Income Tax Return Form A

CROSS RIVER STATE INTERNAL REVENUE SERVICE — INCOME TAX RETURN FORM A

Identity Verified via CRIRS CAS

PART A: PERSONAL INFORMATION

Surname (in CAPITALS)

Surname at Birth (if different)

First Name

Middle Name

Title

Marital Status

Date of Birth

Nationality

Current Residential Address (not P.O. Box)

Mobile No. 1

Mobile No. 2

Email Address

Contact Address

RC No.

TIN

JTB TIN

BVN

Source of Income

Name of Business

Address of Business or Employer (not P.O. Box)

Business Sector

ASSESSMENT DETAILS

ℹ️ These fields map directly to the CRIRS assessment system. Enter all monetary amounts in Naira (₦). Enter 0.00 for any field that does not apply. You can assess multiple years in a single submission using the "Add Another Year" button.

DECLARATION

PENALTY FOR DEFAULT: Making false statements or wilful refusal to pay accurate tax will attract fines or imprisonment in accordance with applicable Nigerian law.

I hereby declare that the information supplied in this form is, to the best of my knowledge, a true and complete statement of my income from all sources. I understand I may face financial penalties and prosecution for providing false information.

Taxpayer Identity Verification

CROSS RIVER STATE INTERNAL REVENUE SERVICE — INCOME TAX RETURN FORM A

PART A: PERSONAL INFORMATION

ASSESSMENT DETAILS

DECLARATION