The National Regional Government of Oromia

Bureau of Revenues

Federal Democratic
Republic of Ethiopia Balance Sheet and Annexes
Ethiopian Revenues &
Custom Authority

Check Filing Status:

 Schedule B Rental Income Tax

 Schedule C Business Income Tax

 Mining Income Tax

Section 1 – Taxpayer Information

1.Taxpayer’s Name (Company Name or Name, Father’s Name, 3. Taxpayer Identification Number 8. For the Year ended:
Grandfather’s Name)

2a. Region 2b. Zone/K-Ketema 4. Tax Account Number Document Number (Official Use Only)

2c. Woreda 2d. Kebele/Farmers Association 2e. House Number 5. Tax Center

6. Telephone Number 7. Fax Number

Section 2 – Business Assets, Liabilities and Capital

Instructions: Prior to completing this portion of the Balance Sheet you will need to complete the individual Annexes on the
following three pages. Be sure and check your filing status at the top of this form. If you are required to file Schedule B and
Schedule C, Separate copies of this balance sheet must be filed. For additional information, consult the for the Balance Sheet
instructions or the Income Tax Proclamation, 286/2002.

Assets
1 Cash 10
2 Accounts Receivable (Transfer Total from Annex 1, Line 4) 20
3 Allowance for Bad Debts 30
4 Net Accounts Receivable (Subtract Line 3 from Line 2 and Enter Total) 40
5 Pre Paid Expenses 50
6 Inventories (Transfer Total from Annex 2, Line 7) 60
7 Operating Supplies 70
8 Other Current Assets (Transfer Total from Annex 3) 80
9 Loans to Shareholders 90
10 Mortgage & Real Estate Loans Receivable 100
11 Other Investments (Transfer Total from Annex 4) 110
Tran 12 Building, Cost of Improvements & Reconstruction 120
sfer
from
13 Computers, Software Products & Related Equipment 130
Ann 14 Plant, Machinery, Tools & Other Equipment 140
ex 15 Motor Vehicles 150
 5A, 16 Office Equipment and Furniture 160
Colu
mn f
17 Add Lines 12 through 16 and Enter Total 165
18 Accumulated Depreciation (Transfer from Annex 5B, Column d) 170
19 Net Book Value (Subtract Line 18 from Line 17 and Enter Total) 180
20 Intangible Assets (Transfer Total from Annex 6A, Column f) 190
21 Accumulated Amortization (Transfer from Annex 6B, Column f) 200
22 Net Book Value / Intangible Assets (Subtract Line 21 from Line 20 and Enter Total) 210
23 Other Assets (Transfer Total from Annex 7) 220
24 Total Assets (Add Lines 1, 4 through 11, 19, 22 and 23) 230

Liabilities
25 Accounts Payable 240
26 Interest Payable 250
27 Loans Payable less than 1 Year (Transfer Total from Annex 8) 260
28 Tax Payable (Transfer Total from Annex 9) 270
29 Other Current Liabilities (Transfer Total from Annex 10) 280
30 Loans from Shareholders 290
31 Loans Payable More than 1 Year (Transfer Total from Annex 11) 300
32 Other Long-Term Liabilities (Transfer Total from Annex 12) 310
33 Total Liabilities (Add Lines 25 through 32 and Enter Total) 320

Capital
34 Capital 330
35 Legal Reserve 340
36 Retained Earnings 350
37 Total Capital (Add Lines 34 through 36 and Enter Total) 360
38 Total Liabilities and Capital (Add Lines 33 and 37 and Enter Total) 370
 Schedule B & C - Business/Rental Income Tax
Balance Sheet Annexes
Taxpayer Information
1.Taxpayer’s Name (Company or Individual) 2. Taxpayer Identification Number 3. For the Year
Ended:

Annex 1 – Accounts Receivable

a. Seq
Num b. Item Description c. Amount
1 Trade Debtors
2 Sundry Debtors
3 Staff Debtors
4 Total of Lines 1 through 3 (Enter Total amount on Line 2 of Balance Sheet)
Annex 2 – Inventories (Applies to Business/Mining Income Only, Not Rental Income)
a. Seq
Num b. Item Description c. Amount
1 Merchandise Stock
Manufacturing Business
2 Finished/Processed Product
3 Work in Process
4 Raw Materials
5 Reject, By Product and Other Related Items
6 Spare Parts, Supplies, Packing and Other Materials
7 Total of Lines 1 through 6. (Enter Total amount on Line 6 of Balance Sheet)
Annex 3 – Other Current Assets
a. Seq
Num b. Account Description c. Amount

Total (Enter Total amount on Line 8 of Balance Sheet (Include Total from Continuation Sheet if Used))
Annex 4 – Other Investments
a. Seq b. Taxpayer
Num Identification Number c. Taxpayer Name d. Description of Investment e. Amount

Total (Enter Total amount on Line 11 of Balance Sheet (Include Total from Continuation Sheet if Used))
Annex 5 – Fixed Assets
a. Seq c. Beginning e. Disposal/
Num b. Item Description d. Addition f. Ending Balance
Balance Transfer
A. Cost of Fixed Assets (Transfer Column f Totals to Lines 12 through 17 on Balance Sheet)
1 Building, Cost of Improvements & Reconstruction
2 Computers, Software & Related Equipment
 3 Plant, Machinery, Tools & Other Equipment
4 Motor Vehicles
5 Office Equipment and Furniture

6 Total of Lines 1 through 5

B. Depreciation of Fixed Assets (Transfer Column “d” Total to Line 18 of Balance Sheet)
7 Building, Cost of Improvements & Reconstruction
8 Computers, Software & Related Equipment
9 Plant, Machinery, Tools & Other Equipment
10 Motor Vehicles
11 Office Equipment and Furniture

12 Total of Lines 7 through 11

13 Net Book Value (Line 6 – Line 12)

Schedule B & C - Business/Rental Income Tax

Balance Sheet Annexes
Taxpayer Information
1.Taxpayer’s Name (Company or Individual) 2. Taxpayer Identification Number 3. For the Year
Ended:

Annex 6 – Intangible Assets

a. Seq c. Beginning e. Disposal/
Num b. Item Description d. Addition f. Ending Balance
Balance Transfer
A. Intangible Assets (Transfer from Column “f” to Line 20 of Balance Sheet)
1 Goodwill
2 Patent
3 Leasehold Land
4
5 Other Intangible Assets
6 Total of Lines 1 through 5
B. Amortization (Transfer from Column “f” to Line 21 of Balance Sheet)
7 Goodwill
8 Patent
9 Leasehold Land
10
11 Other Intangible Assets
12 Total of Lines 7 through 11
13 Net Book Value (Lines 6 minus 12)
Annex 7 – Other Assets
a. Seq
Num b. Account Description c. Amount
 Total (Enter Total amount on Line 23 of Balance Sheet)
Annex 8 – Loans Payable in less than One Year
a. Seq
Num b. Name of Loan Provider (Financed by) c. Amount

Total Loans Payable in Less than 1 Year (Enter Total amount on Line 27 of Balance Sheet)
Annex 9 – Tax Payable
a. Seq
Num b. Type of Tax Payable c. Amount
1 Employment Income Tax Payable
2 Business Income Tax Payable
3 Rental Tax Payable
4 Withholding Tax Payable
5 VAT Payable
6 Turnover Tax Payable
7 Excise Tax Payable
8 Dividend Tax Payable
9 Other Tax Payable
10 Total (Enter Total amount on Line 28 of Balance Sheet (Include Total from Continuation Sheet if Used))

Schedule B & C - Business/Rental Income Tax

Balance Sheet Annexes
Taxpayer Information
1.Taxpayer’s Name (Company or Individual) 2. Taxpayer Identification Number 3. For the Year
Ended:

Annex 10 – Other Current Liabilities

a. Seq
Num b. Account Description c. Amount

Total (Enter Total amount on Line 28 of Balance Sheet (Include Total from Continuation Sheet if
used))
Annex 11 – Loans Payable in More than 1 Year
a. Seq
Num b. Name of Loan Provider (Financed by) c. Amount

Total (Enter Total amount on Line 30 of Balance Sheet (Include Total from Continuation Sheet if
Used))
Annex 12 – Other Long-Term Liabilities
a. Seq
Num b. Name of Loan Provider (Financed by) c. Amount

Total (Enter Total amount on Line 31 of Balance Sheet (Include Total from Continuation Sheet if
Used))

Taxpayer Certification

I declare that the above declaration and all information provide here-with is correct and complete. I understand that
any misrepresentation is punishable as per the tax Laws and the Penal code. Declaration of preparer (other than the
taxpayer) is based on all information of which the preparer has any knowledge
Printed Name Taxpayer/Authorized Representative Printed Name of Preparer

Company Seal
Signature of Taxpayer/Authorized Representative Date Signature of Preparer Date

Instructions for Balance Sheet and Annexes

This form may be used for most business enterprises.

If you are in the mining or rental business, you may use this form but you must check the “Mining” or “Rental”
box at the top of the form. Other business enterprises should check the “Schedule C Business Income Tax” box.
 If you are a Schedule B “rental” business, you are required to file a copy of this balance sheet with a
complete the Rental Income Tax Declaration, Form 1201.
 If you are a Schedule C business, either Schedule C Business Income Tax” or mining, this balance sheet
must be filed with a completed Business Tax Declaration, Form 1301.
Should there be any discrepancy between these instructions and the Proclamation, the language of the
Proclamation shall take precedence.
Business Type – At the top of the Balance sheet, check the appropriate business type (Schedule B Rental;
Schedule C Business Income Tax or Mining). If you have filing requirements for more than one of the above
categories, a separate Balance Sheet must be filed for each tax obligation.
Section 1 – Taxpayer Information
1 Name – Enter the name of individual taxpayer including given name, father’s name and grandfather’s name.
2 Address – Enter all information necessary to identify the location of your residence. If your address has
changed since your last filing, contact your tax Office within 30 days.
3 Taxpayer Identification Number (TIN) – Every person having a tax responsibility is required to have a
TIN and to enter it with each filing. See
Income Tax Proclamation no. 74/2003, Article 43, 44 & 90.
4 Tax Account Number (TAN) – This number is Provided by the Oromia Bureau revenues and must be
entered each time a Personal Income Tax Return is filed. If you have not been issued this number, contact your
local central registration office.
5. For the Year Ended – Enter the last month, day and year representing the end of the year for which you are
filing this Balance Sheet.
6 Tax Center– Enter name of Tax Center where you are registered.
7/8 Telephone and Fax Numbers – If more than one, enter contact numbers for person authorized to sign
this form.

Section 2 – Business Assets, Liabilities and Capital

Prior to completing this section, complete all the Annexes found on pages 3, 4 and 5 of this Balance Sheet.
Then transfer the totals from the Annexes to the appropriate lines.
1 Cash – Enter the total of all cash on hand or on deposit as of the last day of the year for which you are filing.
2 Accounts Receivable – All Accounts Receivable should be listed on Annex 1 on page 2. Transfer the total
from the last line of Annex 1 to Line 2 of the Balance sheet. In accordance with Article 60(3) of the
Proclamation, “an amount is receivable by a person when that person becomes entitled to receive it, even if
the time for discharge of the entitlement is postponed or the entitlement is payable by installments.”
3 Bad Debts – Enter the amount claimed. Note that Article 25 of the Proclamation includes three conditions,
which must be met in order for a bad debt to become a deduction. “(a) An amount corresponding to this debt
was previously included in the income; (b) the debt is written off in the books of the taxpayer; and (c) any
legal action to collect the debt has been taken but the debt is not recoverable.”
Other Lines – Entries on all other lines in the Assets, Liabilities and Capital sections should be based on
generally accepted accounting principles. Where an Annex is referenced, detail about the asset or obligation is
required. In all cases, the taxpayer may be required to produce original documentation as to any or all of the
numbers enter. Calculations should be done according to the instructions on each line.
Section 3- Annexes
The Annexes should be completed prior to completing the tax declaration section. If additional lines are
needed to complete any Annex, attach an additional sheet with that contains the same information as
required in the Annex. Be sure to enter your name or company name and Taxpayer Identification Number and
identify the number and name of the annex at the top. Enter totals from the annexes on the next to last line
(just before the TOTAL line) in the appropriate annex. Be sure to attach your extra sheets to the Tax
Declaration.
Section 4 – Taxpayer Certification
The form must be signed dated & sealed by the taxpayer or the authorized representative at the bottom of all
pages. The _________ will retain the original form. If you need a copy of the Declaration, you should make this
before meeting with the tax office.