National Board of Revenue www.nbr.gov.bd RETURN OF WITHHOLDING TAXES under section 75A of the Income Tax Ordinance, 1984 (XXXVI of 1984) 1. The following schedules shall be integral part of the return- Schedule 24AA, if tax withheld under section 52AA Schedule 24AB, if tax withheld under section 56 Schedule 24AC, if tax withheld from certain sources. 2. First Return shall be filed by thirty first day of January of the financial year in which the deduction or collection was made; Second Return shall be filed by the thirty first day of July of the next financial year following the year in which the deduction or collection was made. PART I Basic information 01 Return for the Financial Year 2 0 - 02 First Return Second Return 03 Name of the Person 04 Type of the person (tick one) 04A A company 04B A co-operative society 04C An NGO 04D Other 05 TIN 06 TCAN 07 Circle 08 Zone 09 Address 10 Phone(s) 11 Fax 12 E-mail 13 Main business (sector) 14 If you are a liaison or a branch office: 14A Name of the parent company 14B Tax residence of the parent company PART II Particulars of tax withheld TIN TCAN 15 Sources and amount of tax withheld Sl Sources Section No. of persons from which tax withheld Amount of tax withheld ৳ A Salaries 50 B Execution of a contract 52(1)(a) C Supply of goods 52(1)(b) D Manufacture, process or conversion 52(1)(c) E Printing, packaging or binding 52(1)(d) F Deduction from payment of royalties etc. 52A G Deduction from the payment of services (attach Schedule 24AA) 52AA H L/C commission 52I I Freight forward agency commission 52M J Payment to resident person against services provided to foreign person 52Q K Deduction of tax from the service of international gateway service in respect of phone call 52R L Deduction from payment on account of local letter of credit 52U M House/office rent 53A N Collection of tax from export of knit-wear and woven garments, etc 53BB O Collection of tax from export of any good except certain items 53BBBB P Payment to actor/actress 53D Q Payment as commission or discount for distribution of goods 53E R Interest on savings and fixed deposit 53F S Insurance commission 53G T Rental value of vacant land, plant or machinery 53J U Advertising bill of newspaper or magazine 53K V Deduction of tax from any sum paid by real estate developer to land owner 53P W Dividends 54 X Deduction from payment to non-residents (attach Schedule 24AB) 56 Y Sources not mentioned above (Attach Schedule 24AC) PART III Particulars of payment of tax withheld (attach proof of payments) TIN TCAN 16 Payment of the tax withheld to the credit of the government 16A Total amount withheld ৳ 16B Total amount paid to the credit of the Government ৳ 16C Excess or deficit of payment (if any) 16A-16B ৳ 17 Details of payment of the tax withheld to the credit of the government (add lines if necessary) Sl Challan* No. Date Bank Amount ৳ (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) 17A Total payment to the credit of the government *if payment is made in any other mode specified by the Board, provide information relevant to that mode. PART IV Enclosures and Verification TIN TCAN 18 Schedules annexed (tick all that are applicable) 24AA 24AB 24AC 19 Other statements, documents, etc. attached (list all) 20 Verification I solemnly declare that- to the best of my knowledge and belief the information given in this return and statements and documents annexed or attached herewith are correct and complete; I am signing this return in my capacity as - - - - - - - - - - - - - - - - - - - - - - - - - - - - and I am competent to sign this return and verify it. Name Signature Designation Date of Signature (DD-MM-YYYY) 2 0 Place of Signature For official use only Return Submission Information Date of Submission (DD-MM-YYYY) 2 0 Tax Office Entry Number Withholding National Board of Revenue www.nbr.gov.bd ACKNOWLEDGEMENT RECEIPT OF RETURN OF WITHHOLDING TAX Return for the Financial Year 2 0 - First Return Second Return Name of the Person TIN TCAN Circle Zone Date of Submission (DD– MM –YYYY) 2 0 Tax Office Entry Number Signature and seal of the official receiving the return Date of Signature Contact Number of Tax Office Schedule 24AA Particulars of tax withheld under section 52AA of the Income Tax Ordinance, 1984 (XXXVI of 1984) TIN TCAN Return for the Financial Year 2 0 - First Return Second Return Sl Sources No. of persons from which tax withheld Amount of tax withhold ৳ 1 Advisory or consultancy service 2 Professional service , technical services fee, or technical assistance fee 3 Catering service 4 Cleaning service 5 Collection and recovery agency 6 Management of events, training, workshops etc. 7 Private security service 8 Supply of manpower 9 Indenting commission 10 Meeting fees, training fees or honorarium 11 Mobile network operator, technical support service provider or service delivery agents engaged in mobile banking operations 12 Credit rating agency 13 Motor garage or workshop 14 Private container port or dockyard service 15 Shipping agency commission 16 Stevedoring/berth operation commission 17 Transport service, car rental 18 Any other services not mentioned above Total Name Signature & Date Schedule 24AB Particulars of tax withheld under section 56 of the Income Tax Ordinance, 1984 (XXXVI of 1984) TIN TCAN Return for the Financial Year 2 0 - First Return Second Return Sl Sources No. of persons from which tax withheld Amount of tax withhold ৳ 1 Advisory or consultancy service 2 Pre-shipment inspection service 3 Professional service, technical services, technical know-how or technical assistance 4 Architecture, interior design or landscape design, fashion design or process design 5 Certification, rating etc. 6 Charge or rent for satellite, airtime or frequency, rent for channel broadcast 7 Legal service 8 Management service including event management 9 Commission 10 Royalty, license fee or payments related to intangibles 11 Interest 12 Advertisement broadcasting 13 Advertisement making 14 Air transport or water transport 15 Contact or sub-contract 16 Supply 17 Capital gain 18 Insurance premium 19 Rental of machinery, equipment etc. 20 Dividend 21 Artist, singer or player 22 Salary or remuneration 23 Exploration or drilling in petroleum operations 24 Survey for oil or gas exploration 25 Any service for making connectivity between oil or gas field and its export point 26 Any payments against any services not mentioned above 27 Any other payments Total Name Signature & Date Schedule 24AC Particulars of tax withheld under sources not mentioned in serial 15 (A-X) of Part II of the Withholding Tax Return TIN TCAN Return for the Financial Year 2 0 - First Return Second Return Sl Sources (provide additional papers if more sources) No. of persons from which tax is withheld Amount of tax withhold ৳ 1 2 3 4 5 6 7 8 -- -- Total