Income Tax Return Worksheet

To which tax year does this return apply?

First Name

Last Name

Were you unemployed for the full year of assessment and received no income and realised no income and realised no capital gain / loss?

Yes No

Did you receive income that is reflected on an IRP5 or IT3(a) certificate?

Yes No

How many certificates did you receive?

Did you incur any medical expenditure (including medical scheme contributions made by you or your employer)?

Yes No

Did you make any Retirement Annuity Fund or Income Protection contributions?

Yes No

Did you receive income from interest (local and foreign) and/or foreign dividends?

Yes No

Did you receive local dividend income?

Yes No

Are you a director of a company or a member of a close corporation?

Yes No

Did you receive any other income and / or incur any other allowable expenses not addressed above?

Yes No

Did you or your minor child make any donations during this year of assessment?

Yes No

If yes, please state the amount donated

Did you or your minor child pay donations tax on the amount donated?

Yes No

Are you or your minor child beneficiaries of trust registered in or outside the Republic?

Yes No

Did you claim any depreciation on an asset?

Yes No

If yes, was the asset owned by you or acquired by you as a purchaser in terms of “instalment credit agreement”?

Yes No

Was the asset used for the purpose of your trade?

Yes No

Did you claim any “home office expenses”?

Yes No

If yes, is your income derived mainly from commission or other variable payments based on your work performance?

Yes No

Is the home office regularly and exclusively used for the purpose of your trade and is it specifically equipped for such purpose?

Yes No

Are your duties mainly performed otherwise than in an office provided by your employer?

Yes No

If you did not receive a travel allowance from your employer (not reflected on your IRP5), was your claim for travel expenditure based on a logbook?

Yes No