Tanzania Revenue Authority - Home
TANZANIA REVENUE AUTHORITY
NOTIFICATION OF LUMP SUM PAYMENT
|To: | |From (insert name of employer) |
| | |………………………………………………….. |
| | |Address …………………………………………. |
| | |…………………………………………………… |
| | |Tel: ……………………..Fax: ………………… |
TIN:
NOTE: This form shall be submitted at least 14 days before the date of payment of any lump sum (gratuity, leave pay, etc).
Title: Mr Mrs Ms
First Name Middle Name Surname (of employee)
Postal Address:
P.O. Box Postal City
TIN: Pay roll number
Date of first arrival to Tanzania
With effect from
Date on which lump sum is to be made
Date of leaving employment (if appropriate)
Date of leaving Tanzania (if appropriate)
Details of salary and PAYE (up to last month of payment)
|Year: ………….. |Amount (TZS) |
|Basic Salary | |
|Allowances (attach schedule) | |
|Benefits (attach schedule) | |
|Subtotal | |
|Less: Employee’s contributions to approved Pension Fund | |
|Total amount | |
|PAYE paid | |
Enter full details of lump sum payment due i.e. nature of payment and gross amount. Where payment relates to more than one calendar year, a yearly break down should be provided.
………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
Amount of normal pay for month in which payment is due
DECLARATION
I hereby declare to the best of my knowledge and belief that the above information is true and correct.
First Name Middle Name Surname
Position
Day Month Year
Signature …………………………………………… Date
Notes
1. Allowances include all cash payments excluding reimbursement (e.g. accommodation, transport, entertainment).
2. Benefits include payments in kind (e.g. housing, motor vehicle, loans). For quantification of the benefit see Section 27 of the Income Tax Act, 2004.
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