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					                                                                                                   PART- V



STATEMENT OF FINAL TAXATION UNDER
SECTION 115(4) OF THE INCOME TAX
ORDINANCE, 2001                                                                                                                                                                          2004
       [To be filed by persons whose receipts/value of goods is
                                                                                                                                 Tax Year                                                                                      5
    chargeable to tax under section 5, 6, 113A, 148, 152, 153, 154,                                                              Zone/LTU/MTU Code                          .              __________________


           156 or 234 of the Income Tax Ordinance, 2001]                                                                         Circle Code            .                                  _________________

            Original for the Department/Duplicate for the Taxpayer
    (Please Mark  in the relevant box/Use additional sheets where necessary)                                                    NTN .          _____________________________________________________________



* In case of a new taxpayer without NTN, prescribed NTN application, attached.                            .                      NIC .           _____________________________________________________________   (For individuals only)


                                             Taxpayer’s (Individual/Association of Persons/Company) Profile
1.      Year Ending On (dd/mm/yyyy).                       _________________________________                                                         2.           Status                IND AOP COY
3.      Name * (In Block Letters) .                                  ____________________________________________________________________________________________________________________________________________________________




4.      Business Name (In Block Letters)                     .       _____________________________________________________________________________________________________________________________ _______________________________




5.      Address       .                                              _____________________________________________________________________________________________________________________________ _______________________________




.                                                                    ____________________________________________________________________________________________________________________________________________________________




.                                                                    _____________________________________________________________________________________________________________________________ ______________________________




6.      Telephone            .                                       (i)   _______________________________________   (ii)   _______________________________________   7. Fax               ________________________________________




8.      E-mail, if any           .                                   ____________________________________________________________________________________________________________________________________________________________




9.                           .
        Sales Tax Registration Number(s)                             _____________________________________________________________________________________________________________________________ _____________________     ,if any

10. Principal Business Activity                     .                Manufacturer              Importer                     Exporter                  Distributor               Wholesaler              Retailer

.                                                                    Commission                Professional                 Services                  Others

11. Nature/description of Business                         .         ____________________________________________________________________________________________________________________________________________________________




12. Business Code                    .                      ___________________________________________________________________________________________________________ (To be filled by the department)

* In case of an individual - His/her name in full AND In case of an association of persons /company - Name and style of the association of persons /company

Nature                                                  Code Applicable        Receipts/Value                                      Tax Payable/Due                      Tax Deducted                         Evidence of
                                                                 Tax Rate                                                                                               /Collected/Paid                      Tax Deducted
                                                                 Percentage(%) Amount (Rs.)                                        Amount (Rs.)                         Amount (Rs.)                         /Collected/Paid


Details of Receipts / Value of goods subject to Final Taxation

13. Imports          .                                  6011     _______________________ ___________________________________       ___________________________________ ___________________________________       Attached            .

14. Dividend             .                              6111     _______________________ ___________________________________       ___________________________________ ___________________________________       Attached            .

.                                                       6121     _______________________ ___________________________________       ___________________________________ ___________________________________       Attached            .

15.     Royalty/Fee for Technical Services          . 6211       _______________________ ___________________________________       ___________________________________ ___________________________________       Attached            .

16. Supply of Goods                      .              6311     _______________________ ___________________________________       ___________________________________ ___________________________________       Attached            .

.                                                       6321     _______________________ ___________________________________       ___________________________________ ___________________________________       Attached            .

.                                                       6331     _______________________ ___________________________________       ___________________________________ ___________________________________       Attached            .

17. Contracts             .                             6411     _______________________ ___________________________________       ___________________________________ ___________________________________       Attached            .

.                                                       6421     _______________________ ___________________________________       ___________________________________ ___________________________________       Attached            .

.                                                       6431     _______________________ ___________________________________       ___________________________________ ___________________________________       Attached            .
.                                                              6441       _______________________ ___________________________________          ___________________________________ ___________________________________       Attached            .

18. Exports            .                                       6511       _______________________ ___________________________________          ___________________________________ ___________________________________       Attached            .

.                                                              6521       _______________________ ___________________________________          ___________________________________ ___________________________________       Attached            .

.                                                              6531       _______________________ ___________________________________          ___________________________________ ___________________________________       Attached            .

19. Prizes and Winnings                         .              6611       _______________________ ___________________________________          ___________________________________ ___________________________________       Attached            .

20. Goods Transport Vehicles 6711                          .              _______________________ ___________________________________          ___________________________________ ___________________________________       Attached            .

                                                                                                            Verification
I, ____________________________________________________________________________________________________________, holder of NIC No. ___________________________________________________________________________ in my capacity
as Self / Member or Partner of Association of Persons/ Principal Officer of Local Authority or Company / Representative of Taxpayer named above do
hereby solemnly declare that to the best of my knowledge and belief the information given in this Statement is correct, complete and in accordance with
the provisions of the Income Tax Ordinance, 2001 and Income Tax Rules, 2002.
(The alternative in the verification, which is not applicable, should be scored out.)

Date(dd/mm/yyyy) ______________________________________________________                                                                                            Signature ____________________________________________________________

                                                                                                ACKNOWLEDGMENT

Inward No.           _________________________________________________________                   _____________________________________________________________________________


Date(dd/mm/yyyy)              ________________________________________________                   Name & signature of receiving official                                                                             Seal.”;

       (ii)           after Part-V substituted as above, the following shall be inserted:-


                                                                                                           “PART- VA



 STATEMENT OF FINAL TAXATION FOR RETAILERS HAVING
  ANNUAL TURNOVER UPTO RS 5,000,000 UNDER SECTION                                                                                            Tax Year                                                2004                                   6
   113A READ WITH SECTION 115(4) OF THE INCOME TAX                                                                                           Zone/LTU/MTU Code                          .              __________________
                          ORDINANCE, 2001
   Original for the Department/Duplicate for the Taxpayer/Triplicate and                                                                     Circle Code             .                                 _________________

                              Quadruplicate for Bank
    (Please Mark  in the relevant box/Use additional sheets where necessary)                                                                NTN .          _____________________________________________________________



* In case of a new taxpayer without NTN, prescribed NTN application, attached.                                        .                      NIC .           _____________________________________________________________   (For individuals only)



                                                             Taxpayer’s (Individual/Association of Persons) Profile
1.       Year Ending On (dd/mm/yyyy).                   _________________________________                                                                        2. Status                                    IND                      AOP
3.       Name * (In Block Letters) .                                             ________________________________________________________________________________________________________________________________________________ ____________



4.       Business Name (In Block Letters)                             .          ____________________________________________________________________________________________________________________________________________________________



5.       Address        .                                                        _____________________________________________________________________________________________________________________________ _______________________________



.                                                                                ____________________________________________________________________________________________________________________________________________________________



.                                                                                ____________________________________________________________________________________________________________________________________________________________



6.       Telephone           .                                                   (i)   _______________________________________   (ii)   _______________________________________   7. Fax               ________________________________________



8.       Nature/description of Business                             .            _______________________________________________________________________________________________________________________________________ _____________________



9.      Business Code                 .                     _______________________________________ ___________________________________________________________________(To be filled by the department)

* In case of an individual - His/her name in full AND In case of an association of persons - Name and style of the association of persons
Particulars                                                                                                                                            Amount (Rs.)                          Code           Amount (Rs.)

10. Annual Turnover of the retailer                                 .                                                                                  ___________________________________      4064

11. Tax at the rate of o.75% on the turnover                                             .                                                                                                      4065        ___________________________________


12. Tax Already Paid
           (a)        Advance tax                      Evidence of payment attached                                                                 .      ___________________________________        4480
           (b)        Tax collected/deducted at source
                      (i) Alongwith motor vehicle tax*
                              Registration No.                                             Engine / Seating Capacity

.                             ______________________________________________________   .   ___________________________________________________________     ___________________________________        0201

.                                                         .
                              ______________________________________________________       ___________________________________________________________     ___________________________________        0202
                      (ii) Alongwith bill for electricity consumption*
                                 Consumer No.                                              In the name of

.                             ______________________________________________________   .   ___________________________________________________________     ___________________________________        0301

.                                                       .
                              ______________________________________________________       ___________________________________________________________     ___________________________________        0302
                      (iii) Alongwith telephone bills, mobile phone and pre-paid cards*
                              Phone Number.                                                In the name of

.                             ______________________________________________________   .   ___________________________________________________________     ___________________________________        0401

.                             ______________________________________________________   .   ___________________________________________________________     ___________________________________        0402

.                     (iv) Others (specify)                ____________________________    Evidence of payment attached                             .      ___________________________________        0501
.                     (v) Sub-Total [Add 12(a) to 12(b)(iv)]                                                                                                                                          9218        ___________________________________



13. Balance Tax [11 minus 12(v)]                                          .(a) Refundable Rs.                       ___________________________________                (b) Payable                    9275        ___________________________________

* Do not attach any evidence. Only give the requisite details.

                                                                                                                 Verification
I, ____________________________________________________________________________________________________________, holder of NIC No. ___________________________________________________________________________ in my capacity
as Self / Member or Partner of Association of Persons / Representative of Taxpayer named above do hereby solemnly declare that to the best of my
knowledge and belief the information given in this Statement is correct, complete and in accordance with the provisions of the Income Tax Ordinance,
2001 and Income Tax Rules, 2002.
(The alternative in the verification, which is not applicable, should be scored out.)

Date(dd/mm/yyyy) __________________________________________________________________                                                                                    Signature _____________________________________________________________

                                                                  Tax Payment                                       (For Bank’s Use)
                       Tax payable on annual turnover of a retailer under section 113A of the Income Tax Ordinance, 2001.

.Rs (in figures)             _______________________________________________
                                                                                                                                                                 Bank’s Stamp


.Rupees (in words)                     ____________________________________________________________________________________________________

                                                                                                                                                               Date of Payment
.   ______________________________________________________________________________________________________________________________________




.Treasury Challan No.                             _________________________________________________                        Treasury/Bank Officer’s Signature                                     ___________________________________________________



                                                                                                      ACKNOWLEDGMENT

Inward No.               _________________________________________________________                     _____________________________________________________________________________


Date(dd/mm/yyyy)                   ________________________________________________                    Name & signature of receiving official                                                                             Seal.”;

				
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