TRANSFER PRICING DECLARATION FORM PARTICULARS OF PARENT COMPANY

Transcription

1 TRANSFER PRICING DECLARATION FORM PART A: PARTICULARS OF PARENT COMPANY A1 of company A2 A3 A4 RC. No. Tax Identification Number (TIN) A5 A A7 A8 A9 address Resident in Nigeria (Indicate X ) Yes No Tax ID of Non-resident Company Country of incorporation Principal Activities A10 A11 A12 A13 Have the company complied with the TP Regulations? Yes No (Indicate X ) If no, state reason(s) for non compliance Is TP Documentation in place? (Indicate X ) Yes No If no, state reason(s) for non compliance

2 PART B: PARTICULARS OF COMPANY B1 Ownership of company {Enter X in as many boxes as applicable} Governme nt Institution Subsidiary/ Associate of a foreign company Subsidiary/ Associate of a Nigerian Company Parent of foreign subsidiary (ies) Parent of Nigerian subsidiary (ies) Branch or PE of a foreign MNE B2 Profit Sharing Business Arrangement {Enter X in as many boxes as applicable} Partnership Joint Venture Others (Please specify) B3 Registered Postcode Town State B4 Telephone Nos. B5 Postal Postcode Town State 2

3 B of Business Premises Postcode Town State B7 B8 B9 B10 address Website of Bank ** where company s records are kept (Enter X in the relevant box) as per B3 as per B5 as per B B11 Other address If B9 is N/A Postcode Town State B12 Principal Activities ** Provide names of other banks with account details on separate sheet. 3

4 PART C: PARTICULARS OF DIRECTORS C1 C1A Director 1: C1B C1C C1D C1E C1F C2 C2A Director 2: C2B C2C C2D C2E C2F 4

5 C3 C3A Director 3: C3B C3C C3D C3E C3F C4 C4A Director 4: C4B C4C C4D C4E C4F 5

6 C5 C5A Director 5: C5B C5C C5D C5E C5F C CA Director : CB CC CD CE CF

7 C7 C7A Director 7: C7B C7C C7D C7E C7F C8 C8A Director 8: C8B C8C C8D C8E C8F 7

8 C9 C9A Director 9: C9B C9C C9D C9E C9F C10 C10A Director 10: C10B C10C C10D C10E C10F 8

9 PART E: OWNERSHIP STRUCTURE D1 Foreign Equity in comparison with paid-up capital: (Enter X in the relevant box) 75% - 100% 51% - 74% 20% - 50% 0% 19% NIL D2 Total controlled Equity in comparison with paid-up capital: (Enter X in the relevant box) 75% - 100% 51% - 74% 20% - 50% 0% 19% NIL D3 Debt Finance from related party in comparison with paid-up capital: (Enter X in the relevant box) 75% - 100% 51% - 74% 20% - 50% 0% 19% NIL D4 Other forms of finance in comparison with paid-up capital: (Enter X in the relevant box) 75% - 100% 51% - 74% 20% - 50% 0% 19% NIL 9

10 D5 Shareholding in other Companies in Nigeria S/N of Entity Country of Residence Registration No TIN Equity Shareholding (%) D4 Other Companies in Nigeria within your Group: S/N of Entity Country of Residence RC No

11 PART E: PARTICULARS OF EXTERNAL AUDITOR E1 of Firm E2 of Firm Postcode Town State E3 11

12 PART F: PARTICULARS AND SIGNATURE OF THE PERSON WHO COMPLETES THIS FORM F1 F2 Postcode Town State F3 F4 TIN F5 Signature** (** affix seal if completed by a firm) Date 12

13 DECLARATION I, Identity Card No. / * (* delete whichever is not relevant) hereby declare that this form contains information that is true, correct and complete pertaining to the Transfer Pricing Declaration for the Year 20.. as required by Tax Law. Designation Signature Date FOR OFFICE USE Date Received of Officer Designation Signature 13