VALUE ADDED TAX (Law of as subsequently modified)

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1 Page 1/13 Recette Centrale B.P L-1010 Luxembourg Tél. (1) : (+352) IBAN : LU Code BIC : CCPLLULL URL (1) : Statutory deadline : Tax office : (2) (1) Entry date : VALUE ADDED TAX (Law of as subsequently modified) Return for year 2016 Financial year from 233 / 234 / 2016 to 235 / 236 / 2016 (Name and first name, or corporate name) (Street and house number) (Country code, post code and city) I. ASSESSMENT OF TAXABLE TURNOVER Amounts VAT excluded A. Overall turnover VAT accounting scheme (tick as appropriate) 204 on sales 205 on payments received 2. Total Sales / Receipts (taxed, and out of national scope transactions, according to business branch) a) Supply and profit margin 1) Supply of inhouse manufactured goods 001 2) Supply of goods not manufactured inhouse 002 3) Net profit margin (special arrangement: Art. 56ter-1 and 56ter-2) 003 b) Supply of services 004 c) Disposal of tangible and intangible capital assets when those transactions are ancillary transactions 005 d) Other assimilated supplies a) Application of goods for private use or for that of the staff (Art.13(a)) 008 b) Application for the purpose of business of goods produced in the course of the business (Art.13(b)) 009 c) Use of goods considered business assets for purposes other than those of the business (Art.16(a)) 010 d) Supply of services carried out free of charge for purposes other than those of the business (Art.16(b)) 011 B. Exemptions and deductible amounts Intra-Community supply a) of goods (Art.43(1)(d) and (f)) to persons identified for VAT purposes in another Member State (MS) (3) 013 b) of new means of transport (Art. 43(1)(e)) to persons not identified for VAT purposes who are established or reside in an other MS Exports (Art. 43(1)(a) and (b)) Other ions (Art.43 and 60bis) Other ions (Art.44 and 56quater) Manufactured tobacco 017

2 Page 2/13 6. Transactions carried out (for which the place of supply is) abroad a) Supply, subsequent to intra-community acquisitions of goods, in the context of triangular transactions, when the customer identified for VAT purposes in the MS of destination of the goods is liable for payment of VAT in that MS (3) 018 b) Supply of goods (other than new means of transport and products subject to exise duty), dispatched or transported by or on behalf of the supplier, carried out to customers not identified for VAT purposes and established or residing in the MS where the dispatch or transport ends, when these supplies are taxable in that MS (distance selling) 203 c) Supply of services, other than ed from VAT in the customer's MS, to customers identified for VAT purposes in another MS, for which the customer is liable for VAT (3) 423 d) Supply of services to customers identified for VAT purposes in another MS, in the customer's MS 424 e) Supplies carried out within the scope of the special arrangement of art. 56sexies 226 f) Other supplies carried out (for which the place of supply is) abroad Inland supplies for which the customer is liable for the payment of VAT 419 C. Taxable turnover ( ) 022 II. ASSESSMENT OF TAX DUE (output tax) Taxable amount (net of VAT) Tax A. Breakdown of taxable turnover rate of 17 % 14 % 12 % 8 % 6 % % B. Intra-Community acquisitions of goods (4) rate of 17 % 14 % 12 % 8 % 6 % C. Acquisitions, in the context of triangular transactions, made for a subsequent supply to a customer identified for VAT purposes in the MS of destination of the goods, and for which that customer has been designated as liable for the payment of VAT (Art. 18ter(2), subpar. 2) 152

3 Page 3/13 D. Importation of goods for business purposes rate of 17 % 14 % 12 % 8 % 6 % 2. for non-business purposes rate of 17 % 14 % 12 % 8 % 6 % E. Supply of services for which the customer is liable for the payment of VAT provided to the declaring person by suppliers established or residing in another MS of the Community a) not within the territory rate of 17 % % % % % b) within the territory provided to the declaring person by suppliers not established or residing within the Community rate of 17 % % % % % provided to the declaring person by suppliers established within the territory rate of 17 %

4 Page 4/13 F. Supply of goods for which the purchaser is liable for the payment of VAT rate of 8 % % G. Special arrangement for tax suspension: adjustment (Art. 60bis, (5) and (8)) 227 H. Total tax due ( ) (to be carried forward to point IV.A) 076 III. ASSESSMENT OF DEDUCTIBLE TAX (input tax) A. Total input tax Total of VAT on stock entries 080 a) VAT invoiced by other taxable persons for goods or services supplied 077 b) VAT due in respect of intra-community acquisitions of goods other than manufactured tobacco 078 c) VAT due or paid in respect of importations of goods other than manufactured tobacco and goods for non-business purposes 079 d) VAT due under the reverse charge (cf points II.E and F) Total of VAT on capital expenditures 084 a) VAT invoiced by other taxable persons for goods or services supplied 081 b) VAT due in respect of intra-community acquisitions of goods other than manufactured tobacco 082 c) VAT due or paid in respect of importations of goods other than manufactured tobacco and goods for non-business purposes 083 d) VAT due under the reverse charge (cf points II.E and F) Total of VAT on operational expenditures 088 a) VAT invoiced by other taxable persons for goods or services supplied 085 b) VAT due in respect of intra-community acquisitions of goods other than manufactured tobacco 086 c) VAT due or paid in respect of importations of goods other than manufactured tobacco and goods for non-business purposes 087 d) VAT due under the reverse charge (cf points II.E and F) Other 179 a) Tax due in respect of the application of goods for business purposes as referred to in Art. 13(b) (cf.point I.A.3.b) 090 b) Tax paid as joint and several guarantee in accordance with the conditions laid down in Art c) Adjusted tax - special arrangement for tax suspension (Art.60bis(9), subpar. 2) 228

5 Page 5/13 B. Total input tax non-deductible Non recoverable input tax relating to supplies pursuant to Art. 44 and 56quater Non recoverable proportion of input tax determined in accordance with Art Non recoverable input tax in accordance with Art. 56ter-1(7) and 56ter-2(7) (when applying the margin scheme) 096 C. Adjustment of deductions (a decrease of the recoverable input tax has to be identified by a minus sign) Adjustment of deductions a) in accordance with provisions of Art b) in accordance with provisions of the grand-ducal Regulation of 7 March option to tax land Other: D. Total input tax deductible ( ) (to be carried forward to point IV.B) 102 IV. TAX TO BE PAID OR TO BE RECLAIMED A. Total tax due (brought forward from point II.H) 103 B. Total input tax deductible (brought forward from point III.D.) 104 C. Exceeding amount (a surplus of deductible tax must be preceded by a minus sign) ( ) 105

6 Page 6/13 V. ADDITIONAL INFORMATION A. Declaring person 1. Phone number for contacting the declaring person: 237 B. Persons employed 1. Number of persons employed (average for the year) with salary or wage with no salary (family members) 109 C. Books, records and documents 1. Taxable persons established in Luxemburg: place of storage of books, records and documents the keeping, drafting and issuing of which are required by the VAT law of 12 February 1979 and its implementing provisions, when this place of storage is outside of the territory of Luxemburg (Art. 65) : 238 The undersigned hereby certifies/certify that the information given in this return is true and complete., Date Signature(s)

7 Page 7/13 Appendix to the VAT return TOTAL BUSINESS PORTION if applicable VAT included % VAT excluded of VAT invoiced (5) A. Total operational expenditures Gross salaries (6) of which productive salaries 2. Gross wages (6) 3. Occasional salaries Compulsory social security contributions (employer's share) (7) Accident insurance Commissions Staff travel and representation expenses Accounting and bookkeeping fees (8) Employer's travel and representation expenses Electricity Gas Water Heating Telecommunications a) Renting/leasing of immovable property with application of VAT (8) b) Renting/leasing of immovable property with no application of VAT c) Renting/leasing of permanently installed equipment and machinery Fire insurance Property tax Business tax Licensing (cabaretage) tax and other taxes Interest paid for long-term debts Interest paid for short-term debts Other financial costs Stock and business equipment insurance Public and professional third party liability insurance Office expenses Cleaning and maintenance of business premises

8 Page 8/ Fees and subscriptions paid to professional associations and learned societies 33. Papers and periodicals for business purposes 34. a) Expenses for work carried out by sub-contractors b) Expenses for other work carried out by third parties 35. Shipping and transport expenses 36. Work clothes 37. Advertising and publicity 38. Packaging 39. Repair and maintenance of equipment and machinery 40. Other repairs 41. New acquisitions (tools and equipment) if their cost can be fully allocated to the year of acquisition or creation pursuant to Article 34 of Income Tax Law Total 'Appendix to Operational expenditures' (brought forward from Operational expenditures) (9) 44. Car expenses B. Assessment total of the taxable amount (10) for non-business use of assets allocated to business (Art.16/a) (to be carried forward to point I.A.3.c) of the annual return) Motor vehicles a) Values 1) Book (net asset) value at the beginning of the financial year 363 2) Acquisitions during the financial year 364 3) Sales during the financial year 365 4) Depreciation during the financial year (11) (to be carried forward to b)5)) 366 5) Book (net asset) value at the end of the financial year 367 Taxable amount (net of VAT) b) Total of expenses during the financial year ) Fuel (petrol, diesel) and lubricants Tax LPG ) Repairs and servicing ) Tyres, etc ) Leasing / renting ) Depreciation (11) (brought forward from a)4)) 380 c) Number of km travelled during the financial year km travelled 383 non-business portion (km) 384 non-business portion (in %) 385 Non-business part of expenditures for motor vehicules (VAT excluded) (385x381) Other assets:

9 Page 9/13 C. Supplies carried out within the scope of the special arrangement of art. 56sexies Services supplied by the declaring person himself as a registered taxpayer in Luxembourg Services to be declared and taxed by the registered taxpayer in Luxembourg, which have been supplied by fixed establishments located in other Member States 107 D. Total entry of stock for business purposes (all amounts VAT excluded) (12) not falling within the scope of Art. 56ter-1 and 56ter of which goods for resale Purchases of goods (within the territory of Luxembourg or abroad and subsequently brought to Luxembourg) which give rise to a chargeable event for the supplier or for the taxable person acquiring the goods 148 a) Purchases within the country (13) 131 1) Purchases other than manufactured tobacco 129 rate of 17 % 14 % 12 % (14) 10 % 8 % 6 % (14) 4 % 394 % 128 2) Manufactured tobacco b) Intra-Community acquisitions 139 1) Acquisitions other than manufactured tobacco 137 rate of 17 % 14 % 12 % 8 % 6 % ) Manufactured tobacco (15)

10 Page 10/13 c) Imports (16) 147 1) Imports other than manufactured tobacco 145 rate of 17 % % % % % % 2) Manufactured tobacco (15) Purchases of goods (within the territory of Luxembourg or abroad and subsequently brought to Luxembourg) which don't give rise to a chargeable event neither for the supplier nor for the taxable person acquiring the goods Purchases of goods abroad which are not brought to Luxembourg E. Stock / Miscellaneous (amounts VAT excluded) Start of financial year End of financial year 1. Total stock and tobacco a) Stock not falling within the scope of Art. 56ter-1 and 56ter-2 and manufactured tobacco referred to in b) excluded rate of 17 % % % % % % % % which of total under 1.a) is 1) stock for resale 2) goods produced inhouse b) Manufactured tobacco in stock Work in progress (VAT excluded) Receivables from clients (VAT excluded) Payments made on account by clients (VAT excluded)

11 Page 11/13 F. Names and addresses to be specified - points 9. and 18.a) of (A) 1. Accountant (A-9.) a) Name b) Address Lessor (A-18.a)) a) Name b) Address G. Annual accounts 1. submitted to the Trade and Companies Register (RCSL) (tick as appropriate) 998 yes 999 no

12 Page 12/13 Appendix to Operational expenditures DETAIL OF EXPENSES LINE BUSINESS PORTION expenditures VAT excluded of VAT invoiced (5) Total to be carried forward to line

13 Page 13/13 Important comments 1. - The return duly completed and signed is to be sent electronically (signed with Luxtrust) or by mail at the address specified on page 1 and will be processed by the competent tax office once entered into the IT-system by the Recette Centrale. - In case of technical problems in relation to the electronic deposit of the return, please contact the helpdesk at the following phone: (+352) The search of the tax office in charge can be made on the following internet page: VAT having become chargeable during the tax period stated on page 1 is to be paid to the State before March first of the year following the tax period (declaring person under Annual Plan) respectively before May first of the year following the tax period (declaring person under periodic conditions). To this end, a return is to be submitted by the same date, setting out all the information needed to calculate the tax and the deductions to be made. - In case of closing down of business, the statutory deadline for submission of this return and payment of tax is within 2 months following closing down of business. - The date of the deposit deadline is available for information only and without guarantee on the first page of the internet site the official regulations being legally binding. - Please clearly indicate your matricule in all of your correspondence and when making payments. - For each tax period, a separate return is to be submitted. - The annexed forms are to be filled in accurately and filed jointly with the return. - The payment of the tax has to be made to the IBAN account: LU Code BIC: CCPLLULL - A surplus of input tax shall be refunded by a transfer to the bank account the declaring person has indicated to the Administration. 3. Amounts entered into fields 013, 018 or 423 match the sums of the corresponding sections of the recapitulative statements submitted for the accounting period. 4. Intra-Community acquisition of goods (Art. 18(1)) and application treated as such (Art. 18bis). Supply of goods, made within the territory in the context of triangular transactions and for which the declaring person is liable for payment of VAT. 5. Exclusively VAT actually invoiced; please do not show VAT due in respect of intra-community acquisitions of goods and importation of goods or VAT due under the reverse charge. 6. Not including payments on behalf of third parties (e.g. sickness benefits advanced on behalf of the national healthcare system - Caisse Nationale de Santé - and which will be reimbursed by the latter). 7. Including all special taxes (e.g. solidarity tax) charged on salaries and wages. 8. Names and addresses to be specified under F). Deduction of VAT in respect of operating costs can be refused if the supplier's name is not or cannot be indicated. 9. A detailed list of expenses not listed under point (A) of the appendix to the annual return can be joined as 'Appendix to Operational expenditures'; total sums of such an 'Appendix' are to be carried forward to line 43 of point (A). 10. The taxable amount shall be the full cost of providing the services. 11. Only if the person declaring was or is able to reclaim VAT paid or declared in respect of the car's purchase. 12. Does not pertain to goods categorised as capital or operational expenditures. 13. Including electricity, gas, heat and cooling energy supplied by a taxable person not established in Luxembourg, when the person declaring is liable for the payment of VAT under the reverse charge mechanism. 14. Agricultural products purchased from a taxable person applying the flat-rate scheme for farmers. 15. Price stated on the tax label less VAT included. 16. Including taxes, duties, levies and other charges, excluding VAT itself, as well as incidental expenses, such as commission, packing, transport and insurance costs, incurred up to the first place of destination within the country. The taxable amount shall also include any of the afore-mentioned incidental expenses resulting from transport to another place of destination within the Community, if that other place is known when the chargeable event occurs (Art. 34).

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