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FORM NO. 22 |
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[See rule 33] |
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Statement of tax deducted at source from contributions repaid to employees |
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in the case of an approved superannuation fund |
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1. Name of the superannuation fund |
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…………………………… |
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2. Name and address of the employee |
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…………………………… |
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3. The period for which the employee has contributed to the |
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superannuation fund |
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…………………………… |
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4. The amount of contributions repaid— |
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(a) principal |
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…………………………… |
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(b) interest |
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…………………………… |
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5. The average rate of deduction of tax during the preceding |
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three years |
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…………………………… |
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6. Amount of tax deducted on repayment |
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…………………………… |
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We, the trustees of ………………………………., do hereby declare that the above particulars are correct. |
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Date ……………………….. |
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……………………… |
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Signature |
