditure not limited by s 23H 4419 4466 4421 4453 4455 6997 6998 6999 4468 4469 4425 4481 4482 4426 4427 6935 TAX COMPUTATIO continued... CREDIT ADJUSTMETS (ICREASE ET PROFIT / DECREASE ET LOSS) on-deductible Amounts Debited to the Income Statement Accounting interest paid (s 24J) Accounting losses derived from foreign sources (excluding CFC) Accounting loss on disposal of fixed and / or other assets Amortisation of lease premiums and improvements to leasehold premises Capital expenditure and / or losses Capital improvements farming operations Depreciation according to financial statements Donations Expenses attributable to dividend and exempt income Expenses attributable to exempt foreign dividends Expenses - non-taxable foreign sources (excl. foreign dividends) Provisions not deductible current year Interest paid in respect of capitalised leased assets Interest, penalties paid in respect of taxes (s 23(d)) Lump sum contributions to retirement and / or benefit funds Page o: 04/06 Research and development Restraint of trade payments Transfer pricing adjustments Prepaid expenditure as limited by s 23H 6942 69A1 69A7 6944 6945 4407 4519 4464 6948 6950 6952 6953 6954 6956 69A2 Financial assistance (s 31(3)) 6960 6949 6957 6958 6959 Interest incurred (s 24J) 6978 Lease payments on capitalised leased assets Research and development deduction Deductions against foreign dividends 4418 4495 4496
TAX COMPUTATIO continued... UDZ (s 13quat ) total cost incurred i.r.o. erection or improvements of a building Accounting adjustments to Fair value adjustments to ALLOWACES / DEDUCTIOS GRATED I PREVIOUS EARS OF ASSESSMET AD OW REVERSED Doubtful debt allowance (s 11(j)) Allowance for future expenditure (s 24C) Credit agreements and debtors allowance (hirepurchase) (s 24) AMOUTS OT CREDITED TO THE ICOME STATEMET Amounts received in advance Amounts accrued but not received Closing value of consumable stock and spare parts Closing value of work in progress (s 22(2A)) Income deemed to be from a source within the Republic Interest accrued (s 24J) Loans / advances granted by an insurer (par. (m) of def. of gross income ) Taxes upon profits and withholding taxes (s 11C(4)) Transfer pricing adjustment RECOUPMET OF ALLOWACES PREVIOUSL GRATED 4480 6946 6947 6961 6968 6969 6970 6971 6974 4465 6975 6976 6977 6978 6979 6980 69A3 6983 TAX COMPUTATIO continued... AMOUTS TO BE ICLUDED I THE DETERMIATIO OF TAXABLE ICOME (Excluding assessed loss brought forward) Calc. profit Calc. loss Capital Gain: Local Capital Loss: Local Capital Gain: Foreign Capital Loss: Foreign Imputed net income from CFC 4250 4251 4252 Tax o: 4253 Tax ear: Reg ame: 4276 TAXABLE FOREIG ICOME SECTIO 6quat (excluding foreign capital gain / loss) Foreign trading Foreign services Foreign annuities Foreign investments foreign income Imputed net income CFC Amount (Rands only) Source CREDITS AVAILABLE (excluding provisional tax) PAE Foreign Tax Credit (refer to Taxable Foreign Income below) Foreign Tax Credit i.r.o. Capital Gain Do you elect to be taxed on net foreign dividends? (Applicable i.r.o. 2007 and prior years) Losses Taxable Foreign Tax Credits,,, Page o: 7450 7451 7452 7453 7454 7455 4102 4105 4114 05/06 Bad debts 4467 Lease charges (s 8(5)) 6986 Wear and tear (s 8(4)) 6985 6992
ote: FIACIAL IFORMATIO ITEMS Schedules must be prepared in all cases where the under mentioned questions are answered in the affirmative. The schedules must contain the information requested in the guide and must be retained for a period of 5 years after submission of this return. Mark the appropriate blocks with an X i.r.o. the following questions: CAPITAL / REVEUE RELATED Did the company claim payments in the elimination of competition? Has there been a change of intention as to the handling of marketable securities acquired in this or prior years? EMPLOEES / REMUERATIO RELATED FIACIG RELATED 7003 70AQ Did the company make an election i.t.o. s 9B? 7021 Did the company make any restraint of trade payments which are deductible in terms of s 11(cA)? Does the company pay commission to employees? Does the company employ any expatriates? Are the employees of the company allowed to receive gifts or gift vouchers from other parties in excess of R2 000? Did the company claim an allowance in respect of registered learnership agreements as contemplated in s 12H of the Act? Was there recoupment of any allowances claimed in terms of s 12H with regard to registered learnership agreements terminated prior to completion thereof, as contemplated in s 12H(5)? Did the company enter into a scheme whereby its employees / directors acquired any equity instruments by virtue of their employment or office held, as contemplated in s 8C? Did the company pay any insurance premiums on the lives of employees or directors? Did the company pay any monthly or annual premiums i.r.o. post-retirement benefits? Did the company pay or credit any amounts (including interest) to any director, shareholder, their spouses, their children or a trust? Did the company enter into any sale and leaseback agreement? Has the company entered into any transaction as contemplated in s 24J, 24K or 24L? Did the company enter into any reportable arrangement in terms of s 76A / s 80M - 80T of the Income Tax Act? If ES, please complete the reportable arrangement number: 7096 70B4 70B5 70B6 7094 70AS 70AT 7007 7026 7068 7041 7045 70AU FIACIAL IFORMATIO ITEMS continued Is the company party to any arrangement which has the following features: Round trip financing? Elements that have the effect of offsetting or cancelling each other? Presence of an accommodating or tax-indifferent party? Did the company enter into a contract of sale or purchase of a business as a going concern? OTHER TAX ALLOWACES / LIMITATIOS Was there any direct / indirect change in shareholder s interest during the year of assessment (excluding listed companies)? Research and development information section 11D Did the company incur any expense on scientific or technological research and development for the purpose of: The discovery of novel, practical and non obvious information of a scientific and technological nature? The devising, developing or creating of any inventions, any design or computer programme or other similar property? Did the company incur any capital expenditure on buildings, machinery, plant, implements or utensils? Did the company receive a government grant for the purpose of scientific or technological research and development? Did the company complete the questionnaire and submit it to the Department of Science and Technology? Tax o: Tax ear: Reg ame: Page o: 70B8 70B9 70C0 70C1 7083 70C2 70C3 70C4 70C5 70C6 FIACIAL IFORMATIO ITEMS continued CORPORATE RULES Was the company during the year of assessment a party to any transaction as contemplated in s 42 47? ITERATIOAL RELATED Does the company, together with any connected person in relation to the company, hold at least 10% of the participation rights in any controlled foreign company? If ES, did the company complete an IT10 that must be retained for a period of five years after date of submission of this return? Did the company enter into any cross-border transactions, i.t.o. an international agreement, as defined in s 31? Does the company have a transfer pricing policy document in support of the transfer pricing policy applied in the current year in relation to the transactions as defined in s 31? Did the company receive any financial assistance from a non-resident connected person or from an investor as defined in s 31(3) and Practice ote 2? If ES, were the provisions of s 31(3) and Practice ote 2 adhered to? Has the company provided goods, services or anything of value (including transactions on capital accounts) to a nonresident connected person for no consideration? (Please note that goods and services include a loan.) Has the company entered into a back-to-back arrangement with any other party which has resulted in an offshore connected person being granted financial assistance? MIIG ACTIVITIES 06/06 Indicate whether the company was engaged in mining or mining operations as defined in s 1 of the Income Tax Act during this year of assessment. If ES, complete Schedules A, B and C available on the SARS website, www.sars.gov.za, and attach to this return. SHORT TERM ISURERS Indicate whether the company is a short term insurer registered with the Financial Service Board? If ES, complete the applicable schedules available on the SARS website, www.sars.gov.za, and attach to this return. 70C7 7022 70C8 7052 7054 7053 7333 7057 70C9 70B3 70D1 RA1-70B7 Did the company receive any benefit from a reportable arrangement as contemplated in s 76A / s 80M - 80T of the Income Tax Act during this year of assessment? 70AV