Section A-C

Sno. Error Line No. Error Box Name.

1 26 e) District/City*

2 27 f) County/Municipality*
g) Sub-County/Town
3 28 Council/Division*
4 29 h) Parish*
5 30 i) Village*
6 37 District*
7 38 City*
8 40 Sub-County*
9 41 Parish*
10 42 Village*

Section D-E

Sno. Error Line No. Error Box Name.

Section F-G

Sno. Error Line No. Error Box Name.

Schedule 1-4

Sno. Error Line No. Error Box Name.

SCHEDULE
5-6
Sno Error Line No Error Box Name
Error Box Description.
Enter District in proper format.

Enter County in proper format.

Enter Sub-county in proper format.

Enter Parish in proper format.
Enter Village in proper format.
Enter district in proper format.
Enter city in proper format.
Enter Sub-county in proper format.
Enter parish in proper format.
Enter village in proper format.

Error Box Description.

Error Box Description.

Error Box Description.

Error Box Description

Error Description.
Please Select Values From Drop Down.

Please Select Values From Drop Down.

Please Select Values From Drop Down.

Please Select Values From Drop Down.
Please Select Values From Drop Down.
Please Select Values From Drop Down.
Please Select Values From Drop Down.
Please Select Values From Drop Down.
Please Select Values From Drop Down.
Please Select Values From Drop Down.

Error Description.

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 Application for Taxpayer Identification Number
For All Individuals
(This Form may be used by all individuals who are applying for a TIN. Individuals who are ONLY employed, or
Registering/ transfering a Motor Vehicle or carrying out a Land transfer are not required to complete section D and
Schedule 3 of this form.)
Section A - Name and Address
1) Title (Optional) Mr.
Others(specify)
2) Surname/ Maiden Name* MUSAIMUGAGA
3) First Name* ADNAN
4) Middle Name
5) Acquired Name (if different from Surname)
6) Family/Father's Surname (if different from
Surname)
7) Mother's Maiden Name* MUGENYI
8) Marital Status Of Applicant* Married
9) Have you previously applied for or been issued a NO
TIN?* (Select YES/NO. If “YES” provide details
below)
a) Enter existing number*
b) Approximate Date of Previous Application*
c) Was your previous TIN obtained under a
different Name?* (Select YES/No. If YES then
complete Schedule 4)
10) Postal address where notices and correspondence should be sent
a) Post Office Box number/Private Bag
b) District/city where box is located*
11) Home address in Uganda (This must be a permanent physical address. Complete all boxes a
through h that apply)
a) Plot Number
b) Street Name BOMBO ROAD
c) Building Name
d) Trading Center* WANDEGEYA
e) District/City* KAMPALA
f) County/Municipality* KAWEMPE DIVISION SOUTH
g) Sub-County/Town Council/Division* KAWEMPE DIVISION
h) Parish* WANDEGEYA
i) Village* KIMWANYI
12) Mobile Phone Number* 256
13) Landline Number
14) Email Address* adnanmusaimugaga@gmail.com
Section B - Birth and Citizenship and Purpose of Registration
1) Country of Birth* Uganda
2) Place of Birth (As Appropriate)
District* KAMPALA
City* KAMPALA CENTRAL DIVI
State* (If Country of Birth is not Uganda)
Sub-County* KAMPALA CENTRAL DIVISION
Parish* KAMWOKYA I
Village* VILLAGE A
3) Sex* Male
4) Date of Birth (DD/MM/YYYY)* 01/01/1990
5) Citizenship (Select only if you are not a citizen of
Uganda)*
6) Are you Minor?* (Select YES/NO. If YES then NO
complete Schedule 1*)
7) Have you been known by another name other than NO
the Maiden Name listed in A-2 above?* (Select
YES/NO. If YES then complete Schedule 2*)

8) Why do you need a TIN? (Indicate YES/NO, as applicable for each tax type) NOTE: For
VAT,LED,Gaming Tax you must attach another form. See instructions starting on page 3 for more
information.
a) Income Tax
b) VAT (Complete Form DT-1011)
c) Stamp Duty
d) Imports/Exports YES
e) Local Excise (Complete Form DT-1012)
f) Gaming Tax Registration (Complete Form DT-
1013)
g) Motor Vehicle Registration/Transfer YES
h) Oil and Gas (Complete Form DT-1017)
Section C - Identification Documents
Indicate the identification you have by selecting YES/NO. If YES, enter the reference number of the
form of identification you have. You MUST attach to this application either a copy of a National ID or
copies of any other two identification documents. (NSSF Card, Passport, Employee’s ID or Voter’s
Card)
1) National ID
2) NSSF Card
3) Passport YES
4) Employees ID YES
5) Voters Card
6) Drivers Permit
7) Work Permit
8) Village Identity Card
9) Current Bank Statement (Past 90 days)
10) Visa
11) Diplomatic Foreign Affairs ID
12) Financial Card
13) Refugee ID
 Form DT-1001

Toll Free Number 0800117000

758242870
Reference Number (If YES)*

B0936807
3105022
 Section D - Partnership, Corporate an
Indicate below your additional business interests/ investments in any partnerships, companies or trust
Entity Type*

Section E - Sources of Income and Type of Business Activity

Select all income sources that apply. If the business address required in item 4 is the same as the home
provided in Section A, Item 11, provide YES in 4-III below
1) Employment (Select YES/NO)
a) Principal Employer's Name*
b) Is Employer Uganda Resident ?*
i) Employer's TIN*
2) Property Income (Royalties, interest dividends
annuity, gifts, Winnings from Gaming and any other
income other than from business, rental or
employment(Select YES/NO))

3) Rental Income (Select YES/NO)

4) Business Income from a Sole Proprietorship or
Family Run Business (Select YES/NO)
Business name*
I) Business Registration Certificate Number*
II) Date Business Started (DD/MM/YYYY)*
III) Is your business address the same as your
home address? If YES, leave boxes "a" through "i"
blank.*
a) Plot Number
b) Street Name
c) Building Name
d) Trading Center*
e) District/City*
f) County/Municipality*
g) Sub-County/Town Council/Division*
h) Parish*
i) Village*
5) Description of Activity*
6) Activity Code *
a) Division *
b) Class *
7) Do you have additional places of business? If YES
then complete Form DT-1014 (Application for
Additonal Places of Business i.e. Branch Annexure)
and attach copy.*
8) Do you qualify to withhold tax from employees or
suppliers or Winnings from Gaming provide YES
and complete Schedule 3 to register for Withholding
Tax. You will thereafter be required to submit
monthly schedules of tax withheld.*
 Section D - Partnership, Corporate and Trusts Information
nterests/ investments in any partnerships, companies or trust
b) Business Name of Partnership, Corporation or Trust *

s of Income and Type of Business Activity

e business address required in item 4 is the same as the home address
ES in 4-III below
NO
NO

NO

NO

NO
nd Trusts Information

Registration Number* TIN*

 Section F - Alternate Contact
If we should contact someone other than you NO
to discuss the issuance of this TIN, Enter
information about that person below. Is
alternate contact detail same as provided in
Section A?
1) Surname/Maiden Name* MUGENYI
2) First Name* MUHAMMAD
3) Middle Name
4) If You Have An Existing TIN, Enter
Number
5) Acquired Name (if different from
Surname)..
6) Family/ father's Surname
7) Designation/ Relationship FATHER
8) Mobile Phone Number* 256
9) Land Line Number
10) Email..
Section G - Referee
This application must be referenced by a taxpayer whose TIN is active. Fill in the details
below.
1) Surname/Maiden Name .* BAZANYE
2) First Name.* EDWARD
3) Middle Name. ALBERT
4) Referee's TIN * 1009723081
5) Acquired Name (if different from
Surname).
6) Family/ father's Surname.
7) Designation/ Relationship.
8) Mobile Phone Number.* 256
9) Land Line Number.
10) Email.
780395639

706442725
You DO NOT need to file this sheet with your registration unless you have completed one of the
four schedules below.
Schedule 1 - Guardian for Minor
If this application for a TIN is on behalf of a minor, please provide the following information
about the parent or guardian.
1) Surname/Maiden Name.*
2) First Name .*
3) Middle Name .*
4) If You Have An Existing TIN, Enter Number
here*
5) Acquired Name (If Different from Surname).*

6) Family/Father's Surname (if different from

Surname).*
7) Mother's Maiden Name* ..
Schedule 2 - Other Names Used
If you have ever been known by another name, please provide the following information
1) Title (Optional) .

You will Schedule 3 - Registration

need to register for
for Pay As You Pay(PAYE)
Earn As You Earn and Withholding
/ Withholding of Tax
Tax if you withhold amounts
from payments made to payees such as:
1) Employees for Salary and Wages* (Select
YES/NO)
2) Contractor or Sub-contractor under Agreement*
(Select YES/NO)
3) Suppliers* (Select YES/NO)
4) Foreign Payments* (Select YES/NO)
5) Gaming* (Select YES/NO)
6) What date will withholding Commence ? *
Schedule 4 - Name Used on Prior TIN Registration Applications
(Complete only if you ticked the box in Section A, Line 9c )
1) Title (Optional).
Others(specify).*
2) Surname/Maiden Name*
3) First Name.*
4) Middle Name.*
5) Acquired Name (If Different from Surname) .*
6) Family/Father's Surname (if different from
Surname) .*
7) Mother's Maiden Name.*
h your registration unless you have completed one of the

e 1 - Guardian for Minor

of a minor, please provide the following information

e 2 - Other Names Used

name, please provide the following information
Others(specify) 2) Surname/Maiden Name*

or Pay(PAYE)
Earn As You Earn and Withholding
/ Withholding of Tax
Tax if you withhold amounts

on Prior TIN Registration Applications

Section A, Line 9c )
3) First Name* 4) Middle Name
 5) Acquired Name (If 6) Family/Father’s Surname Dates Used*
Different from Surname) (if different from Surname)
 Schedule 5 - Mining Operations
(Complete this section if you are undertaking mining operations)
1)Do you have a license to undertake mining operations in relation
to mining and midstream operations ? (attach evidence)*
Total_Schedule_5_1

Total_Schedule_5_2

Schedule 6 - Midstream Operati

(Complete this section if you are undertaking mids
1)Do you have a license to undertake midstream operations in relation to mining and midstream
Total_Schedule_6
ule 6 - Midstream Operations
n if you are undertaking midstream operations)
tion to mining and midstream operations ? (attach evidence)*
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