2017 additional Tax Form

DIRECÇÃO GERAL IMPOSTUS
DIRECÇÃO NACIONAL INFORMAÇÃO CONTRIBUINTES PETROLIFERAS E MINERAIS

Building#5 (Ground Floor), Palacio do Governo RDTL, Avenida do Presidente de
Nicolau Lobato
P.O Box-18, Dili , Timor-Leste,
Web: www.mof.gov.tl/Taxation/Petroleum Tax/Tax forms
“ S e j a

u m

b o m

c i d a d ã o ,

s e j a u m n o v o
N a ç ã o ”

h e r ó i

p a r a

a

n o s s a

Additional Tax of Petroleum Tax (Under Section 72, 73, 74 and 75 of Chapter XI of
UNTAET Regulation No. 2000/18 as Amended)
Month of ………………………………2017
Company Name :
TIN
:
Type of the additional tax applied

Amount of Additional Tax
paid (in US $)

Date of payment to the TL
Petroleum Fund Bank
Account’

Account Number 021080973
Due Tax

US$

Additional Tax:
Section 72.1

Section 73. 1

Section 74.
Section 75

US$
Total amount of the 5%
US$
Total amount of the 1%
US$
Section 73. 1 (a) total amount of the 25% US$
Section 73.1 (b) total amount of the 100 % US$

Total amount of the 15%
US$
Section 74 (a) total amount of the 25%
US$
Section 74 (b) total amount of the 100%
US$
US$

Grand Total
Contact Person :
Full name : ____________________________ position _______________________
__________________________________________(Clear)
Next contact person;
Full name : ___________________________ Position : _______________________
email : ____________________________________________(Clear)

email

NDPMR Contact E-mails: hsarmento@mof.gov.tl or aramos@mof.gov.tl; or adcosta@mof.gov.tl or mofsoares@mof.gov.tl
. or urodriques@mof.gov.tl

NDPMR forms: 01-07-2016 Last updated 29/01/2017

Declaration:
I, (full name and designation) ……………………………………………………… , declare on behalf
of the Company, that this information is true and correct under ‘Chapter XI of the UNTAET
Regulation No. 2000/18 as Amended.
Signature: ______________________________ Date :
_____________________
Notes:
1. Please attach copy of EFT bank transfer instruction form in support of electronic
payment of above taxes to the TL Petroleum Fund bank account which details are as
follows:
Name and Address of the Bank- The Federal Reserve Bank of New York, 33 Liberty
Street, New York, NY 10045;
SWIFT CODE- FRNYUS33
Beneficiary Name – ‘Banking and Payments Authority of East Timor- Petroleum Fund
Account’
Account Number- 021080973

2. Payment and submitting of additional Tax forms with EFT due on or before as due date

mentioned in additional tax notice or on next business day if is a public holiday in
Timor-Leste;

NDPMR Contact E-mails: hsarmento@mof.gov.tl or aramos@mof.gov.tl; or adcosta@mof.gov.tl or mofsoares@mof.gov.tl
. or urodriques@mof.gov.tl
NDPMR forms: 01-07-2016 Last updated 29/01/2017

DIRECÇÃO GERAL RECEITAS
DIRECÇÃO NACIONAL INFORMAÇÃO CONTRIBUINTES 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
“ S e j a

u m

b o m

c i d a d ã o ,

s e j a u m n o v o
N a ç ã o ”

h e r ó i

p a r a

a

n o s s a

Offences and Penalties of Petroleum Tax (Under Section 77, 78, 79, 80 and 81 of Chapter
XI of UNTAET Regulation No. 2000/18 as Amended)
Month of ………………………………2017
Company Name :
TIN
:
Type of the additional tax applied

Amount of Additional Tax
paid (in US $)

Date of payment to the
TL Petroleum Fund
Bank Account’

Account Number 021080973
Due Tax

US$

Additional Tax:
Section 77

Section 78
Section 79
Section 80
Section 81

US$
Section 78 (a) total amount of the 25%
US$
Section 78 (b) total amount of the 100 % US$
Section 79 (a)
Section 80 (d)
Section 81 (a)

US$
US$

Grand Total
Contact Person :
Full name : ____________________________ position _______________________
__________________________________________(Clear)
Next contact person;
Full name : ___________________________ Position : _______________________
email : ____________________________________________(Clear)

email

NDPMR Contact E-mails: hsarmento@mof.gov.tl or aramos@mof.gov.tl; or adcosta@mof.gov.tl or mofsoares@mof.gov.tl
. or urodriques@mof.gov.tl
NDPMR forms: 01-07-2016 Last updated 29/01/2017

Declaration:
I, (full name and designation) ……………………………………………………… , declare on behalf
of the Company, that this information is true and correct under ‘Chapter XI of the UNTAET
Regulation No. 2000/18 as Amended.
Signature: ______________________________ Date :
_____________________
Notes:
1. Please attach copy of EFT bank transfer instruction form in support of electronic payment of
above taxes to the TL Petroleum Fund bank account which details are as follows:
Name and Address of the Bank- The Federal Reserve Bank of New York, 33 Liberty Street,
New York, NY 10045;
SWIFT CODE- FRNYUS33
Beneficiary Name – ‘Banking and Payments Authority of East Timor- Petroleum Fund
Account’

Account Number- 021080973
2. Payment and submitting of Offences and penalties of the Petroleum Tax forms with EFT due
on or before as due date mentioned in Offences and penalties of the Petroleum Tax notice or on
next business day if is a public holiday in Timor-Leste;

NDPMR Contact E-mails: hsarmento@mof.gov.tl or aramos@mof.gov.tl; or adcosta@mof.gov.tl or mofsoares@mof.gov.tl
. or urodriques@mof.gov.tl
NDPMR forms: 01-07-2016 Last updated 29/01/2017