Acknowledgement Form for Refund Application

Taxpayer Details

Taxpayer Details
Payment Registration Number *
TIN Taxpayer Name *
Email Id *
Plot No Building Name
Street Address Trade Center *
District/City* County/Municipality*
Sub county / Town Council/Division* Parish*
Village* Local Council
Contact Telephone Number* Mobile Number*
 Fields marked with * are mandatory

Refund Details

Refund Claim Details
Acknowledgement Date *    
Amount Claimed *
Reason for Refund Claim *  
Name of Bank *  
Bank Branch *  
Account Number(only UGX Accounts) *  
Account Holder Name *  
 Fields marked with * are mandatory

Attachments

Attachment(s)
Type of Attachment *

Attachment to be uploaded
 
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(Letters are case sensitive)
 Fields marked with * are mandatory

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