Acknowledgement Form for Refund Application

Taxpayer Details

Acknowledgement Date *    
Refund For Application Type
Refund Claim details
Total Refund Amount *  
Refund For * Number *
Amount *  
1) TIN  
2) Taxpayer Details (Individual)
Title  If other specify
Surname* First Name*
Middle Name Acquired Name
Family Surname Date of Birth*   
Sex/Gender* Male   Female  
3)  Taxpayer Details (Non Individual)
4) Address of Owner
Plot Number Street Name
Building Name District*
County* Sub-County*
Parish* Village*
Trading Center*
P.O. Box No Town City
5) Other Details
Landline Number    Mobile Phone Number*   
Email Address  

Refund Details

Reason for Refund Claim *  
Bank Details For Refund Purposes
Name of Bank *  
Bank Branch *  
Account Number(only UGX Accounts) *  
 Fields marked with * are mandatory