Third Schedule Clause 47

FEDERAL REPUBLIC OF NIGERIA

PLATEAU STATE INTERNAL REVENUE SERVICE

PRESUMPTIVE TAX REGISTRATION FORM

Made pursuant to Clause 6 of the Personal Income Tax (Amendment) Act, 2011: All information should be filled in ink and capitals letters, no abbreviation is allowed. Entries should not spill to neighbouring block.

1) Name of Taxpayer Registered Name:________________________

2) Nationality:_____________________________________________

3) Residential Address:______________________________________

4) GSM Number:___________________________________________

5) Business type:___________________________________________

6) Business Name:__________________________________________

7) Registered Business Name:_________________________________

8) Commencement Date:_____________________________________

9) Means of Identification :___________________________________

10) Business Registration No:__________________________________

11) Tax Payer Identification No (TIN) :__________________________

_________________________ Date:___________________

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