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Lagos State Board Of Internal Revenue u l o P. A. Y. E. H1 EMPLOYER. EMPLOYER ANNUAL DECLARATION AND CERTIFICATE H1 SHEET No. TAX YEAR ENDED 31ST DECEMBER 20 DETAILS OF TAX Net Tax DETAILS OF EARNINGS Total Earnings Earnings Earnings Previous this for the Employ- year ment deducted deducted K N K N R if Tax National Provident Deduction Fund refunded in the previous W. O. P. F decuction Name Ref* in this em- REF* No ployment K N K CERTIFICATE OVERLEAF TO BE COMPLETED AND SIGNED. Particulars to be included in this list Class 1 Emonluments of any kind for a previous year or a subsequent year included in the totals on the 20. /. Tax Declaration Card. and not included in the Tax Deduction Card. Any payment for the year 20 /. e*g* casual fees which have not been subjected to PAYE deduction of tax Total Payment for the year not exceeding N20 may be omitted. Lump sum payments for the 20 /. In respect of the expenses not being actual reimbursements by the employer and not included on the Tax Deduction Card. Payments made for the year 20 / by the employer and not epaid by the employee in respect of pecuniary liabilities of the employee and not included on the Tax Deduction Card with the exception of medical or dental expenses and the cost of anypassage to or from Nigeria incured by the employee. For Official Enter in the appropriate Name of recepient Nature of Amount of column the year to which the Payment payment is applicable Class 1 Class 2 k Employers Annual Declaration of Emoluments etc* To be completed and sent to the Chief Inspecor of Taxes with the Tax Declaration cards ON OR BEFORE 14th January 20. Number of completed T. D. Cs returned Total tax Deductions net during the year. Total tax paid to Revenue by MONTHLY REMITTANCES*. I hereby certfy that I have declared on this form on the attached list and on the enclosed Tax Deduction Cards full and particulars of the emoluments paid to the employees of. the tax deducted therefrom and the contributions to approve Pension Funds paid by or unbehalf of each employee for the year ended 31st December 20 All Tax Deduction Cards have returned* Signed. TAX YEAR ENDED 31ST DECEMBER 20 DETAILS OF TAX Net Tax DETAILS OF EARNINGS Total Earnings Earnings Earnings Previous this for the Employ- year ment deducted deducted K N K N R if Tax National Provident Deduction Fund refunded in the previous W. O. P. F decuction Name Ref* in this em- REF* No ployment K N K CERTIFICATE OVERLEAF TO BE COMPLETED AND SIGNED. O. P. F decuction Name Ref* in this em- REF* No ployment K N K CERTIFICATE OVERLEAF TO BE COMPLETED AND SIGNED. Particulars to be included in this list Class 1 Emonluments of any kind for a previous year or a subsequent year included in the totals on the 20. Particulars to be included in this list Class 1 Emonluments of any kind for a previous year or a subsequent year included in the totals on the 20. /. Tax Declaration Card. and not included in the Tax Deduction Card. Any payment for the year 20 /.

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