Income Tax Return for Individuals Taxpayer Ref No.

* Year of Assessment*
(Income Tax Act. No. 58 of 1962, as amended)

Form Wizard
^
INFORMATION TO CREATE YOUR PERSONAL INCOME TAX RETURN

Standard ^
Is this declaration made by a Tax Practitioner? Y N
Did you pay any medical expenditure (including medical Was any income distributed to you / vested in you as a
scheme contributions where you are not the principal / main Y N
member of the medical scheme) in respect of any immediate Y N beneficiary of a trust, or deemed to have accrued in terms of s7 ?
family member who is dependent on you for family care and Indicate the number of trust(s) applicable? Number of
support? trusts
Mark with an “X” if you are a foreign national and not a RSA tax
resident. Did you or your employer make any retirement annuity Y N Were there any transactions (contributions, transfers,
fund contributions for the benefit of yourself? withdrawals, income received/accrued) on any Tax Free Y N
Taxpayer ceased to be a tax resident of the RSA Investments held by you during this year of assessment?
Mark with an “X” if you made any contributions to pension and/or Number of tax
provident fund for the purposes of past / additional services Indicate the number of tax free investment(s) free
investment(s)
bought, and that is not reflected on any IRP5 or IT3(a) certificate.
Date on which you ceased to be a resident:
Do you want to claim a deduction against a travel Did you derive income from the letting of fixed
CCYY/MM/DD allowance? Y N property(ies)(excluding amounts received / accrued as a
beneficiary of a trust(s), or deemed to have accrued in terms of Y N
s7)?
How many vehicles should be used in the Number of
calculation? vechiles Number of
Were you unemployed for the full year of assessment and did From how many separate rental activities did you derive income? activities
not receive any income (e.g. pension, interest, etc.) including any Y N
capital gain/loss?
Do you want to claim a deduction against an employer
provided vehicles? Y N
Did you make any retirement annuity fund contributions? Are you a director of a company or a member of a close corporation? Y N
Y N

Specify the number of vehicles acquired by the employer by means of: Does any declaration in this return relate to an application made
under the SARS Voluntary Disclosure Programme? Y N
Were you unemployed for any period during this year of Y N Number of
assessment? vechiles
An operating lease
Mark with an “X” if you have assets in excess of R50 million.
Number of
For how many periods were you unemployed? days Number of
Any method other than an operating lease vehicles

Did you receive any form of remuneration for foreign Do you want to claim donations made to approved organisation(s)
services rendered that is reflected on your South African Y N Y N
Did you receive income that is reflected on an IRP5 or IT3(a) IRP5/IT3(a) certificate(s)? in terms of s18A?
Y N
certificate?
Was any portion of this foreign services Number of
remuneration subject to tax in another country? Y N How many organisations did you donate to? organisations
Number of
How many certificates did you receive? certificates

Did you pay any medical expenditure (including medical Did you receive any interest (local and foreign), distributions from
scheme contributions made by you or your employer Y N a Real Estate Investment Trust (REIT)/Taxable local dividends, Did you receive any other income (excluding amounts received /
towards a medical scheme where you are the principal / taxable foreign dividends and / or dividends deemed to be accrued as a beneficiary of a trust(s), or deemed to have accrued Y N
main member)? income in terms of s8E & s8EA (excluding amounts received as Y N in terms of s7 ) and/or incur any other allowable expenses not
a beneficiary of a trust(s), or deemed to have accrued in terms of addressed above?
s7)?

Did you receive exempt local and/or foreign dividend Y N

income?
 Comprehensive
^

Foreign Income ^
(Excluding amounts received / accrued as a beneficiary of a trust(s), or deemed ^ Local Farming ^ Medical Expenditure ^
to have accrued in terms of s7)

Did you pay any medical expenditure (including medical scheme

Did you receive any foreign income (including remuneration) apart Did you participate in any local farming operations? Y N contributions made by you or your employer towards a medical Y N
from foreign interest and foreign dividend income and excluding Y N scheme where you are the principal / main member)?
foreign capital gain transactions?
Did you participate in any farming partnership operations? Y N Did you pay any medical expenditure (including medical scheme
contributions where you are not the principal / main member of Y N
Capital Gain / Loss the medical scheme) in respect of any immediate family member
(Excluding amounts received / accrued as a beneficiary of a trust(s), ^ Number of who is dependent on you for family care and support?
or deemed to have accrued in terms of s7) How many farming partnership operations did you participate in? partnerships

Did you dispose of any local assets attracting capital gain or loss Y N
(including crypto asset(s))?
Other Taxable Receipts and Accruals (Including remuneration Retirement Annuity Fund Contributions ^
from foreign employer(s) for services rendered in South Africa) (Excluding amounts
How many disposals (shares to be combined as one disposal) Number of ^
received / accrued as a beneficiary of a trust(s), or deemed to have accrued in terms
took place? disposals of s7)
Did you or a deemed employer (partnership) make any retirement Y N
annuity fund contributions for the benefit of yourself?
Did you dispose of any foreign assets attracting capital gain or loss Y N Did you have any receipts and accruals not addressed by the Y N
(including crypto asset(s))? previous questions but excluding amounts that you consider
non-taxable?
How many disposals (shares to be combined as one disposal) Number of
took place? disposals
Recoupment of Venture Capital Company shares sold
Foreign Tax Credits – s6quin <OR> Foreign Tax
^
Refunded / Discharged ^
Partnerships ^ Were any SARS approved Venture Capital Company shares sold Y N
during the year of assessment for which a tax deduction was
Were any foreign tax credits refunded/discharged during the allowed?
year of assessment for which a rebate/deduction was allowed Y N
Are you a partner in a partnership(s)? Y N during a previous year of assessment?
Other Deductions / Exemption ^
Number of
How many partnership(s)? partnerships
Amounts Considered Non-Taxable
(Excluding amounts received / accrued as a beneficiary of a trust(s), ^ Did you incur any expenditure that you wish to claim as a
or deemed to have accrued in terms of s7) deduction that was not addressed by the previous questions? Y N

Local Business, Trade and Professional Income (Including

crypto asset(s)) (Excluding amounts received / accrued as a beneficiary of a trust(s),
^
or deemed to have accrued in terms of s7) Did you receive any income that you consider non-taxable? Y N

Did you derive income from local business, trade or profession Y N

other than rental income from the letting of fixed property(ies)?

Number of
How many separate trading activities did you carry on? partnerships
Taxpayer Information ^

Personal Details ^

Surname First Name Other Name

Date of Birth

Initials CCYY/MM/DD ID No. Passport No.

Passport Issue Date

Passport Country CCYY/MM/DD Marital Status

Spouse Details ^

Initials ID No. Passport No.

Passport Country

Contact Details ^

Mark here with an “X” if you declare that you do not have an email address.
IMPORTANT: Any changes made to your contact details on your return will not
update your eFiling Security Contact Details. eFiling Security Contact Details can be
Email Confirm Email maintained via “My Profile” on SARS eFiling, SARS eFiling App or at a SARS
branch.”
Mark here with an ‘X if you declare that you do not have a cell-phone number.

Cell No. Confirm Cell No.

Home Tel No. Bus Tel No.

Do you confirm that the email and telephone number(s) supplied are correct? Y N
Physical Address Details ^

Unit No. Complex (if applicable)

Street No. Street / Farm Name

Suburb /District

City/Town Country Postal Code

Postal Address Details ^

Mark here with an “X” if same as above or complete your Postal Address Is your Postal Address a Street Address? Y N

Postal Address Structure

Postal Agency or Other Sub-unit (if applicable) (e.g. Postnet Suite ID)

PO Box Private Bag Other PO Special Service (specify) Number

Post Office Country Postal Code

Unit No. Complex (if applicable)

Physical Address Structure

Street No. Street / Farm Name

Suburb /District

City/Town Country Postal Code

Tax Practitioner Details ^

If this declaration is not made by a Tax Practitioner, change your “Is this
declaration made by a Tax Practitioner?” answer to “No” on the first page of
Tax Practitioner No. Tax Practitioner Tel No. this return.

Mark here with an “X” if you declare that you do not have an email address.

Email

Mark here with an “X” if same as above or complete your Postal Address Is your Postal Address a Street Address? Y N

Postal Address Structure

Postal Agency or Other Sub-unit (if applicable) (e.g. Postnet Suite ID)

PO Box Private Bag Other PO Special Service (specify) Number

Post Office Country Postal Code

Unit No. Complex (if applicable)

Physical Address Structure

Street No. Street / Farm Name

Suburb /District

City/Town Country Postal Code

Bank Details

Bank Account Holder Declaration ^

Account Holder Declaration Reason for No Local / 3rd Party Bank Account

Bank Account Details ^

Bank Name Branch Name Account Holder Name (Account name as registered at bank)

Bank Account Status Account No. All changes will be verified before updating your banking profile. SARS will let you know if you need to come in to a SARS
branch with supporting documents. Bank details are required for refunds.

Branch No. Account Type: Cheque Savings Transmission

Mark here with an ‘X’ if you do declare that this information is true and correct in every respect. Edit
Employee Tax Certificate Information [IRP5/IT3(a)] ^

IRP5/IT3(a) - SARS ^

Employer Name

Certificate No. Year of Assessment PAYE Ref. No.

Income Received ^ Income Received (continued) ^ Deductions / Contributions / Information (continued) ^

R Amount Source Code R Amount Source Code R Amount Source Code

R Amount Source Code R Amount Source Code R Amount Source Code

Source Code Source Code R Amount Source Code

R Amount R Amount

Source Code Source Code R Amount Source Code

R Amount R Amount

Source Code Source Code R Amount Source Code

R Amount R Amount

R Amount Source Code Source Code R Amount Source Code

R Amount

R Amount Source Code R Amount Source Code

R Amount Source Code

R Amount Source Code R Amount Source Code

R Non-Taxable Income 3 6 9 6

Source Code R Amount Source Code

R Amount R Gross Employment Income (Taxable) 3 6 9 9

R Total Deductions / Contributions / Information 4497

R Amount Source Code
Deductions / Contributions / Information ^

R Amount Source Code

R Amount Source Code

R Amount Source Code R Amount Source Code

R Amount Source Code R Amount Source Code

Employee Tax Certificate Information [IRP5/IT3(a)] - continue

Tax Credits and/or Employer/Employee Contribution ^ Pay Periods Directive Numbers

R PAYE 4102 Periods in Year of Assessment Directive No.

R PAYE on Lump Sum Benefit 4115 No. of Periods Worked Directive No.

Period Employed From (CCYYMMDD)

R Employee and Employer UIF Contribution 4141 Directive No.
CCYY/MM/DD

Period Employed To (CCYYMMDD) Directive No.

R Employer SDL Contribution 4142
CCYY/MM/DD

R Total Tax, SDL and UIF 4149 Directive No.

R Medical Scheme Fees Tax Credit 4116

R Additional Medical Scheme Fees Tax Credit 4120

Reason for Non-Deduction of Employees’ Tax 4150

Voluntary Over Deduction Y N

 Taxpayer Information - Income ^

Investment Income
Excl. Exempt Dividends and any amounts received / accrued as a beneficiary of a trust(s), or deemed to have accrued in terms of s7

Note:
• All the investment income must be declared in full (even if you are married in community of property).
• If you are married in community of property SARS may have already included your spouse’s investment income based on third party data readily available.
• Interest earned by a non-resident qualifying for an exemption in terms of s10(1)(h) must be included in the Local Interest income field.
Please note, SARS will do the required apportionment(s) and / or apply the applicable exemptions.

Local Interest – Rands only, no cents

Local Interest (excluding SARS Interest)

Mark with an “X” if you were physically absent from RSA for at least 182 days (or 183 days in a leap year) during the 12
month period preceding the date in which the interest was received? ^
Allowable interest expenses incurred in the production of interest
R Interest Exempt in terms of s10(1)(h) (amount must be included in the
local interest amount)
R received

R Local Interest (excluding SARS Interest) 4201

Institution Account No. Amount

Mark here with an “X” if this amount should be excluded

Institution Acc No. R Amount from the communal estate (if married in community of
property)

Mark here with an “X” if this amount should be excluded

Institution Acc No. R Amount from the communal estate (if married in community of
property)
Add
Mark here with an “X” if this amount should be excluded
Institution Acc No. R Amount from the communal estate (if married in community of
property)

SARS Interest during this year of assessment

^

R SARS Interest received during this year of assessment 4237

Tax Type Taxpayer Ref No. R Amount

Tax type Amount

Add
Taxpayer Ref No. R
Foreign Interest and Foreign Tax Credits on Foreign Interest – Rands only, unless cents specified

R Foreign Interest 4218 R Foreign Tax Credits on Foreign Interest 4113

Institution Account No. Foreign Interest Amount Foreign Tax Credit on

Foreign Interest Amount

Institution Foreign Interest Amount Foreign Tax Credit on Foreign Interest Amount Mark here with an “X” if this amount should
Acc No. R R be excluded from the communal estate (if
married in community of property)

Mark here with an “X” if this amount should

Institution Acc No. R Foreign Interest Amount R Foreign Tax Credit on Foreign Interest Amount be excluded from the communal estate (if
married in community of property)
Add
Mark here with an “X” if this amount should
Institution Acc No. R Foreign Interest Amount R Foreign Tax Credit on Foreign Interest Amount be excluded from the communal estate (if
married in community of property)

Gross Foreign Dividends subject to SA normal tax and Foreign Tax Credits on Foreign Dividends – Rands only, unless cents specified

R Gross Foreign Dividends subject to SA normal 4216 R Foreign Tax Credits on Foreign Dividends ^ 4112
^
Gross Foreign Dividends subject Foreign Tax Credits on
Institution Account No.
to SA normal tax Amount Foreign Dividends Amount

Institution Gross Foreign Dividends subject to SA normal Foreign Tax Credits on Foreign Dividends Mark here with an “X” if this amount should
Acc No. R tax Amount R Amount be excluded from the communal estate (if
married in community of property)

Gross Foreign Dividends subject to SA normal Foreign Tax Credits on Foreign Dividends Mark here with an “X” if this amount should
Institution Acc No. R R be excluded from the communal estate (if
tax Amount Amount
married in community of property)
Add
Gross Foreign Dividends subject to SA normal Foreign Tax Credits on Foreign Dividends Mark here with an “X” if this amount should
Institution Acc No. R R be excluded from the communal estate (if
tax Amount Amount
married in community of property)

Distributions from Real Estate Investment Trust(s) (REIT) / Taxable Local Dividends

Distribution from REIT / Taxable Local

Dividends
^
R Distribution from REIT/Taxable Local Dividends 4238

Institution Account No. Amount

Mark here with an “X” if this amount should be excluded
Institution Acc No. R Amount from the communal estate (if married in community of
property)

Mark here with an “X” if this amount should be excluded

Institution Acc No. R Amount from the communal estate (if married in community of
property)
Add
Mark here with an “X” if this amount should be excluded
Institution Acc No. R Amount from the communal estate (if married in community of
property)
 Dividends Deemed to be Income in terms of s8E and s8EA

Dividends deemed to be income in terms of

s8E and s8EA ^ R Dividends deemed to be income in terms of s8E and s8EA 4292

Institution Account No. Amount

Institution Acc No. R Amount

Institution Acc No. R Amount

Add
Institution Acc No. R Amount

Foreign Income Excl. Investment Income, CGT and amounts received / accrued as a beneficiary of a trust(s), or deemed to have accrued in terms of s7 – Rands only, unless cents specified ^

Mark here with an ‘X’ if the Foreign Rental (Profit/Loss) declared below should be Note: If you are married in community of property, the full Foreign Rental Profit/Loss applicable to you must be declared as SARS will apply the required apportionment.
excluded from the communal estate (if married in community of property)

Other – Loss (Excluding Rental from the letting of fixed

R Foreign Rental (from the letting of fixed property(ies)) - Profit 4288 R Farming – Profit 0192 R property(ies)) 4229

Income received from foreign employment services not reflected on

Foreign Rental (from the letting of fixed property(ies)) - Loss 4289 R Farming – Loss 0193 R a South African IRP5/IT3(a) certificate, subject to tax outside RSA 4298
R and the s10(1)(o)(ii) exemption does not apply
Income received from foreign employment services not reflected on
Royalties – Profit 4278 R a South African IRP5/IT3(a) certificate, subject to tax outside RSA 4299
R Foreign Tax Credits on Foreign Rental Income 4121 R and the s10(1)(o)(i) exemption applies

Income received from foreign employment services not reflected on

Business / Trading – Profit (excluding rental income derived from the R Royalties – Loss 4279 R a South African IRP5/IT3(a) certificate, subject to tax outside RSA 4304
R letting of fixed property(ies)) 4222 and the s10(1)(o)(i) exemption does not apply
Other Foreign Tax Credits (excluding Rental from the letting of fixed
Other – Profit (Excluding Rental from the letting of fixed 4228 R property(ies) and Income received from foreign employment services 4111
Business / Trading – Loss (excluding rental income derived from the R not reflected on a South African IRP5/IT3(a) certificate, subject to
R letting of fixed property(ies)) 4223 property(ies))
tax outside RSA and the s10(1)(o)(ii) exemption applies)
Income received from foreign employment services not reflected on
R Controlled Foreign Company (CFC) – Share of Profit 4230 R a South African IRP5/IT3(a) certificate, subject to tax outside RSA 4259
and the s10(1)(o)(ii) exemption applies
Foreign Tax Credit on income received from foreign employment
Income received from foreign employment services reflected on a R services not reflected on a South African IRP5/IT3(a) certificate,
R South African IRP5/IT3(a) certificate, subject to tax outside the 4235 subject to tax outside RSA and the s10(1)(o)(ii) exemption applies
RSA and the s10(1)(o)(ii) exemption does not apply.
 Foreign Tax Credits Refunded / Discharged ^

Specify the portion of the amount so refunded / discharged as was Specify the portion of the amount so refunded / discharged as was
R R previously allowed by SARS as a deduction in terms of s6quat(1C) 4249 ^
previously allowed by SARS as a rebate from a South African source of income

Trust Income – Income distributed to you / vested in you as a beneficiary of a trust or deemed to have accrued in terms of s7 ^

Trust Details ^

Trust Name

Trust Registration Number Trust Tax Reference Number

Details of Local Income ^

Mark with an “X” if you were physically absent from RSA for at least 182 days (or 183 days in a leap year) during the 12
month period preceding the date in which the interest was received?

Source
^
Distributions from Real Estate Investment Trust(s) (REIT) / Taxable Local Business and Trading Income (excluding Rental Income from Source
R Local Remuneration
Code R Local Dividends 4238 R letting of fixed property(ies) and income from Farming Operations) Code

Source Source Source

R Local Annuities R Local Capital Gain / Loss R Income from Local Farming Operations (IT48)
Code Code Code

R Local Interest 4201 R Local Rental Income from the letting of fixed property(ies) 4210 R Deemed Annuity 3611

R Interest Exempt in terms of s10(1)(h) (amount must be included in

the local interest amount)

4237 Source
R SARS Interest R Dividends deemed to be income in terms of s8E and s8EA 4292 R Other Local Income
Code

Details of Foreign Income ^

Source
R Foreign Interest 4218 R Foreign Capital Gain / Loss
Code R Imputed Net Income from Controlled Foreign Companies (CFC) 4276

Foreign Tax Credit on Imputed Net Income from Controlled Foreign

R Foreign Tax Credits on Foreign Interest 4113 R Foreign Tax Credits i.r.o. Capital Gain / Loss 4114 R 4122
Companies (CFC)

R Foreign Dividends 4216 R Foreign Farming 0192 R Other Foreign Income 4220

R Foreign Tax Credits on Foreign Dividends 4112 R Foreign Tax Credits on Foreign Farming Income 4119 R Foreign Tax Credits on other Foreign Income 4110
Amount Considered Non-Taxable

R Amount Considered non-Taxable

Capital Gain / Loss

Note: If you are married in community of property, the full amounts relating to Proceeds, Base Cost and Exclusion / Roll-over (excluding annual exclusions) applicable to you must be declared, as SARS will apply the required apportionment.
Note: The annual exclusion and inclusion rate and carry forward losses will be calculated by SARS.

Determination of Local Gain / Loss

Mark here with an “X” if this amount should be excluded from the communal estate (if married in
community of property)

Select the applicable Main Asset Type Source Code R Proceeds

R Gain 4250

Do you confirm that this transaction relates to a primary R Base Cost

residence? Y N
R Or Loss 4251
If Yes, indicate whether the primary residence is held Y N R Primary Residence / Other Exclusions (excl. annual exclusions)
jointly?
Was the disposal made to a connected person (including the
Y N parent, child, stepchild, brother, sister, grandchild or grandparent of
Is the primary residence held in a partnership? R Exclusion / Roll-over (excluding annual exclusions) Y N
that natural person) in terms of paragraph 39 of Eighth Schedule?

If Yes, state the percentage held Percentage Held % Less: Prior year clogged loss brought forward and deductible from
R the capital gains listed above derived from a disposal to the same
connected person (par. 39 of the Eighth Schedule)
Mark here with an ‘X’’ to confirm that the full amounts relating to
proceeds and base cost of the primary residence are declared.
In which year was
this disposal made?
Does any exemption/rollover other than primary residence Y N
exemption apply to this transaction? CCYY

Details of Connected Person

Type of connected person Is the connected person a SA resident? Y N

Name and Surname Identity Number Passport Number

Name of Trust / Registered Name Registration No. Tax Ref No.

Determination of Foreign Gain / Loss

Mark here with an “X” if this amount should be excluded from the communal estate (if married in
community of property)

Select the applicable Main Asset Type Source Code R Proceeds Exclusion/Roll-over (excluding annual exclusions)
R

Do you confirm that this transaction relates to a primary residence? Y N

R Base Cost R Gain 4252

If Yes, indicate whether the primary residence is held jointly? Y N R Or Loss 4253
R Primary Residence / Other Exclusions (excl. annual exclusions)

Is the primary residence held in a partnership? Y N

R Foreign Tax Credits in respect of Foreign Capital Gain/Loss 4114

If Yes, state the percentage held Percentage Held %

Was the disposal made to a connected person (including the
parent, child, stepchild, brother, sister, grandchild or grandparent of
Y N
Mark here with an ‘X’ to confirm that the full amounts relating to that natural person) in terms of paragraph 39 of Eighth Schedule?
proceeds and base cost of the primary residence are declared.
Less: Prior year clogged loss brought forward and deductible from
Does any exemption/rollover other than primary residence Y N R the capital gains listed above derived from a disposal to the same
exemption apply to this transaction? connected person (par. 39 of the Eighth Schedule)
In which year was
this disposal made?

CCYY

Details of Connected Person

Type of connected person Is the connected person a SA resident? Y N

Name and Surname Identity Number Passport Number

Name of Trust / Registered Name

Registration No. Tax Ref No.

Local Rental Income from the Letting of Fixed Property(ies) (Excluding amounts received / accrued as a beneficiary of a trust(s), or deemed to have accrued in terms of s7)

Mark here with an ‘X’ if this amount should be excluded from the communal estate (if married in community of property)
Note:
• If in a partnership, declare full partnership financial details.
• Where a unique identifier was allocated to this trade in the previous year, please complete that allocated number. Also ensure that the
Name of Property / Description of Asset description above is the same as the previous year.

Mark with an “X” if the property is not used for trading

Unique Identifier purposes anymore (e.g., the property was sold).

Income – Rands only, no cents

R Rental Income

Expenditure – Rands only, no cents

R Accounting Fees R Electricity / Rates and Taxes R Repairs / Maintenance

R Agency Fees R Insurance R Other

R Bad Debts Interest / Finance Charges Description relating to other

R

R Depreciation R Levies Paid

R TOTAL

Determination of Profit / Loss – Rands only, no cents

R Taxable Profit 4210 R Taxable Loss 4211

Should the loss incurred be excluded (ring-fenced) for the calculation of your tax liability? Y N Are you in a partnership? Y N

If Yes, state the percentage held Percentage Held % Mark here with an ‘X’ if variable ratios should be applied for the sharing of
income and/or expenses..
Local Business, Trade and Professional Income (Including crypto asset(s)) (other than Rental Income from the Letting of Fixed Property(ies) and distributions received / accrued as a beneficiary of a trust(s), or deemed to
have accrued in terms of s7)

Note:
Name of Business / Trade • If in a partnership, declare full partnership financial details.
• Where a unique identifier was allocated to this trade in the previous year, please complete that allocated number. Also ensure that the
description above is the same as the previous year.

Mark with an “X” if the business is “No” no longer trading /

Unique Identifier operational (e,g, the business was sold or ceased operation)

Income – Rands only, no cents

R Turnover / Sales R Gross Profit Description relating to other

Income Reflected on an IRP5/IT3(a) regarded to be R Gross Loss

R trading Income

R Cost of Sales R Income Other than Turnover R TOTAL

Expenditure – Rands only, no cents

R Accounting Fees R Entertainment R Salaries and Wages

R Administration Cost R Insurance R Telephone

R Bad Debts R Interest / Finance Charges

R Travel Costs – Local

R Bank Charges R Lease Payment

R Travel Costs – Foreign
R Capital Allowances R Legal Costs

R Other
R Commission paid R Provision for Doubtful Debts

R Consulting Fees Paid R Rental Paid R TOTAL

R Depreciation R Repairs / Maintenance R Accounting Profit

R Electricity / Rates and Taxes R Royalties and License Fees R Accounting Loss

Description relating to other

Adjustments: Add Back – Rands only, no cents

R Depreciation R Disallowable Foreign Expenses R Donations

R Doubtful Debts R Finance Charges R Private / Personal Expenses

R Provisions Recoupment R Unproductive Interest

R

R Other R Legal Costs R TOTAL

Description relating to other

Adjustments: Allowable – Rands only, no cents

R UDZ (s 13quat) – improvements allowable in respect of this year R Depreciation: s11(e) R Other deductions in respect of Buildings – excluding s 13quat

R Depreciation, Manufacturers, etc.: s12C Learnership Allowance: Agreements in effect / completed in current R Doubtful Debt: s11(j)
R year (Agreements entered into before 1 October 2016): s12H

Learnership Allowance: Agreements in effect / completed in current

R Elected Depreciable Asset Allowance: s11(o) R Future Expenditure: s24C R year (Agreements entered into on or after 1 October 2016): s12H

UDZ (s 13quat) – erection/acquisition of a new building allowable in R Other R TOTAL

R respect of this year

Description relating to other

Determination of Profit / Loss – Rands only, no cents

Source Mark here with an ‘X’ if you are mining in crypto assets.
R Taxable Profit R Taxable Loss
Code

Should the loss incurred be excluded (ring-fenced) for the calculation of your tax liability? Y N Are you in a partnership? Y N If Yes, state the Profit / loss percentage Amount %

Mark with an ‘X’ if variable ratios should be applied for the sharing of income and/or expenses. Did you or the partnership make any pension / provident / retirement annuity fund contribution(s) for your benefit as a deemed employee of the partnership? Y N

Fund Type
Pension Fund

Name of the Fund FSCA Registration Number Pension Number

R Contributed by the Partnership R Fringe Benefit 3817 R Contributions made by you

Is this information reflected on any IRP5 / IT3(a)

Total 4001 certificate included in this return? Y N
R

Provident Fund

Name of the Fund FSCA Registration Number Provident Number

R Contributed by the Partnership R Fringe Benefit 3825 R Contributions made by you

Is this information reflected on any IRP5 / IT3(a) Y N

R Total 4003 certificate included in this return?

Retirement Annuity Fund

Name of the Fund FSCA Registration Number Policy Number

R Contributed by the Partnership R Fringe Benefit 3828 R Contributions made by you

Note: Please ensure that you have claimed this total contributions next to source code
R Total 4006 Is this information reflected on any IRP5 / IT3(a) Y N 4006 in the Retirement Annuity Fund Contributions container.
certificate included in this return?

Additional Information

UDZ (s 13quat) Improvements not owned by taxpayer – s12N

Was the building or part of the building for which these allowances Did you claim any deduction as a deemed owner in Total cost incurred in respect of erection/acquisition or
Y N Y N R improvements of a building
were claimed, brought into use after 31 March 2023? terms of s12N?
Other Taxable Receipts and Accruals (Including remuneration from foreign employer(s) for services rendered in South Africa) – Rands only, no cents (Excluding amounts received / accrued as a beneficiary of a trust(s), or
deemed to have accrued in terms of s7)

Note: Use this section to declare any amounts that have not been R Remuneration from Foreign employer for services rendered in SA 4236 R Other 4214
addressed by previous sections.

R Royalties – Profit 4212 Description relating to other

R Severance benefit received from foreign employer for services 3925
rendered in SA

R Royalties – Loss 4213 Directive No.

Amounts Received/Accrued Considered Non - Taxable – Rands only, no cents(Excluding amounts received / accrued as a beneficiary of a trust(s), or deemed to have accrued in terms of s7)

Amounts accrued to you as an exclusive deemed resident of

R another country in terms of a double taxation agreement between R Exempt Local Dividends R Other
RSA and that other country

R Exempt Foreign Dividends Description relating to other

R Donations

R Inheritances
R Foreign Pension

Tax Free Investments (TFI) – Rands only, no cents

Tax Free Investments (TFI) – Account Details

Institution Pol / Client No. Investment Type

R Contributions made to a TFI during the year of assessment 4219 R Transfer in (from another TFI) during this year of assessment 4246 R Transfer out (to another TFI) during this year of assessment 4247

R Amounts withdrawn out of a TFI during the year of assessment 4248 R Net return on Investment - Profit 4239 R Net return on Investment - Loss 4240

R Interest 4241 R Dividends 4242 R Capital Gains 4243

R Capital Loss 4244 R Other (For example: Manufactured dividends) 4257

Farming Operations

Income from Local Farming Operations (IT48) – Rands only, no cents

If any of the following paragraphs of the First Schedule to the Income Tax Act applies to this assessment, please mark the applicable block(s) with an "X": Par 13(1)(a) Par 13A Par 15 Par 17 Par 20
Par 13(1)(b)
Description

Note: Where a unique identifier was allocated to this trade in the previous year, please complete that allocated
Unique Identifier Mark with an “X” if the farming operations ceased (e,g. the
farm was sold). number.

Gross receipts and accruals (Including private usage, but excluding partnership income and distributions from a trust(s)) R Amount

Partnership income (Add profit / loss) R Amount

Income from local Farming Operations (IT48) distributed by a trust(s) R Amount

Plus: Livestock on hand at the end of the current year of assessment

Plus: Produce on hand at the end of the current year of assessment

{ Excluding market value of livestock and produce acquired otherwise than by purchase, natural
increase or in the ordinary course of farming operations (e.g. donations and inheritance) R Amount

R Amount

Sub-Total (i) Amount

R

Livestock on hand at the end of the preceding year of assessment R Amount

Livestock purchased and received in exchange Amount

R

Balance of livestock not allowed in the preceding year of assessment R Amount

Sub-Total (ii) Amount

R

Less: Amount deducted [Sub-Total (ii) limited to Sub-Total (i)] Amount Amount
R R

Less: Balance carried forward to the following year of assessment (This amount may not create or increase a loss) R Amount

Sub-Total R Amount
Less: Allowable Expenses R Amount

Less: Produce on hand at the end of the preceding year of assessment R Amount

Less: Special depreciation R Amount Amount

R

Less: Net Profit / Loss R Amount

Less: Amount of improvements deductible from Net Profit Amount

R
Taxable income/ loss from farming operations R Amount

Equalisation rate selection If a loss was incurred, should it be excluded (ring-fenced) for the calculation of your tax liability? Y N
Source Code

Note: Please remember to complete the Statement of Assets and Liabilities of this return

Special Depreciation Information - Rands only, no cents

Current Year Subsequent Year Year Following Subsequent Year

R Balance b/f previous year R Balance b/f previous year

R Purchases current year

R Deductions in respect of purchases current year R Deductions in respect of purchases current year R Deductions in respect of purchases current year

R Deductions added back in respect of assets sold R Deductions added back in respect of assets sold

R Amount allowable current year

Information on Capital Improvements - Rands only, no cents

R Balance brought forward from previous year R Plus: Total brought forward from partnership IT48V’s R Balance carried forward to subsequent year

R Less: Recoupments R Total improvements

R Plus: Purchases/costs - current year R Less: Allowable deductions current year

Details of Farming Expenses (IT48)

Expenses

R Accounting fees R Lease payments (s11(f)) R Seeds and fertilizers

R Administration costs and bank charges R Legal expenses R Telephone, fax and internet expenses

R Bad debts R Livestock feeds

R Travelling and accommodation - Local

R Costs of residential buildings for employees (s13ter) R Packing materials R Travelling and accommodation - Foreign

R Electricity, rates and taxes R Protective clothing Veterinary expenses (incl. medicines)
R

R Rations and other staff costs (excl. housing, salary and wages) Wear and tear allowance (s11(e) – excl. special depreciation in
R Entertainment expenses R terms of s12B)

Learnership Allowance: Agreements in effect / completed in

Expenses for cleaning land R Rent (incl. hiring of farm land, equipment, etc.)
R R current year (Agreements entered into before 1 October 2016):
s12H

Learnership Allowance: Agreements in effect / completed in

R Repairs and maintenance
R Fuel, oil and related expenses R current year (Agreements entered into on or after 1 October
2016): s12H

R Salaries and wages

R Insurance and Licenses R Other

R Interest and finance charges R Security expenses Description relating to other

R Total Expenses
Adjustments: Add back

R Disallowable foreign expenses R Private/Personal expenses R Total Adjustments: Add back

R Donations R Recoupment (excl. capital improvements)

R Finance Charges R Unproductive Interest

R Legal expenses R Other

Description relating to other

Total Allowable Expenses

R Total

Capital Improvements Incurred during the Year of Assessment (paragraph 12(1) of the First Schedule)

Expenses

Carrying of electric power from the main transmission lines to the

Erection of, or additions or improvements to farm buildings (other farm apparatus or under an agreement concluded with the Electricity
R Dipping tanks R R
than buildings used for domestic purposes) Supply Commission as stipulated

Planting of trees, shrubs or perennial plants for the production of Wages paid to employees employed in construction of capital works
R Dams, irrigation schemes, boreholes and pumping plants R grapes or other fruit, nuts, tea, coffee, hops, sugar, vegetable oils or R as set out above
fibers and the establishment of an area for such purposes

R Fences R Building of roads and bridges used in farming operations

Total Purchases/Costs – Current year

R Total
Local Partnership Farming Operations (IT48V)

Income from Local Partnership Farming Operations (IT48V) – Rands only, no cents

Partnership Name

Gross receipts and accruals (Including private usage) R Amount

Plus: Livestock on hand at the end of the current year of assessment

Excluding market value of livestock and produce acquired otherwise than by purchase, natural increase or in Amount
the ordinary course of farming operations (e.g. donations and inheritance)
R

Plus: Produce on hand at the end of the current year of assessment

Excluding market value of livestock and produce acquired otherwise than by purchase, natural increase or in
the ordinary course of farming operations (e.g. donations and inheritance) R Amount

Sub-Total (i)

R Amount

Livestock on hand at the end of the preceding year of assessment R Amount

Livestock purchased and received in exchange R Amount

Balance of livestock not allowed in the preceding year of assessment R Amount

Sub-Total (ii)

R Amount

Less: Amount deducted [Sub-Total (ii) limited to Sub-Total (i)]

R Amount R Amount

Less: Balance carried forward to the following year of assessment (This amount may not create or increase a loss) Amount Sub-Total
R
R Amount

Less: Allowable Expenses Amount

R

Less: Produce on hand at the end of the preceding year of assessment R Amount

Less: Special depreciation R Amount R Amount

Net Profit / Loss Partnership R Amount

Your share % of Taxable Income / Loss from partnership farming operations R Amount
(Carry this amount forward to your personal IT48)
Special Depreciation Information - Rands only, no cents

Current Year Subsequent Year Year Following Subsequent Year

R Balance b/f previous year R Balance b/f previous year

R Purchases current year

R Deductions in respect of purchases current year R Deductions in respect of purchases current year R Deductions in respect of purchases current year

R Deductions added back in respect of assets sold R Deductions added back in respect of assets sold

R Amount allowable current year

Information on Capital Improvements - Rands only, no cents

R Purchases/costs - current year Note: Reflect your % share of this amount on the IT48.
Partner’s Information for Share Distribution (Farming)

1 Surname / Trading Name Income Tax Reference Number

Initials (if applicable) Share % R Profit / Loss R Improvements

2 Surname / Trading Name Income Tax Reference Number

Initials (if applicable) Share % R Profit / Loss R Improvements

Surname / Trading Name Income Tax Reference Number

3
Initials (if applicable) Share % R Profit / Loss R Improvements

Surname / Trading Name Income Tax Reference Number

4
Initials (if applicable) Share % R Profit / Loss R Improvements

5 Surname / Trading Name Income Tax Reference Number

Initials (if applicable) Share % R Profit / Loss R Improvements

Details of Farming Expenses (IT48V)

Expenses

R Accounting fees R Lease payments (s11(f)) R Seeds and fertilizers

R Administration costs and bank charges R Legal expenses R Telephone, fax and internet expenses

R Bad debts R Livestock feeds Travelling and accommodation - Local

R

R Costs of residential buildings for employees (s13ter) R Packing materials Travelling and accommodation - Foreign
R

R Electricity, rates and taxes R Protective clothing Veterinary expenses (incl. medicines)
R

R Rations and other staff costs (excl. housing, salary and wages) Wear and tear allowance (s11(e) – excl. special depreciation in
R Entertainment expenses R terms of s12B)

Learnership Allowance: Agreements in effect / completed in

Expenses for cleaning land R Rent (incl. hiring of farm land, equipment, etc.)
R R current year (Agreements entered into before 1 October 2016):
s12H

Learnership Allowance: Agreements in effect / completed in

R Repairs and maintenance
R Fuel, oil and related expenses R current year (Agreements entered into on or after 1 October
2016): s12H

R Salaries and wages

R Insurance and Licenses R Other

R Interest and finance charges R Security expenses Description relating to other

R Total Expenses
Adjustments: Add back

R Disallowable foreign expenses R Private/Personal expenses R Total Adjustments: Add back

R Donations R Recoupment (excl. capital improvements)

R Finance Charges R Unproductive Interest

R Legal expenses R Other

Description relating to other

Total Allowable Expenses

R Total

Capital Improvements Incurred during the Year of Assessment (paragraph 12(1) of the First Schedule)

Expenses

Planting of trees, shrubs or perennial plants for the production of

R Dipping tanks R grapes or other fruit, nuts, tea, coffee, hops, sugar, vegetable oils or Total Purchases/Costs – Current year
fibers and the establishment of an area for such purposes

R Dams, irrigation schemes, boreholes and pumping plants R Building of roads and bridges used in farming operations
R Total

Carrying of electric power from the main transmission lines to the

R farm apparatus or under an agreement concluded with the Electricity
R Fences
Supply Commission as stipulated

Erection of, or additions or improvements to farm buildings (other Wages paid to employees employed in construction of capital works
R R as set out above
than buildings used for domestic purposes)
Taxpayer Information - Deductions ^

Medical Deductions – Rands only, no cents ^

Medical Expenditure
(including medical scheme contributions made by you or your employer towards a medical scheme where you are the principal / main member)
^

Were you the principal / main member of a medical scheme to which you and/or your employer made contributions? Y N

In how many medical scheme(s) were you the principal / main member during this year of assessment? Number of Schemes

Details of Medical Scheme ^

Medical Scheme Name

Medical Scheme Membership Number

State the total number of dependants (including yourself) per month:

Mar Apr May Jun Jul Aug

Sep Oct Nov Dec Jan Feb

R State the total medical contributions made by yourself and / or your employer to this scheme (incl. subsidies from former employer) 4005

R State any medical expenses paid by you that were claimed from your medical scheme and reflected on the medical certificate (other than physical impairment or disability expenses) 4020
Taxpayer Information - Deductions ^

Medical Deductions – Rands only, no cents ^

Medical Expenditure
(including medical scheme contributions where you are not the principal / main member of the medical scheme) in respect of any immediate family member who is dependent on you for family care and support
^

Were any of the immediate family member(s) dependant(s) of a medical scheme(s) to which you paid the contributions? Y N

Indicate the number of medical schemes to which you paid the contributions in respect of such dependant(s) Number of Schemes

Details of Medical Scheme ^

Medical Scheme Name

Medical Scheme Membership Number

Details of the principal / main member of the medical scheme

Full Name and Surname Taxpayer Reference Number

Identity Number Passport Number

State the total number of dependants per month:

Mar Apr May Jun Jul Aug

Sep Oct Nov Dec Jan Feb

R State the total amount of medical scheme contributions paid on behalf of any immediate family member(s) who is dependent on you for family care and support 4035

R State the amount of the medical expenses paid by you that were claimed from the medical scheme and reflected on the medical certificate (other than physical impairment or disability expenses) 4020
Taxpayer Information - Deductions ^

Medical Deductions – Rands only, no cents ^

Expenses Not Reflected on any Medical Certificate

R State any qualifying medical expenses paid by you that were not claimed from any medical scheme and not reflected on any medical scheme certificate (other than physical impairment or disability expenses) 4034

Physical Impairment

R State any qualifying physical impairment expenses paid by you and not recovered from any medical scheme(s) and not included above
4022

Disability

Are you, your spouse or any of your qualifying children a person with a disability? Y N Indicate the number of qualifying person(s) with a disability

If ‘Yes’, has the disability been confirmed by a duly registered medical practitioner as prescribed? Y N

Details of Disability

Specify the date on which the latest ITR-DD for this person was confirmed by a duly registered practitioner:
Indicate the person with the disability
CCYY/MM/DD
Is the disability a?
Registered Medical Practitioner Practice Number
Date of birth of person with disability

CCYY/MM/DD R State the qualifying disability expenses paid by you i.r.o yourself, your spouse and qualifying children and not
recovered from any medical scheme and not included in any expenses claimed above
4023

Medical subsidies from former employer(s) (if applicable)

R State the medical subsidies from former employer 4493

Taxpayer Information - Deductions

Retirement Annuity Fund Contributions (including amounts reflected under source code 4006 on the IRP5/IT3(a) certificate if not already reflected below) – Rands only, no cents

To how many Retirement Annuity policy(ies) did you or your employer contribute during this year of
assessment? R Total contributions for this year of assessment 4006

Details of Policy(ies)

Name of the Fund Policy Number R Contributions made to this policy

Pension and / or Provident fund Additional Voluntary Contributions including the purchase of past or additional services(excluding amounts already reflected on any IRP5 or IT3(a) certificate)

Fund Type Note: Additional Voluntary Contributions or the Purchases of Past / Additional Services in terms of the rules of pension / provident funds refer to contributions made additionally to
the pension and / or provident fund(s) by the taxpayer to create a better retirement benefit.

To how many Pension Funds did you make payments towards past / additional services during this year
of assessment? R Pension Fund contribution 4001

To how many Provident Funds did you make payments towards past / additional services during Provident Fund contribution 4003
this year of assessment? R

Details of Pension Fund

Name of the Fund Your Membership / Pension Number R Payment made

Details of Provident Fund

Name of the Fund Your Provident Number R Payment made

Taxpayer Information – Deductions - Continue

Travel Claim Against Allowance – Rands only, no cents

Did you use a logbook to determine your business km travelled? Y N Vehicle Registration No. Indicate whether the vehicle was acquired by way of

Date of Purchase
Car Model Car Make
CCYY/MM/DD

R Cost Price or Cash Value

Details of Kilometres Travelled

Starting Date Closing Date

Opening Kilometres
CCYY/MM/DD CCYY/MM/DD

Closing Kilometres Total Kilometres Business Kilometres

Where Records of Actual Expenditure Were Kept

R Fuel and Oil R Maintenance and Repairs R Insurance and License Fees

R Wear and Tear R Or Lease Payment R Finance Charges

R Other

Employer Provided Vehicle: Other than an Operating Lease – Rands only, no cents

Did you use a logbook to determine your business km travelled? Y N Vehicle Registration No.

Car Make Car Model Year Manufactured

R Cost Price or Cash Value R Fringe Benefit Value

Taxpayer Information – Deductions - Continue

Details of Kilometres Travelled

Starting Date Closing Date

Opening Kilometres
CCYY/MM/DD CCYY/MM/DD

Closing Kilometres Total Kilometres Business Kilometres

Full Cost Incurred by the Employee (No reimbursement by the Employer)

Were you fully or partially reimbursed by your employer in respect of the following expenses?

Insurance Y N R Insurance

License Fees Y N R License Fees

Maintenance Y N R Maintenance

Fuel Y N
Was a maintenance plan included in the cost price or cash value of the vehicle provided by your Y N
employer?

Employer Provided Vehicle: Operating Lease – Rands only, no cents

Did you use a logbook to determine your business km travelled? Y N Vehicle Registration No. Fringe Benefit Value
R

Details of Kilometres Travelled

Starting Date Closing Date

CCYY/MM/DD Opening Kilometres

CCYY/MM/DD

Closing Kilometres Total Kilometres Business Kilometres

Taxpayer Information – Deductions - Continue

Donations allowable in terms of s18A to approved organisations – Rands only, no cents

Donations (excluding any amount already on the IRP5 certificate and any other allowable donations made) – Rands only, no cents

R Total amount donated during the year of assessment 4011 Complete the details of the organisation(s) to whom donations Complete the details of the 10 organisations to whom donations
were made: with the highest monetary value were made:

Donations detail

PBO number
PBO number PBO number

R Amount donated to this organisation R Amount donated to this organisation R Amount donated to this organisation

PBO number PBO number PBO number

R Amount donated to this organisation R Amount donated to this organisation R Amount donated to this organisation

PBO number
PBO number PBO number

R Amount donated to this organisation R Amount donated to this organisation R Amount donated to this organisation
Taxpayer Information – Deductions - Continue

Other Deductions / Exemptions – Rands only, no cents

Expenses against local taxable subsistence allowance 4017 Expenses against foreign taxable subsistence allowance 4019 Donations allowable in terms of. s18A to approved public benefit 4011
R R R organisations

R Depreciation 4027 R Home Office Expenses 4028 R Travel Expenses (e.g. commission income) 4015

R Amounts Refunded in terms of s11(nA) and 11(nB) 4042 R Allowable Accountancy / Administration Expense 4043 R Legal expenses in terms of s11(c) 4044

R Bad debt/Provision for doubtful debt 4045 R Use of motor vehicle 4046 R Section 8C losses 4031

Remuneration for foreign employment services that qualifies for 4033 Remuneration (s8A/8C gains) taxed on IRP5 but comply with 4032
R Holders of Public Office: Deduction in terms of s 8(1)(d) 4047 R s10(1)(o)(i) exemption R exemption in terms of s10(1)(o)(ii). (This amount is restricted to
s8A/8C gains, excluding dividends)

Deduction of interest repaid to SARS (in terms of s7F) that was 4052 Remuneration for foreign employment services that qualifies for 4041
R Other 4016 R previously taxed in terms of s7E R s10(1)(o)(ii) exemption (excluding s 8A/8C gains and dividends)

Deduction i.t.o. s6quat(1C) for foreign taxes paid or proved to be

Description relating to other R payable to a foreign government of any country on any SA 4053
sourced trade income

Qualifying Criteria for s10(1)(o)(i)

Are you a SA resident as defined in the Income Tax Act? Y N Were you employed as an officer or crew member to render services on a ship outside SA? Y N

If yes, please state the total number of full days you were outside SA to render services during this year of assessment: Remuneration received/accrued in respect of foreign services
R rendered
Taxpayer Information – Deductions - Continue

Qualifying Criteria for s10(1)(o)(ii) exemption ( excluding s8A/8C gains and dividends)

Are you a SA resident as defined in the Income Tax Act? Y N

Confirm that the remuneration against which this exemption is claimed was not derived i.r.o. the holding of a public office as contemplated in s9(2)(g), or from services
rendered / work / labour performed for the SA government / municipality / constitutional institution / SA public entity as contemplated in s9(2)(h) of the Income Tax Act Y N

Were you employed to render services outside SA? Y N

If yes, please state the number of days you were outside SA during any 12 month qualifying period:

Start date of the 12 month qualifying period (CCYYMMDD) End date of the 12 month qualifying period
Total number of full days outside
SA during the 12 month qualifying
CCYY/MM/DD CCYY/MM/DD period

Did you within the period indicated above spend a continuous period exceeding 60 full days outside SA? Y N

Total number of work days during the above qualifying period relating to this year of assessment Total number of work days outside South Africa during the above qualifying period relating to this year of assessment.

Total remuneration received / accrued in this year of assessment Remuneration exempt

R in respect of foreign services rendered R

Foreign Tax Credit on income received from foreign employment Foreign Tax Credit on income received from foreign employment
R services not reflected on a South African IRP5/IT3(a) certificate, R services reflected on a South African IRP5/IT3(a) certificate, subject Total Foreign Tax on foreign employment services
subject to tax outside RSA and the s10(1)(o)(ii) exemption applies R 4123
to tax outside RSA and the s10(1)(o)(ii) exemption applies

Qualifying Criteria for s10(1)(o)(ii) exemption relating to s8A/8C gains (excluding dividends)

Are you a SA resident as defined in the Income Tax Act? Y N

In respect of the s10(1)(o)(ii) exemption claimed, how many s8A/8C gains are applicable during this year of assessment?

Please provide source period relating to the s8A/8C revenue gain

Start date of the Source period End date of the Source period
Total number of work days during source Total number of work days outside
CCYY/MM/DD CCYY/MM/DD period SA during source period

R Gross value of the gain

Details per Year of Assessment

Year of Assessment Start date during Year of End date during Year of
during Source period Assessment in Source Assessment in Source period
period
Total work days during this Total work days outside SA during this Did section10(1)(o)(ii) apply?
CCYY CCYY/MM/DD CCYY/MM/DD year of assessment year of assessment Y N
Qualifying Criteria for the Deduction of Foreign Taxes Paid or Proved to be Payable to a Foreign Government of any Country on any SA Sourced Trading Income (including salary income) - Rands only, no cents

Did you have a right of recovery other than a right of recovery i.t.o. a mutual agreement procedure, or any entitlement to carry back losses arising during any previous year of assessment? Y N Was this foreign tax amount refunded to Y N
Taxable income from SA sourced trade income (including salary you during this year of assessment?
income) taxed outside SA (before taking into account any
Note: This income must have been declared elsewhere in this return. R allowable deductions i.t.o. s11F, s18A and s6quat(1C), as these
deductions will be calculated by SARS)

Recoupment in respect of Venture Capital Companies (VCC) shares sold: s12J – Rands only, no cents

Amount recouped in respect of VCC shares sold, for which a 4245

R tax deduction was allowed

Statement of Local Assets and Liabilities – Rands only, no cents

Local Assets (at cost) Local Assets (at cost) continue Local Liabilities (at cost)

R Fixed Properties and all Improvements to Properties R Mortgage Bonds

R Cash on Hand, in Bank and Other Similar Institutions

Shares in Private Company or Member’s Interest in Close R Loan Accounts

R Corporation R Personal Effects (jewellery, paintings, furniture, etc.)

R Loan Accounts R Other Assets R Creditors

Financial Instruments Listed (shares, unit trusts, etc.) – excluding Total Local Assets
R crypto asset(s) R R Bank Overdraft

Financial Instruments – crypto asset(s) Local Assets (at Market value)

R
R Other Liabilities

R Fixed Properties and all improvements to properties

R Net Capital of Business, Trade, Profession or Farming

R Total Local Liabilities

Shares in Private Company or Member’s interest in Close
R Equipment, Machinery, Implements R
Corporation

Financial Instruments Listed (Shares, unit trusts, etc.) - excluding

R Motor Vehicles, Caravans, Boats R
crypto asset(s)

R Financial instruments - crypto asset(s)

R Debtors

R Net Capital of Business, Trade, Profession or Farming.

R Stock

R Total Local Assets at Market Value

R Livestock - elected value(s)
Statement of Foreign Assets and Liabilities – Rands only, no cents

Note: The foreign currency value at cost must be translated to Rand using the exchange rate as at the end of the tax year when the asset was acquired.

R Total Foreign Assets at Cost R Total Foreign Assets at Market Value R Total Foreign Liabilities

Partnership Details

Provide full name of partnership in which you were a partner during the year of assessment: Specify your profit / loss sharing % during the year of assessment:

Partnership Name Amount %

Indicate whether you derived a profit / loss from the partnership during the year of assessment? Profit Loss

Unemployment

Were you unemployed for the full year of assessment? Y N Did you receive no income and realise no capital gain / loss? Y N

Periods of Unemployment

Unemployed from Unemployed to

CCYY/MM/DD CCYY/MM/DD

Voluntary Disclosure Programme

If no VDP application was made, change your VDP answer to “No” on the Please indicate the VDP application no. issued by SARS
first page of this return
Declaration

Declaration Declaration Will be displayed in place of taxpayer declaration, if the user is a

tax practitioner.

I declare that: I declare that:

• The information furnished in this return is true and correct in every respect; XXXXXXXXXXXXXXXXXXX · To the best of my knowledge the information provided by the XXXXXXXXXXXXXXXXXXX
and XXXXXXXXXXXXXXXXXXX taxpayer to me is correct and complete. XXXXXXXXXXXXXXXXXXX
• I have disclosed in full the gross amounts of all income accrued to or · All the income and relevant information as provided by the taxpayer
received by me during the period covered by this return; and Please ensure you sign over to me is hereby disclosed to SARS. Please ensure you sign over
• I have the necessary receipts and records to support all my declarations the 2 lines of “X”s above · I have the necessary receipts and records to support this declaration the 2 lines of “X”s above
on this form which I will retain for inspection purposes. and will retain these for inspection purposes

Date Date
For enquiries go to www.sars.gov.za or For enquiries go to www.sars.gov.za or
call 0800 00 7277 call 0800 00 7277
CCYYMMDD CCYYMMDD

Declaration Declaration Will be displayed in place of taxpayer declaration, if the user is a

tax practitioner.

I declare that:
I declare that: · To the best of my knowledge the information provided by the
• The information furnished in this return is true and correct in every respect; and taxpayer to me is correct and complete.
• I have disclosed in full the gross amounts of all income accrued to or · All the income and relevant information as provided by the taxpayer
received by me during the period covered by this return; and to me is hereby disclosed to SARS.
• I have the necessary receipts and records to support all my declarations · I have the necessary receipts and records to support this declaration
on this form which I will retain for inspection purposes. and will retain these for inspection purposes

Date For enquiries go to www.sars.gov.za or

Date For enquiries go to www.sars.gov.za or
call 0800 00 7277 call 0800 00 7277
CCYYMMDD CCYYMMDD

Confirm Confirm