Revenue Collection Division RETURN of INCOME for BUSINESS, PROFESSIONALS, FARMING, RENT, DIVIDEND, INTEREST, BENEFICIARIES and PARTNERS Derived during the year ended 31st December B Tax Identification No.: () First Name: Middle Name: Last Name: Residential Address : F.N.P.F. No.: Date of Birth: Father's Name: Sex: Phone No.: Male Female Postal Address (if different from above) : Mobile No.: Email: Name of Spouse: Spouse's : Date marriage registered: Occupation, Trade, Business or Vocation : Provide your local bank details to the right for direct deposit of your tax refund. Non-resident taxpayers to complete and attach supplementary TT Declaration Form (IRS230) for banking abroad. Spouse employed during this period? Yes No Bank Name: Bank Branch: Account No. : RESIDENTIAL STATUS (Tick one box only ) NON-RESIDENT ONLY Permit No.: Resident : Non-Resident: 4 Date of Arrival in Fiji: Expected Date of Departure: Actual Date of Departure: FEMALE RESIDENT (Tick one box only as appropriate) Unmarried OR legally separated without a dependent child : Husband working & lodging a separate return : Widow : Date of Death: Married with a dependent husband : 0 2 3 5 MALE RESIDENT (Tick one box only as appropriate) Unmarried OR legally separated without a dependent child OR wife lodges a separate return : Married with a dependent wife : Widower : Date of Death: Combined return of husband and wife : 0 1 3 7 Legally separated with dependent child / children : Legally separated with dependent child / children : OFFICE USE ONLY DATA ENTRY : FSIC : Stamp Here ASSESSOR : BATCH NO. : CHECKER : RETURN NO. :
2 TOTAL INCOME DERIVED DURING THE YEAR 1 INCOME FROM EMPLOYMENT (attach slip or certificate) Name of Employer Salary or Wages Office Use Only c Pension Income Wife's Income (if less than 1,200) Total Total Salary or Wages (C/F to line 51): 2 3 Total Value of Benefits DIRECTOR'S/MANAGEMENT FEES RECEIVED Name of Company or Organisation Director's/ Management Fees Total Total Fees (C/F to line 51): 4 SHARE OF PARTNERSHIP INCOME/(LOSS) Name of Partnership Income Total Partnership Income (C/F to line 50): 5 SHARE OF TRUST/ESTATE INCOME Name of Trust/Estate Income Total Income (C/F to line 51):
3 TOTAL INCOME DERIVED DURING THE YEAR (continued) 6 INTEREST INCOME Office Use Only Name of Financial Instituation Gross Interest 7 OVERSEAS INCOME Total Total Interest Income (C/F to line 51): Name of Company Gross Interest Total Total Overseas Income(C/F to line 51): DIVIDENDS RECEIVED Name of Company Gross Dividends Total Total Dividends (C/F to line 51): 9 RENTAL INCOME Gross Rents and Premiums : Period from to less EXPENSES Gross Rents and Premiums : Period from to (a) Rates c less EXPENSES (b) Rent paid in respect of Lease (a) Rates (c) Insurance on Property (b) Rent paid in respect of Lease (d) Repairs & Maintenance (c) Insurance on Property (e) Interest (d) Repairs & Maintenance (f) Depreciation (e) Interest (g) Other Expenses (f) Depreciation (g) Other Expenses Total Expenses: Deduct Adjustment for Portion of Property occupied by You Total Expenses: Net Income/(Loss) from Rent: Address/Location of Property
4 TOTAL INCOME DERIVED DURING THE YEAR (continued) 10 Net Farming Income 11 Net Income from other Farming Activities 12 Net Income from other Business 13 Other income Office Use Only Add: 14 15 16 17 1 19 20 21 22 Items not allowable as deductions (attach details) Accounting Depreciation Capital Expenditure Income Taxes Donations and Subscriptions Legal Expenses Losses on disposal of Assets for accounting purposes Preliminary Expenses Gain on disposal of Fixed assets for tax purposes Other Items (attach details) Sub Total : Less: Deductions/Concessions Sub Total : 23 24 25 26 27 2 29 30 31 32 33 34 35 36 37 3 39 40 41 42 43 44 45 46 47 4 Pension Exemption Lump Sum Payment Deduction (max. 5,000) Employee Share Scheme (max. 1,000) Dividend Deduction Interest on Housing Loan (max 400) Net Exempt Income Tax depreciation allowable Cash Donations to Approved Organisations/Charities Hotels Aid Investment Allowance Accelerated Depreciation Film Making & Audio Visual Production- exempt income (6th Schedule) F1 - Contribution to Audio Visual Production (150% of monies expended) F2 - Contribution to Audio Visual Production (125% of monies expended) Tourist Vessels (th Schedule) Export Promotion Incentive Fuel Concession Employment Taxation Scheme Export Profit (Section 21B) Investment Allowances (Section 21C) Losses on disposable of assets for Tax purposes Vanua Levu Incentives 300% deduction on capital expenditure Vanua Levu Incentives 200% deduction for employment taxation scheme Vanua Levu Incentives 100% exemption for exports Small & Micro Enterprises deductions Donation to Flash Flood 200% Other Items (attach details) Sub Total : 49 50 51 Taxable Business Income/(Loss) for Current Year Losses brought forward from prior years TOTAL INCOME/(LOSS) (Add lines 1-22 minus lines 23-4)
5 52 ALLOWANCES CLAIMABLE FOR INCOME TAX PURPOSES MARITAL ALLOWANCE 53 DEPENDANT CHILD ALLOWANCE Name of Child Relationship Date of Birth Separate Income of Child Is Child at School? If child incapacitated nature of infirmity Office Use Only 54 ELDERLY DEPENDANT ALLOWANCE Name of elderly dependant Relationship Date of Birth Total Child Allowance: Separate Income of Elderly Dependant Total Elderly Dependant Allowance: 55 F.N.P.F., LIFE INSURANCE, SUPERANNUATION (Maximum claim is 1500 (or 3000 joint return) F.N.P.F. Contribution Name of Company Name of Insured Date of Policy Term of Capital sum Policy Assured Total F.N.P.F. and Insurance: 56 57 Total Allowances Chargeable Income/(Loss) 5 Redundancy Payment (attach details) less: Exemption Taxable Amount of Redundancy Payment : 59 60 61 Opening Stock plus: Purchases less: Closing Stock = COST OF GOODS SOLD 62 63 Total Sales less: Cost of Goods Sold 64 Gross Trading Income = GROSS TRADING INCOME
6 INFORMATION REQUIRED Office Use Only 65 plus: Interest Income 66 plus: Dividend Income 67 plus: Other Income = TOTAL GROSS INCOME 6 Total Expenses 69 Interest Expenses 70 Net Income 71 Total Assets 72 Total Liabilities 73 DETAILS OF CONTRACTUAL PAYMENTS RECEIVED Name of Contractor of Contractor Gross Payment Total : Total Payments 74 DETAILS OF CANE PAYMENTS RECEIVED Name of Contractor of Contractor Farm No. Sector No. Tax Deducted Gross Payment DECLARATION AND AUTHORITY OF TAXPAYER Total : Total Payments I, declare that this tax return is true and complete. I agree I do not agree to transfer part or whole of my credit to offset my spouse's liability. (Tick the appropriate box) Signature: Date: DECLARATION BY TAX AGENT I, declare that this tax return has been prepared in accordance with information supplied by the taxpayer. Tax Agent's No.: Signature: Date: NOTE : All attachments to this return must be signed by the person authorised to make the return. IT IS A SERIOUS OFFENCE TO MAKE A FALSE INCOME TAX RETURN