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Lagos State Government: Individual Data Input e-TCC Form

This document is an individual data input form for an electronic Tax Clearance Certificate (e-TCC) from the Lagos State Government Board of Internal Revenue. It requests personal information such as name, date of birth, address, identification numbers, occupation, income and tax paid for the last three years, signature, and photograph from the taxpayer. It also requests authorizing signatures from an accountant representing the company and the head of the tax station. The form is used to process an individual's e-TCC.

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255 views2 pages

Lagos State Government: Individual Data Input e-TCC Form

This document is an individual data input form for an electronic Tax Clearance Certificate (e-TCC) from the Lagos State Government Board of Internal Revenue. It requests personal information such as name, date of birth, address, identification numbers, occupation, income and tax paid for the last three years, signature, and photograph from the taxpayer. It also requests authorizing signatures from an accountant representing the company and the head of the tax station. The form is used to process an individual's e-TCC.

Uploaded by

perelapel
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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LAGOS STATE GOVERNMENT

Form No. BOARD OF INTERNAL REVENUE


THE GOOD SHEPHERD BUILDING
BLOCK H, PLOT H1, CENTRAL BUSINESS DISTRICT
OPPOSITE LAGOS STATE SECRETARIAT MAIN GATE, ALAUSA
IKEJA, LAGOS STATE
www.lasg-ebs-rcm.com

Individual Data Input e-TCC Form


Supply All Information in Ink and in Block Letters

INDIVIDUAL INFORMATION (To be supplied by the Taxpayer)

1 Surname

2 First Name

3 Middle Name

4 Date of Birth - - DD/MM/YYYY

5 Title (Mr, Mrs, Miss, Chief, Dr, Alhaji etc)

6 Sex Male Female

7 Marital Status Single Married Separated Widow Widower Divorced

8 Taxpayer ID Bank Verification No.


(BVN)
9 House/Flat No.

10 Street Name

11 Town/Area LGA/LCDA

12 State

13 National ID NO

14 Mobile Phone No

15 Nationality

16 Tax Station Name

17 Employment Type Employee Contract Political Appointee Self Employed Tick as Appropriate

18 Occupation

19 Profession

20 Maiden Name

Income And Tax Paid for the Last Three Years..............................................................................................................................


Year 1 Year 2 Year 3
21 Income Year

22 Income

23 Tax Paid

24 Signature and Date Affix your passport


photograph here
with gum only
I certify that the Taxpayer referred above has met all requirements necessary for the processing of his/her Electronic Tax Clearance Certificate (e-TCC) Please do not staple
Authorised Coy Rep.
25 (e.g. Accountant)

26 Signature and Date

27 Authorised by
(e.g.Head Tax Station)

28 Signature and Date


Email Address
29

30 State of Origin

31 Company Name

32 Company Branch

33 Company Address

34 Web Address

35 Official Position

36 International
passport No

37 Alien Registration
No
From.................................. To..................................

Names and
38 addresses of
previous From.................................. To..................................
Employers

If Married State
39 Spouse’s Name

Spouse’s
40 Occupation

Spouse’s Business
41 or Employment
Address

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