Employee Income Statement Template Page 2
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1
2Form B
Self-Employed Income Statement
FORM B should be completed below and submitted with the Business Registration
(
ﺳﺠﻞ ﺗﺠﺎري
)
and income tax
statements ( .)ﺿﺮﻳﺒﺔ اﻟﺪﺧﻞIt should be completed for each self-employed member of the family.
Photocopy this form as needed.
Name of applicant for financial aid: ___________________________________________________________
_____________________________________________________
Name of Self-Employed family member:
Relationship to Applicant: ____________________________________________________________________
Partner: No. of partners: ___________________ Percent Share: __________
Sole Owner
Other, _________________________________________________________
Free-Lance
Specify
: _______________________________________________________________
Name of Institution
if applicable
___________________________________________ Date
_____________________
Registration number:
:
: _________________________________________
Nature of Company’s/Owner’s Work/Business
in detail
________________________________________________________________________________________
________________________________________________________________________________________
__________________________/____________________________/___________________________
Address:
Area
Street
Bldg.
_________________________/__________________________
_________________________
Telephone:
City
Country
___________________________________________________________________________________
E-mail:
____________________________________________________________
Number of employees/workers:
Annual gross income LL:
The gross income is the total revenue of the institution.
_______________________________________________________________________________________
Annual net income LL:
The net income is the total personal income of the self-employed family member and partners, if
any, after deduction of all institution’s expenses.
_______________________________________________________________________________________
____________________________________________________________________________
Name and seal:
______________________________________________
____________________________
Signature:
Date:
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