Employee Certificate Tax Form

DIRECÇÃO GERAL RECEITAS

DIRECÇÃO NACIONAL DE RECEITAS PETROLIFERAS E MINERAIS

Building#5 (Ground Floor), Palacio do Governo RDTL, Avenida do Presidente de
Nicolau Lobato
P.O Box-18, Dili , Timor-Leste, Phone- +(670) 333 9542
Web: www.mof.gov.tl/Taxation/Petroleum Tax/Tax forms
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SECTION 24 WAGE INCOME TAX WITHHELD INFORMATION FORM
Name of the
Company :
………………………………………………..
TIN …………………
Name of Employer or responsible for : ……………………………………………..
Email address/contact no.
: ……………………………........... No. ……………………….
Name of the
employee

……………………………………

Nationality

Source of
Income

JPDA
Annex F

JPDA non
Annex F

TLEA

Non in Oil
activities

Tick (X)

Id. (Passport) Number

Tick (x)

Resident
(…………)

Non-Resident

Period of
Employed :

From: ……………………….
(ddmmyy)

To: ……………………………………..
(ddmmyy)

Total Gross Wages Paid:
US$ ……………………………………………

(…..……)

Total Wages Income Tax Withheld:
US$ ……………………………….

During the year …………….as withholding tax and subsequently deposited to Account No. 021080973 with The Federal Reserve
Bank of New York in favour of ‘Banking & Payment Authority of East Timor - Petroleum Fund Account

Employer’s Declaration:
This is to certify that the above named employee had the Wage Income Tax shown above withheld from
his Gross Wages pursuant to the provisions of Section 22 of the Taxes & Duties Act 2008 or Article
21/26 of the Law on Income Tax. The undersigned also certifies that the above mentioned tax withheld
from the employee has been remitted to the designated Timor-Leste Petroleum Fund bank account
within the stipulated time.
Signature:__________________________________________________Date:_________________
(Full name and designation)
Email address : …………………………………………. phone No. ………………………………
Notes:
1.
This certificate may be issued under Section 24 of the Taxes & Duties Act 2008, if requested by the
employees on annual basis or may be issued when the employee leave the employment;
NDPMR Contact E-mails:

hsarmento@mof.gov.tl
jmonteiro@mof.gov.tl or jjeronimo@mof.gov.tl
PTD Form No: 02-01-01 Last updated 29/12/2014

or aramos@mof.gov.tl

or

adacosta@mof.gov.tl

or

2.

The employer must also lodge prescribed monthly employee withholding tax forms separately to NDPMR
within 15th days of the following month of the payment;

NDPMR Contact E-mails:
hsarmento@mof.gov.tl
jmonteiro@mof.gov.tl or jjeronimo@mof.gov.tl

PTD Form No: 02-01-01 Last updated 29/12/2014

or aramos@mof.gov.tl

or

adacosta@mof.gov.tl

or