Professional Documents
Culture Documents
ANNUAL
INDIVIDUAL
INCOME TAX RETURN
1770
TAX YEAR :
FINANCE DEPARTMENT OF RI
DIREKTORATE GENERAL OF TAX
(BOX)
MO
YR
MO
YR
to
TAX ID (N P W P)
:
NAME OF TAXPAYER
...
RESIDENTIAL ADDRESS
...
. KLU
...
...
TELEPHONE / FAX
....................................
...
A.
NORM
BOOKKEEPING
RUPIAH
B.
C.
NET INCOME
TAXABLE
INCOME
1.
2.
3.
OTHER DOMESTIC NET INCOME [BROUGHT FORWARD FROM FORM 1770 I PART
D TOTAL COLUMN
(5)] ..................................................................................................................
4.
5.
6.
TITHE........................................ .....................................................................................................
7.
8.
9.
10.
D.
E.
INCOME TAX
PAYABLE
TAX CREDIT
M / .....
M / W / .....
ASSET SPLIT
/ .....
LIVING
APART / .....
11.
12.
INCOME TAX PAYABLE ( RATES PER ART. 17 OF INCOME TAX LAW x LETTER C NO.
11 ) ..................................................................................................................................................
13.
14.
15.
16.
a.
b.
17.
OVERWITHHELD/OVERCOLLECTED TAX
F.1.1.32.16
F.
UNDER/OVER
PAYMENT OF
TAX
18.
a.
----------------------------------------------------------------------------------- (16
17) ...........
b.
REQUEST
H.
I.
J.
K.
ART. 25
INSTALLMENT
FOR THE
FOLLOWING
YEAR
INCOME
SUBJECT TO
FINAL TAX,
INCOME OF
CERTAIN
ENTREPRENEURS AND
NON TAX
OBJECTS
ASSETS AND
LIABILITIES
ATTACHMENTS
Rp
b.
TAX
(RUPIAH)
(1)
a.
b.
c.
(2)
Rp ........
Rp ....
L.
STATEMENT
b.
c.
d.
e.
f.
INCOME TAX PAYABLE CALCULATION FOR TAX PAYER WITH ASSET SPLIT
g.
h.
i.
......................................................................................................................................................................................
I AM AWARE OF ALL THE CONSEQUENCES INCLUDING THE PENALTIES PER THE PREVAILING LAWS AND I HEREBY
STATE THAT ALL INFORMATION AND ATTACHMENTS CONTAINED HEREIN ARE CORRECT, COMPLETE AND CLEAR.
,
F.1.1.32.16
TAXPAYER
SIGNATURE
PROXY
FULL NAME
..200