Federal Democratic Republic of Ethiopia Ethiopian Revenue and Customs Authority

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Federal Democratic Republic of Ethiopia Pension Contribution Declaration Form

Proclamation No. 715/2011,

Ethiopian Revenue and Customs Authority (Private Organization Employees Pension Proclamation)
Section 1 - Tax payer Information
1. Tax Payer's Name (Company Name or Your Name,Fathers Name,Grand Fathers Name) 3. Tax payer Identification Number 4. Tax Account Number 8. Tax Period: Page 1
Month Year of 1

2a. Region 2b. Zone/K-Ketema 5. Tax Center Document Number (Official use Only)

14 A.A
2c. Woreda 2d. Kebele/Farmers Association 2e. House Number 6. Telephone Number 7. Fax Number

Section 2 - Declaration Details


g) Pension
c) Employee Name f) Pension Contribuition Contribuition h) Total
d) Start Date of Employment e) Basic Salary n) Employee
b) Employee TIN (Name,Father's Name and (DD/MM/YY) (BIRR) of Employee __7__% of Employer amount of the signature
a) grandfather's Name) (BIRR) __11__% Contribution
Seq. (BIRR) _18__% (BIRR)
Num (f + g)
1
2
3
4
Transfer totals from All Contribution
Sheets to this line »

Total
(line 20) (line 30) (line 40) (line 50)
Section 3 - calculation of Pension Contr. For this Period Section 4 - Employees Removed from Payroll as of this month For Official

Employee's Name
Seq (Name,Father's Name,
10 Number of Employees on your payroll for this Month Num Employee TIN grand Father's Name) Date of Payment
Total Basic Salary
20 ( From column e Above) 1 Receipt Number
Total Pension Contribution of Employee
30 ( From column f Above) 2 Amount Payment
Total Pension Contribution of Employer
40 ( From column g Above) 3 Cheque number
Total Amount of Pension Contribution
50 ( From column h Above) Cashier's Signature
Section 5 - Taxpayer Certification
I declare that the above declaration and all information provide here-with Taxpayer or Authorized Agent Employer Seal For Tax Office: Authorized tax officer
(including continuation sheets) is correct and complete. I understand that Name _____________________ Name ______________________
any misrepresentation is punishable as per the tax Laws and the penal code. Signature __________________ Signature ___________________
Dat ____________________ Date ______________________
Ethiopian Revenue & Customs Authority (as of 8/5/2011) ERCA Form (P1/2011)
N.B If you need more space, please use the continuation sheet.

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