8/18/2019 Form Trs01 f

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ហេលខSignature

េឈ ះName

លខិិ្កសង់្ បព់ន

តរងិពន

ទ្ង ់TRS 01

TAX RETURN

FOR SMALL TAXPAYERS

ស្ម់អជព់នចូ

េសច   ី្ កស / Declaration :

ច់  ៃីែឆ ំStart date

ល់ To

 ុ  បំទ/ន ុ   ំូធនះអថ ័ម៌ែលប្កខេល េ ើ   ិជ្  ឹ្វ្ប េដយគ ្  ិ  កិណយួ   ិប្កេនះេទ។ េយ េ ើ ុ  ំូទទួលុ្វេំពះុ ់្  ិេ េ ើ័ម៌ណយួមកែ  ។ំ I hereby assure that all information provided in this form including all attachments is true and accurate and there is nooperation undeclared. I shall be punished by the law of the Kingdom of Cambodia if the provided documents are found to be fraudulent or in formation to be incorrect.

ហេលខSignature

េឈ ះName

កល  េិទDate េធ� េ ើេន

Place,

្ម់  ទិបូ / Stick bar code here!

េលខអត� ណកមសេរព េ ើពន  /  Tax Identification Number (TIN)ក  យិ  េិទសេ េ ើ្មល់  ិ  ិ្កេះ  Tax period of tax return

ស្ម់ន   ពីនដ / Tax official use only   ម� សស់ហ្គស ឬណំង្សច់

Company owner  / Company representative

សខដ Tax Branch

្េទ Type of Taxes

ល.Nº

1

2

3

4

5

6

7

8

1%

10%

3%

2%

10%

លូដ   ិ Tax base

្ត Tax rate

្ប់្វ់ Tax to be paid

A B   C

(B1)

(B2)

(B3)

(B4)

(B5)

(B6)

(B7)

(B8)

D

្ប់េំដះេល េ ើ្ប់េំញ

អេល េ ើៃែ

អ  េិ

អ្ម់ំ  សឺធៈ

អេល េ ើកស ់េ

ក់ទុេល េ ើៃ  ួល

េល េ ើ្បេ់េៀវ

អេផៗ

ំូលុ្ចែំ /  Total turnover of this month

Prepayment of profit tax

Value added tax

Specific tax

Public lighting tax

Accommodation tax

Withholding tax on rental

Salary tax

Other taxes

សុ្បព់នTotal

េឈ ះម ់ហ្គName of owner

ភអ  វីBusiness activities

េឈ ះហ្គName of enterprise

អយដ ផះេលAddress No.

ផ  ូវStreet

ូ  ិVillage

ឃុំ /ង� ់Commune ្/្/District េ /រធ  ីProvince/Cityសេឡ  ិ្  ិEmail

ទូ័ល័ /ទូ័េល េ ើុMobile phone / Office telephone

Month Year

/ Tax calculation

៛K

្ក្ចែំ ឆ  ំ

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8/18/2019 Form Trs01 f

2/2

30 000 000

22 222 2221.35