Self Assessment LIRS

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In this order Surname; First name; Middle Name
​House No, Street, Town/Area, LG/LCDA, State​
Fill in the number E.G LA 12345
If any change in the above circumstances had occurred during or since the year ended 31st December, 20__
DD/MM/YYYY
DD/MM/YYYY
At 1st January 20__
DD/MM/YYYY
Full Name, Date of Birth, Name and Address of educational establishment, Child’s income in his or her own right (N)
Annex copies of Accounts for the Year Ended 31st December 20……….
Enter the gross Amount before deduction of tax
List the name, Address and amount paid for each. Asterisks those aid by your employers
Note: Please asterisk those paid for by your employer or a separate entity apart from self, and annex the details.
See description
See description
Name of Company, Whether on Life of Self or Spouse Capital sum paid on death, Premiums PAID during the year ended 31st December, 20.... (To the nearest N);
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