Transcription of TAX AMNESTY APPLICATION FORM - GRA
1 GHANA REVENUE AUTHORITY. DOMESTIC TAX REVENUE DIVISION. Republic of Ghana TAX AMNESTY . APPLICATION form . (Section 3(1); Internal Revenue (Tax AMNESTY ) Act, 2012 (Act 853). NAME OF TAXPAYER. NEW TIN. OLD TIN OLD IRS FILE No POSTAL ADDRES. LOCATION ADDRESS. TELEPHONE No(s). E-MAIL. NAME OF CONTACT PERSON. NATURE OF BUSINESS. (Tick X' as appropriate) Yes No Are you undergoing any Audit or Investigation? Are you undergoing any Enforcement Action? Have you ever been notified of an assessment or additional assessment relating to the tax type you are applying for the AMNESTY ? If you replied (Yes) to any of the above, please provide brief details.. Underline the Tax type(s) for which you wish apply for Tax AMNESTY ;. Corporate tax; Personal Income tax; PAYE; Withholding taxes Dividend; Royalty; Rent Tax; Capital Gains Tax;. Gift Tax; Others (Specify).)
2 Summary of undisclosed incomes or unpaid taxes for each year of assessment for the Tax type(s). selected. (Select Tax Type from the above). Year of Undeclared Undeclared Tax Type Assessment Taxable income Outstanding Tax TOTAL. DECLARATION. I do hereby declare that the information provided in this form and accompanying Returns are to the best of my knowledge true, correct and complete. Signature: KLC;MDKD;. Designation: Date FOR OFFICE USE ONLY. Date received: .. Name & signature of Vetting Officer: .. List of Returns submitted with APPLICATION form : .. Tax liability confirmed (per tax type): .. Total Tax Payable: Tax paid: .. Payment Receipt No: . Name & signature of Supervisor.. Payment Receipt Date.
