GHANA REVENUE AUTHORITY
DOMESTIC TAX REVENUE DIVISION
COMPANY SELF ASSESSMENT FORM
REVISED ANNUAL ESTIMATE
CURRENT TAX OFFICE
LTO
MTO
STO
(Tick One)
Name of GRA Tax Office
YEAR OF ASSESSMENT
(yyyy)
PERIOD:
FROM
TO
(dd/mm)
Select currency in which data is presented. GH¢
(dd/mm)
US$
£
€
COMPANY
NAME
NEW
TIN
OLD
TIN
IRS TAX FILE NO
COMPUTATION OF TAX
(Please refer to the completion notes overleaf for guidance in completing this form)
AMOUNT
1. Revised Annual Chargeable Income
2. Revised Annual Total Income Tax payable
3. Amount Already Paid/ Earlier Installment
4. Revised Total Amount of Tax Due
5. Number of Quarters Outstanding
6. Amount to be paid / Each Remaining Quarter
DECLARATION
I,
hereby declare that the Information in this form is true and accurate.
(Full Name)
Signed
Designation / Position
Date
DT 0102a ver 1.0
COMPLETION NOTES ON COMPANY SELF ESTIMATED FORM
This form gives a summary of the Estimated Computation of Tax for a Self-Assessed Company
NB: A new form is to be completed at any time the Estimate is revised
The fields to be completed are:
CURRENT TAX OFFICE : The GRA office where taxpayer transacts business
YEAR OF ASSESSMENT: This is the financial year to which the return relates
PERIOD: This refers to the beginning and end of the basis period (The Accounting year ) of the
Company
NAME OF COMPANY: This is the legally registered name of the company
NEW TIN: This the new TIN (eleven characters) - Taxpayer Identification Number
OLD TIN: This is the old TIN (ten characters) - Taxpayer Identification Number
IRS TAX FILE NUMBER: This is the number assigned to the company by the former Internal
Revenue Service
POSTAL ADDRESS: This refers to the postal contact address of the company
REVISED ANNUAL CHARGEABLE INCOME: This is the revised estimated annual income that is
to be subjected to Tax, i.e. the figure which is charged to tax at the various corporate tax rates per the
schedule of corporate tax rates attached.
REVISED ANNUAL TOTAL INCOME TAX PAYABLE: This is the revised estimated annual income
tax to be paid to the Ghana Revenue Authority.
AMOUNT ALREADY PAID/ EARLIER INSTALLMENT: This is the Amount paid earlier from an
earlier estimated annual total income tax payable OR Revised annual total income tax payable
REVISED TOTAL AMOUNT OF TAX DUE: This refers to the amount due GRA by deducting
Amount already paid/ earlier installment form Revised annual total income tax payable
NUMBER OF QUARTER(S) OUTSTANDING: The number of quarter(s) remaining to end the
financial year of the Tax payer
AMOUNT TO BE PAID/ EACH REMAINING QUARTER: The remaining estimated annual income
tax to be paid to the Ghana Revenue Authority at the end of each remaining quarter.
DECLARATION.
This must be done by an authorized officer of the company and the required details that include the
following Should be completed:
i.
Name in full
ii.
Designation/position
iii.
Signature
iv.
Date
DT 0102a ver 1.0