PART A TAX TYPE REGISTRATION ZAMBIA REVENUE AUTHORITY APPLICATION FOR TAX REGISTRATION (Complete this form in block letters) *WHAT ARE YOU REGISTERING FOR? (Tick applicable box) TPIN PAYE INCOME TAX VAT PART B TPIN REGISTRATION SECTION A PERSONAL DETAILS (This Section applies to individual applicants) *SURNAME *FORENAME (S) *TITLE (Mr, Mrs, Ms, etc) 5 *CITIZENSHIP (Tick appropriate box) ZAMBIAN NON ZAMBIAN 6 *COUNTRY OF RESIDENCE 7 *NRC No. (For individual Citizens & Residents) 8 *PASSPORT No. (For non Citizens & Residents) (Attach copy of NRC) (Attach copy of Passport) SECTION B BUSINESS DETAILS (If you are in business, fill this Section) 9 0 *BUSINESS NAME *TRADING NAME *BUSINESS REGISTRATION No.. DATE OF COMMENCEMENT OF BUSINESS (Attach copy of Certificate Registration/Incorporation, Articles of Association) *NATURE OF BUSINESS *ESTIMATED TURNOVER TRADE CLASS CODE K 5 *TYPE OF TAXPAYER (Tick appropriate box) Company (Resident) Company (Other) Partnership Club, Association, Society, etc Individual (Resident) Individual (Other) Govt. Ministry or Agency Other *Mandatory Fields that must be filled
SECTION C GENERAL DETAILS (All applicants, Individual and Business to complete this Section) 6 ADDRESS DETAILS (Attach sketch map of physical address) *PLOT/HSE NO. STREET AREA * *PROVINCE *TELEPHONE NUMBERS PROVINCE *FAX NUMBERS E-MAIL ADDRESS MOBILE NUMBERS 7 DETAILS OF YOUR PRINCIPAL CONTACT PERSON *NAME (in full ) *POSITION *PHONE NUMBERS FAX NUMBERS PROVINCE E-MAIL MOBILE NUMBERS 8 LIST BELOW BUSINESSES OFFICIALS DIRECTORS/SHAREHOLDERS (use separate paper to add more) FULL NAMES BUSINESS POSITION POSTAL ADDRESS 9 LIST BELOW ANY OTHER BUSINESSES ASSOCIATED WITH THIS APPLICATION (use separate paper to add more) BUSINESS NAME TPIN ASSOCIATION TYPE
0 LIST VALUE OF ASSETS OF THE BUSINESS (ESTIMATES) (K) MOTOR VEHICLES PLANT AND MACHINERY FURNITURE AND FITTINGS OFFICE EQUIPMENT LAND AND BUILDINGS STOCK SHARES IN COMPANIES TREASURY BILL AND GOVT. BONDS CASH AT BANK CASH IN HAND BANK DETAILS (Attach Bank Statement) BANK NAME ACCOUNT TYPE BRANCH NAME ACCOUNT NO. ACCOUNT HOLDER SOURCE OF CAPITAL AMOUNT OF CAPITAL (K) BUSINESS PROPERTY (Tick appropriate box) OWNED RENTED 5 AMOUNT OF RENT PAID (K) 6 WITHHOLDING TAX DEDUCTED 7 W/HOLDING TAX A/C NO. YES NO 8 ADDRESS OF THE LANDLORD *NAME (in full ) *POSITION *PHONE NUMBERS FAX NUMBERS PROVINCE E-MAIL MOBILE NUMBERS
PART C PAYE REGISTRATION 9 NUMBER OF EMPLOYEES 0 INDICATE AVERAGE RANGE OF YOUR EMPLOYEES EARNINGS MINIMUM (K) MAXIMUM (K) WHEN ARE PAYMENTS MADE? (Tick appropriate box) WEEKLY MONTHLY QUARTERLY ANNUALLY HAVE YOU PREVIOUSLY OPERATED PAYE FOR YOUR EMPLOYEES? YES NO IF YES, GIVE FULL NAMES AND ADDRESS OF YOUR PREVIOUS BUSINESS, PAYE REF. NO. AND THE DATE IT CEASED NAME PAYE REF. NO. DATE CEASED PART D COMPANY/PARTNERSHIP REGISTRATION (If Partnership, ignore fields and 5 and complete TPIN form). TYPE OF BUSINESS (Tick appropriate box) PUBLIC LIMITED PRIVATE LIMITED PARTNERSHIP (ATTACH ARTICLES OF ASSOCIATION/PARTNERSHIP DEED/FORM FROM PACRO) 5. NUMBER OF SHARES 6. TYPE OF SHARES (Tick appropriate box) ORDINARY PREFERENTIAL PART E VAT REGISTRATION (Complete VAT Knowledge confirmation form and attach the relevant VAT registration requirements) 7 TURNOVER AND IMPORT FIGURES TAXABLE TURNOVER EXEMPT TURNOVER VALUE OF EXPORTS VALUE OF IMPORTS LAST MONTHS NEXT MONTHS
K Million TAXABLE TURNOVER D D M M Y Y Y Y E.D.R. TAX CYCLE K Million EXEMPT TURNOVER K Million D Figure (Assets) TURNOVER ABOVE K0 BILLION ( LTO) TURNOVER ABOVE K00 MILLION TO K0 BILLION (MTO) TURNOVER K00 MILLION AND BELOW ( STO) PART F DECLARATION (To be completed by an authorized person i.e. Proprietor, Director, Company Secretary) I (Full name in block letters) declare that the information given in this application is true and complete SIGNATURE: DATE: CAPACITY OF SIGNATORY: PART G (To be completed by ZRA Officers) SECTION A APPROVAL OF REGISTRATION (To be completed by approving Officers) A TAX TYPE TPIN TAX OFFICE APPROVED? APPROVED BY SIGNATURE DATE YES NO APPROVED B PAYE C INCOME TAX D VAT E TURNOVER TAX SECTION B ASIGNMENT OF REGISTRATION NUMBERS (To be completed by Data Entry Operator) TAX TYPE REGISTRATION NUMBER NAME SIGNATURE DATE A B C D TPIN PAYE COMPANY/PARTNERSHIP VAT 5
Sketch Map of Physical Address 6