REPÚBLICA DEMOCRÁTICA DE TIMOR LESTE MINISTÉRIO DAS FINANÇAS
DIRECÇÃO GERAL DE RECEITAS E ALFÂNDEGAS DIRECÇÃO NASIONAL DE RECEITAS PETROLIFERAS
Building#5 (Ground Floor), Palacio do Governo RDTL, Avenida do Presidente de Nicolau Lobato
P.O Box-18, Dili , Timor-Leste, Phone- +(670) 333 9542
TIMOR-LESTE PETROLEUM TAX- Summary of Monthly Tax Obligations
1. Month and Calendar Year : ……….. 2010 2. Tax Identification Number (TIN) :
3. Taxpayer Name :
4. Current Postal Address :
5. Contact Name :
6. Contact Phone Number :
Summary of Monthly Tax Obligations
(Transfer the amount from the individual tax form
for each tax obligation)
Type of Tax obligation Amount of Tax
(in US $) Petroleum Fund Bank AccountDate of payment to the TL Timor-Leste residents or PE withholding tax
Timor-Leste non-residents withholding tax Timor-Leste resident employees withholding tax Timor-Leste non-resident employees withholding tax JPDA monthly VAT collection
Monthly Income Tax Installment Monthly APT/SPT Installment
Total
Notes: 1. Attach the individual tax form for each type of tax obligation;
2. Please attach copy of EFT bank transfer instruction form in support of electronic transfer of above taxes to the TL Petroleum Fund Bank Account.
Taxpayers Declaration:
I, (full name and designation) ___________________________________________, declare on behalf of the Company, that the particulars set out in this statement are true and correct.
Signature: __________________________________________Date:_____________
Web: www.mof.gov.tl/en/rc/DPR
NDPR Contact E-mails: mrangel@mof.gov.tl or jxavier@mof.gov.tl or mfaria@mof.gov.tl or hsarmento@mof.gov.tl or akhan@mof.gov.tl or dcastiglione@mof.gov.tl NDPR Form No: 02-03-01
