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Physical Address : Finance House, High Court Road Postal Address: Commissiner Domestic Taxes, Lesotho Revenue Authority, P.O. Box 1085, Maseru 100, Lesotho Tel: +266 22325931 Fax: +266 22310357 Website: www.lra.org.ls Company Income Tax Return for Year ended 31 March 2016 (see separate instructions) Enter approved substituted accounting date if different from above (day, month, year) D D M M 2 0 Y Y DETAILS OF COMPANY Name of company Postal address (P/Bag or P.O Box) Business physical address (street name or chief s name) Village/Suburb District Contact telephone number Nature of business Name and designation of nominated officer Tick/circle applicable box(es) Resident company Non-resident company Lesotho branch of non-resident company Final return (out of business) TIN Postal code Email address Caution: In Parts A through D, only report amounts allowed in computing chargeable income. PART A LESOTHO-SOURCE BUSINESS INCOME & EXPENSES (Do not include foreign-source, property, or other income.) 1. Business income (Sales/ turnover, investments, interest, premiums, gains from business assets, etc., including net business income from partnerships, trusts, and estates - attach schedule) 2. Expenses: a. Cost of sales or operations b. General & administrative c. Staff/labour costs d. Interest expense e. Depreciation and amortisation f. Foreign exchange losses g. Other expenses and losses from business assets (attach schedule) h. Total expenses (line 2a+2b+2c+2d+2e+2f+2g) 3. Current year net profit or loss (line 1-2h) Manufacturing Income (Resident Companies only) (b) Commercial Farming Income (c) Other Business Income 1

PART B FOREIGN-SOURCE BUSINESS INCOME & EXPENSES (Do not include property or other income.) Manufacturing Income (Resident Companies only) 1. Foreign-source business income (Sales/ turnover, investments, interest, premiums, gains from business assets, etc., including net foreign-source business income from partnerships, trusts, and estates - attach schedule) 2. Expenses: a. Cost of sales or operations b. General & administrative c. Staff/labour costs d. Interest expense e. Depreciation and amortisation f. Foreign exchange losses g. Other expenses and losses from business assets (attach schedule) h. Total expenses (line 2a+2b+2c+2d+2e+2f+2g) 3. Current year net profit or loss (line 1-2h) Commercial farming income Form S128-C (b) Other business income PART C PROPERTY & OTHER INCOME AND EXPENSES SECTION 1 - RENTAL INCOME & EXPENSES (If more than one property in either column, enter the totals here and attach a schedule showing the details for each property.) 1a. Type of property (Single family/stand-alone house, apartment house, commercial building, land etc.) 1b. Address of property Property situated in Lesotho (b) Property situated in a foreign country 2. Gross rents (including net rental income from partnerships, trusts, and estates as shown on attached schedule) 3. Expenses: a. Repairs & maintenance b. Interest expense c. Property insurance d. Utilities (electricity, water, and sewerage) e. Refuse disposal f. Security expenses g. Depreciation and amortisation h. Other expenses (attach schedule) i. Total expenses (line 3a+3b+3c+3d+3e+3f+3g+3h) 4. Net rental income or loss (line 2-3i). SECTION 2 - INVESTMENT & OTHER INCOME AND EXPENSES 5. Income or gains: a. Interest, dividends, and royalties b. Gains on the disposal of investment assets c. Other income (attach schedule include property and other income from partnerships, trusts, and estates) d. Total investment & other income (5a+5b+5c) Lesotho-source income (b) Foreign-source income 2

6. Expenses and losses from investment assets and donations paid to the Lesotho Sports and Recreation Commission (attach schedule) 7. Net investment & other income or loss (5d-6) SECTION 3 PROPERTY AND OTHER INCOME OR LOSS 8. Current year net profit or loss (4+7) PART D CHARGEABLE INCOME 1. Manufacturing Income a. Enter manufacturing income or loss from Part A, line 3, col. b. Enter manufacturing losses brought forward from prior years c. Chargeable manufacturing income (1a-1b). If zero or less, enter nil 2. Commercial Farming Income a. Enter Lesotho-source commercial farming income or loss from Part A, line 3, col. (b) b. Enter Lesotho-source commercial farming losses from prior years. c. Chargeable commercial farming income (2a-2b). If zero or less, enter nil 3. Business, Property and Other Income a. Enter other Lesotho-source business income or loss from Part A, line 3, col. (c) b. Enter Lesotho-source property & other income or loss from Part C, line 8, col. c. Add lines 3a and 3b d. Enter Lesotho-source, business, property, and other losses from prior years. e. Chargeable Lesotho-source business, property and other income. Subtract line (d) from line (c). If zero or less, enter nil 4. Foreign Source Income a. Enter foreign-source commercial farming income or loss from Part B, line 3, col. b. Enter foreign-source commercial farming losses from prior years c. Chargeable foreign-source commercial farming income. If zero or less, enter nil d. Enter foreign-source business income or loss from Part B, line 3, col. (b) e. Enter foreign-source property & other income or loss from Part C, line 8, col. (b) f). Add lines 4d and 4e g. Enter foreign-source business, property, and other losses from prior years h. Chargeable foreign-source business, property and other income. Subtract line (g) from line (f). If zero or less, enter nil 3

PART E CREDIT FOR FOREIGN TAX PAID (Resident companies only) 1. Foreign-source Income: a. Enter Part D, line 4a. If zero or less, enter nil. b. Enter the amount of foreign-source commercial farming losses from prior years deducted on Part D, line 4b. c. Foreign source commercial farming income - subtract line 1b from line 1a. If zero or less, enter nil. Then complete columns (b), (c), and (d) on this line. d. Add the amount from Part D, lines 4d and 4e. If zero or less, enter nil e. Enter the amount of foreign-source business, property and other losses from prior years deducted on Part D, line 4g f. Foreign source business, property and other income - subtract line 1e from line 1d. If zero or less, enter nil. Then complete columns (b), (c), and (d) on this line Foreign-source net income 2. Credit for foreign tax paid. In col. (d), add 1c+1f. Transfer this amount to Part F, line 3a (b) Foreign tax paid on the amount in column (c) Lesotho tax on the amount in column (see instructions) Form S128-C (d) Credit allowed (enter the smaller of the amount in column (b) or column (c)) PART F TAX COMPUTATION Chargeable income (b) Tax rate (c) Tax (column * column (b)) 1. Tax before credits a. Enter in col. manufacturing income from Part D, line 1c. Then complete column (c) on this line b. Enter in col. Lesotho-source commercial farming income from Part D, line 2c. Then complete column (c) on this line c. Enter in col. Lesotho-source business, property and other income from Part D, line 3e. Then complete column (c) on this line d. Enter in col. foreign-source commercial farming income from Part D, line 4c. Then complete column (c) on this line e. Enter in col. foreign-source business, property and other income from Part D, line 4h. Then complete column (c) on this line f. Branch profits tax on repatriated income (see instructions and attach computation) 2. Total tax before credits. Add 1a+1b+1c+1d +1e in column and 1b+1c+1d+1e+1f in column (c). 10% 10% 25% (*40%) * Non-resident companies electing under section 109 to be taxed by assessment must use a tax rate of 40% on this line. 3. Credits and payments (tax already paid): a. Credit for foreign tax paid from Part E, line 2 b. Income tax (WHT)paid as Lesotho resident contractor (attach tax withholding certificate) 10% 25% 4

c. Income tax (WHT) withheld on interest income paid to Lesotho residents (attach tax withholding certificate or partnership statement) d. Income tax (WHT) paid on service income payments as non-resident (attach tax withholding certificate) *applicable to electing nonresidents only. e. Income tax (WHT) withheld on dividends, interest, royalties, management charges, and other income paid as non-resident (attach tax withholding certificate) *applicable to electing nonresidents only. f. First advance installment of income tax paid g. Second advance installment of income tax paid h. Third advance installment of income tax paid i. Advance corporation tax payments 4. Total tax paid. Add 3a+3b+3c+3d+3e+3f+3g+3h+3i 5. Tax due. Line 2 minus line 4. Enter nil if less than -0-6. Tax overpaid. Line 4 minus line 2. Enter nil if less than -0-. If you are claiming repayment of the tax overpaid as shown on this line, tick this box PART G STATEMENT OF FINANCIAL POSITION ASSETS Non-current assets 1. Land 2a. Buildings, plant, and equipment Year ended 31 March 2015 (or accounting period ended 201 ) 2b. Less: Accumulated depreciation ( ) ( ) 3. Goodwill 4a. Other intangible assets 4b. Less: Accumulated amortisation ( ) ( ) 5. Investments in subsidiaries 6. Long-term investments 7. Deferred tax assets 8. Non-current finance lease receivables 9. Other non-current assets 10. Total non-current assets (1+2a+2b+3+4a+4b+5+6+7+8+9) Current assets 11. Inventories 12. Trade and other receivables 13. Current finance lease receivables 14. Costs and estimated earnings in excess of contract billings 15. Current tax assets 16. Cash 17. Assets held for sale 18. Other current assets 19. Total current assets (11+12+13+14+15+16 +17+18) 20. TOTAL ASSETS (10+19) Year ended 31 March 2016 (or accounting period ended 201 ) 5

EQUITY AND LIABILITIES (b) (c) (d) Equity 21. Issued capital 22. Reserves 23. Retained earnings (accumulated loss) 24. Equity related to assets held for sale 25. Non-controlling interests 26. TOTAL EQUITY (21+22+23+24+25) Non-current liabilities 27. Long-term loans 28. Deferred tax liabilities 29. Non-current provisions 30. Non-current deferred revenue 31. Other non-current liabilities 32. Total non-current liabilities (27+28+29+30+31) Current liabilities 33. Trade and other payables 34. Contract billings in excess of costs and estimated earnings 35. Short-term loans 36. Current tax liabilities 37. Current provisions 38. Current deferred revenue 39. Liabilities related to assets held for sale 40. Other current liabilities 41. Total current liabilities (33+34+35+36 +37+38+39+40) 42. TOTAL LIABILITIES (32+41) 43. TOTAL EQUITY & LIABILITIES (26+42) (20=43) PART H RECONCILIATION OF BOOK INCOME (LOSS) TO CHARGEABLE INCOME 1. Total profit/loss after tax per books 2. Income tax per books 3. Income subject to tax not recorded on books (attach schedule) 4. Expenses recorded on books but not deductible on this return (unallowable deductions): a. Gifts to individuals b. 50% of entertainment and meals c. Fines and penalties d. Insurance premiums for Lesotho risks paid to non-resident insurers e. Book depreciation in excess of tax f. Excess interest expense Year ended 31 March 2016 (or accounting period ended 201 ) 6

g. Other expenses not allowed for tax (attach schedule) h. Total expenses (4a+4b+4c+4d+4e+4f+4g) 5. Total (1+2+3+4h) 6. Income recorded on books exempt from tax (attach schedule) 7. Deductions on this return not charged against book income: a. Additional 25% deduction for approved training of Lesotho citizens b. Tax depreciation in excess of book c. Losses brought forward from prior years d. Other deductions not claimed on books (attach schedule) e. Total deductions (7a+7b+7c+7d) 8. Total (6+7e) 9. Chargeable income (Part F, line 2, col. A) = (5-8) Declaration of Paid Preparer (External tax consultant/accountant/auditor) (Skip this section if there is no paid preparer.) Based on all information of which I have any knowledge, I declare that the information given on this return is correct and complete and is a full statement of the income and gains chargeable to income tax for the year ended 31 March 2016 (or accounting period ended 201 ). I understand that false statements can result in prosecution and imposition of penalties. Name of paid preparer Signature of paid preparer Firm s name Firm s TIN Date (day, month, year) TIN of paid preparer D D M M 2 0 Y Y Contact telephone number Declaration of Nominated Officer I, the nominated officer, declare that the information given on this return is correct and complete and is a full statement of the income and gains chargeable to income tax for the year ended 31 March 2016 (or accounting period ended 201 ). If I am reclaiming repayment of the tax overpaid as shown on line 6 of Part F, I have ticked the box on that line. I understand that false statements can result in prosecution and imposition of penalties. Signature of officer TIN Postal address of officer (P/ Bag or P.O Box) Email address Date (day, month, year) Contact telephone number Postal code D D M M 2 0 Y Y If there has been a change of nominated officer during the year of assessment, show below the date of change and the name of the previous nominated officer. Date of change (day, month, year): Name of previous nominated officer: 7