Employee'S Declaration Of Emoluments, Deductions And Tax Credits - Government Of The Republic Of Trinidad And Tobago Board Of Inland Revenue

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Form T.D.-1

GOVERNMENT OF THE REPUBLIC OF TRINIDAD AND TOBAGO

BOARD OF INLAND REVENUE

EMPLOYEE’S DECLARATION OF EMOLUMENTS, DEDUCTIONS AND TAX CREDITS

Any person who makes a false declaration is liable on summary conviction to a fine or imprisonment or

both such fine and imprisonment.

(Please read Notes overleaf before completing this form-Use Block Letters)

B.I.R. File Number ....................................……………… I.D. Card Number .....................................………..

Surname ........................................................................................………………………………………………..

Other Names .................................................................................………….............................................……….

Home Address .........................................................................................................................................................

Telephone Number ……………………………………..

Date of Birth ……………………………………...

Name of Spouse residing with me ..........................................................................................................................

Spouse’s Place of Employment ...............................................................…………..................………………….

Date of Marriage ........................................................................................ Spouse’s B.I.R. No. ..........................

Current Emolument Income

Income from Salary, Wages or Pension: (including taxable allowances and benefits in kind)

Name and Address of Employers

Rate of Pay

Annual

Weekly/Fortnightly/Monthly

Amount

.......................................................................................................

$.......................

$...................….

.......................................................................................................

$.......................