Tax Clearance Certificate Application

Kindly ensure that all the information provided are accurate and true.

Note that all field with asterix (*) must be completed.

PART A: PERSONAL PARTICULARS

Title *

Name *

First

Middle

Last

TIN *

Click here to create a TIN

Marital Status *

Residential Address *

Address Line 1

City

State / Province / Region

Country

Business/Employer Address *

Address Line 1

City

State / Province / Region

Country

Contact No. *

Occupation *

If Married, State Spouse's Information

Name

First

Last

Date of Birth

Business/Employer's Address

Address Line 1

City

State / Province / Region

Country

Occupation

Employer

Names of Children

PART B: SOURCE OF INCOME

Salary per Annum

Allowances

Commission, Bonuses, Gratuities e.t.c

Trade, Businesses, Profession, Vocation

Consolidated Gross Income

PART C: INCOME AND TAX FOR THE CURRENT AND PREVIOUS YEARS

Income Year 1 (₦) *

Tax Paid Year 1 (₦) *

Income Year 2 (₦)

Tax Paid Year 2 (₦)

Income Year 3 (₦)

Tax Paid Year 3 (₦)

Upload Evidence of tax paid.

PENALTY FOR DEFAULT

Please note that in accordance with the relevant law, making false statement and returns or unlawful to pay tax will attract up to five (5) years imprisonment

DECLARATION

I Hereby declare that information supplied in this form contain a true and correct statement of the amount of my income from all sources.

Name *

First

Last

Check the box below if you agree *

I AGREE

Upload Passport *

Message

“In theory, taxes should be like shopping. What I buy is government services. What I pay are my taxes.”

Andrew Ayabam

Executive Chairman

Kindly ensure that all the information provided are accurate and true.

PART A: PERSONAL PARTICULARS

PART B: SOURCE OF INCOME

PART C: INCOME AND TAX FOR THE CURRENT AND PREVIOUS YEARS

DECLARATION

Andrew Ayabam

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