Abbaa Taayitaa Galiiwwan Oromiyaa/ Oromia Revenues Authority

Bu’uura labsii taaksii dabalata qabeenyaa lakk. 285/1995 tiin ragaa bittaa taaksii dabalata qabeenyaa dhiyeessaa fi taaksii dabalata qabeenyaa bitataan qabamee kaffalamu/ Value added tax purchase & VAT withholdin receipt by the suppliers as per
VAT proc. No. 285/2002
Unka taaksiin dabalata qabeenyaa bittaa irratti kaffalame ittiin gabaafamu/ purchases inputs reporting form

Guyyaa/Date ______________
1. Odeeffannoo waliigalaa
1.1. Maqaa Dhaabbatichaa/Dhuunfaa/ Company/Individual name __________________________________________
1.2. Gosa Daldalaa/ Occupation ____________________________________
1.3. Teessoo/ Address: Godina/Magaala/Zone/City ________________________, Aanaa/ Woreda __________________, Imeelii/ Email _______________, Lakk. Manaa/ House No. ___________________, Bilbila/ Phone _______________, Faaksii/ Fax ______________
1.4. Lakk. Taaksii dabalata qabeenyaa/ VAT reg. No. ____________________________________
1.5. Lakk. Eenyummeessaa kaffalaa taaksii/ TIN No. _____________________________________
1.6. Yeroo beeksisa taaksii/ Period for declaration: irraa/ From _______________________ Hanga/ To _________________
2. Taaksii dabalata qabeenyaa galtee bittaa irratti kaffalamee fi taaksii dabalata qabeenyaa bitataan qabamee kaffalamu/ VAT paid on input (purchase) & VAT withholding

Teessoo bakka bu’aa T.D.Q dhiyeessaan/ bitataan qabamee kaffalamuu/ supplier/ VAT withholding agent Lakk. Nagahee
Akaakuu meeshaa/ tajaajilaa/ types of goods/services
T.L./ S.No.

addresses Lakk. Nagahee T.D.Q bitataan Hanga T.D.Q bitataan

Lakk MRC/ VAT bittaa irratti kaffalame/
Guyyaa bittaan T.D.Q/ Incoice qabamee qabamee hafe/ VAT
Lakk. TDQ/ VAT MRC NO. Hamma/ Gatii waliigalaa T.D.Q dura/ VAT paid on purchase
Maqaa/ Name Lakk. TIN/ TIN NO. raawwatame/ Date NO. Ibsa/ description kaffalamu/ VAT withheld amount
reg. NO. quantity Gross amount before VAT WH receipt NO.
of purchase
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Ida'ama
Ida'ama waliigalaa fuula itti aanu dabalatee/ Transfer
total from all sheet
Odeeffannoon armaan olitti ibsame sirrii ta’u nan mirkaneessa/ We certify that the above information is correct.
Kan qopheesse/ prepared by: Maqaa/ Name ____________________________ Mallattoo/ signature ____________ Guyyaa/ Date ____________
Chaappaa/seal
Ka mirkaneesse/ Approved by: Maqaa/ Name ____________________________ Mallattoo/ signature ____________ Guyyaa/ Date ____________ STAMP
T.D.Q bittaa meeshaa/tajaajila biyya keessaa irratti kaffalame/ VAT paid on local purchases of good/service __________________________
T.D.Q bittaa meeshaa/tajaajila biyya alaa irratti kaffalame/ VAT paid on foreign purchases of good/service ___________________________

Bu'uura labsii taaksii dabalata qabeenyaa fooyya'e lakk. 1157/2011 bittaa meeshaalee kaappitaalaa biyya keessaa fi alaa irratti taaksii dabalata qabeenyaa kaffalame/ VAT paid on local & foreign purchases of capital goods (based on VAT proc. No. 1157/2019) __________________________
Taaksii dabalata qabenyaa bittaa biyya keessaa/ baasiiwwan biroo irratti kaffalame/ VAT paid on local purchases of services/General expenses ____________________________
 Abbaa Taayitaa Galiiwwan Oromiyaa/ Oromia Revenues Authority
Bu’uura labsii taaksii dabalata qabeenyaa lakk. 285/1995 tiin ragaa bittaa taaksii dabalata qabeenyaa dhiyeessaa fi taaksii dabalata qabeenyaa bitataan qabamee kaffalamu/ Value added tax purchase & VAT withholdin receipt by the suppliers as per
VAT proc. No. 285/2002
Unka taaksiin dabalata qabeenyaa bittaa irratti kaffalame ittiin gabaafamu/ purchases inputs reporting form
Guyyaa/Date ______________

Teessoo bakka bu’aa T.D.Q dhiyeessaan/ bitataan qabamee kaffalamuu/ supplier/ VAT withholding agent Lakk. Nagahee
T.L./ S.No.

Akaakuu meeshaa/ tajaajilaa/ types of goods/services

addresses Lakk. Nagahee T.D.Q bitataan Hanga T.D.Q bitataan
Lakk MRC/ VAT bittaa irratti kaffalame/
Guyyaa bittaan T.D.Q/ Incoice qabamee qabamee hafe/ VAT
Lakk. TDQ/ VAT MRC NO. Hamma/ Gatii waliigalaa T.D.Q dura/ VAT paid on purchase
Maqaa/ Name Lakk. TIN/ TIN NO. raawwatame/ Date NO. Ibsa/ description kaffalamu/ VAT withheld amount
reg. NO. quantity Gross amount before VAT WH receipt NO.
of purchase

Ida'ama/ Total

Odeeffannoon armaan olitti ibsame sirrii ta’u nan mirkaneessa/ We certify that the above information is correct.
Kan qopheesse/ prepared by: Maqaa/ Name ____________________________ Mallattoo/ signature ____________ Guyyaa/ Date ____________
Chaappaa/seal
Ka mirkaneesse/ Approved by: Maqaa/ Name ____________________________ Mallattoo/ signature ____________ Guyyaa/ Date ____________ STAMP