09.07.2015 Views

Potvrdenie o prijme_Aj

Potvrdenie o prijme_Aj

Potvrdenie o prijme_Aj

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In date Employee’s signatureTax Liability Confirmationloan applicant loan co-applicant guarantor co-guarantorEmployer InformationTitle: Name: Surname:Permanent Address:Town/City:Zip Code:Personal No./Date of Birth: Company Registration No.: In Business Since:Marital Status:single married divorced widower/widowNumber of Children in Custody:Number of Family Members:Taxpayer’s Income InformationThe taxpayer’s income tax return of individuals in compliance with Act No. 595/2003 Coll. as amended for the past two taxatio n period:Year:Tax Base: ۫*Tax:**Total income / revenues:***Year:Tax Base: ۫*Tax:**Total income / revenues:***EUREUREUREUREUREURto wit:to wit:to wit:to wit:to wit:to wit:We hereby confirm that all tax liabilities as that today have been have not been settledWe confirm that the taxpayer has filed the tax return the amended tax returnName of Responsible Employee:Telephone No.:In on Signature of Responsible Employee Seal of Tax AuthorityHereby, I grant my consent to disclosing data indicated on this Certificate of Tax Levy to the relevant Tax Office for purposes their verification forcorrectness and I agree that the relevant Tax Office of the SR provide outcomes of the verification to VUB a.s. for purposes of assessment myloan application.In date Taxpayer Signature* total income tax basis (in the Income Tax Return Form (hereinafter referred to as the ITRF) ITFR type A – row 36; ITFR type B – row 72)** total tax liability (in the ITFR type A – row 56; in the ITFR type B – row 94)*** total income (in the ITFR type A – row 36; in the ITFR type B – rows 37, table 1, col 1, row 9)

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