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
.......................................................................................................
.......................................................................................................
$.......................
$...................….
.......................................................................................................
.......................................................................................................
$.......................
$........................
Total Emolument Income ... ... ... ... ... ... ... ... ...
$........................
CERTIFICATION
FOR OFFICIAL USE ONLY
I HEREBY CERTIFY that the information given in
this Declaration filed with* ..........................................
.......................................................................................
....................................... IS TRUE AND CORRECT.
Signature .......................................................
(Employee)
Date ...............................................................
* Insert name of Employer or Board of Inland Revenue as appropriate.