Materi Perpajakan | Dwi Martani

(1)

GENERAL INSTRUCTIONS FOR THE COMPLETION SPT 1770 DIGITAL FORM

1.

This form is in compliance with the regulations the Director General of Taxes Number

PER-34/PJ/2010 about Income Tax Annual Return Form and General Instructions as

amended

by regulation the Director General of Taxes Number PER-

36

/PJ/201

5

. This form

is used for

completion income tax annual tax return for Taxable Year 2014 and onwards;

2.

Print this form in 98% scale

(

not printed in mode "fit size" or "shrink size"

). This

printing results must be signed and must not be folded or crumpled. Use HVS paper size:

a.

F4/Folio/US Folio/

Government Legal

(8,5 X 13 inch);

b.

Minimum weight 70 gr;

3.

To be able to use this form optimally, use the application Adobe Reader version 8 or newer;

4.

Complete the Taxable Year, the identity of the Taxpayer and the other mandatory

information properly. Taxpayers can contact the tax office where the Taxpayer is registered

to ensure their Taxpayer Indentity Number (TIN) or through applications on the site

www.pajak.go.id

.

Description of status of married individual are as follows:

a.

KK : Tax rights and obligations undertaken by the head of the family;

b.

HB : Spouse have lived separated based on a court decision;

c.

PH : It is requested in writing by both the husband and wife on the basis of an

agreement for the separation of property and income; and

d. MT : It is requested by the wife who chooses to meet her tax right and obligation

separately.

5. Complete the attachments form first. Summation formulas, reduction, connection with

certain parts and others have been available in this form, so that Taxpayers do not need to

do a recount;

6.

<AUTO>

sign shows the calculation results automatically. There are times when automatic

calculation is too late to execute, to make sure it runs well, point the cursor pointer to

the field where the calculation formula should be run, block the numbers there, then press

DELETE key followed by ENTER. However, Taxpayer is expected to keep doing re-checking

the results of calculations on this tax return, especially in the field

<AUTO>

;

7. If additional form of 1770-I page 2, 1770-II and 1770-IV are needed because the information

to be loaded is more than one page, that forms now are available in the directory (folder).

These files can be reproduced to adjust the needs in a way to copy and replace file name

(rename), for example: 1770-I-p2-1, 1770-I-p2-2 etc;

8. After all attachments completed, then complete the main form up to the box "Total Net

Income After Loss Carry Forward",

a. in terms of Taxpayer status KK or HB, then fill the box "Personal Exemption" and the

next boxes;

b. in terms of Taxpayer status MT or PH, then the box "Personal Exemption" and "Taxable

Income" is automatically filled with symbols 0. Next, Taxpayer complete “Workpaper of

Income Tax Payable Calculation for Taxpayers with PH and MT Status”. After the

workpaper completed, complete the main form on the "Adjustment for Foreign Tax

Credits Refunded and had been Credited in The Previous Year Return (Income Tax

Article 24)" and the next boxes.

9. The

SHOW

button used to show calculation formulas in completing digital tax return;

10. The

RESET

button used to clear the data of digital tax return form that have been loaded

previously. After completing the tax return and print it, do not forget to save it to another file

(Save-as and name different from the original file), then use the

RESET

button to clear the

file;

11. The

HIDE

button used to hide the calculation formula so that it can be printed blank form if

you want to complete it manually;

(2)

FOR TAXPAYER WHO HAVE INCOME:

•

FROM ONE OR MORE EMPLOYER;

•

SUBJECTED TO FINAL AND/OR FINALIZED TAX; AND/OR BOOKKEEPING RECORDING

•

OTHER DOMESTIC INCOME/FOREIGN INCOME.

ST/ND/RD/TH AMENDED RETURN

•

PRINT OR TYPE WITH CAPITAL LETTER AND BLACK INK

•

:

TAXPAYER'S NAME :

:

TELEPHONE /FAX NUMBERS : /

: KK HB PH MT

SPOUSE'S TIN :

1. ₁

2. ₂

3. ₃

4. OFFSHORE 4

5. ₅

………..

6

7. TOTAL NET INCOME AFTER ZAKAT/COMPULSORY RELIGIOUS DONATION (5 - 6) ฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀

8. ₈

9. ₉

10. PERSONAL EXEMPTIONS TK / K / K / I / 10

11. ₁₁

12. INCOME

14

15. ₁₅

16. a. TAX DUE AFTER CREDIT

b. TAX OVERLY WITHHELD

17. a. _17a

b. _17b

18. ₁₈

a. UNDERPAID TAX (INCOME TAX ARTICLE 29)

b. OVERPAID TAX (INCOME TAX ARTICLE 28 A) 20. REQUEST: Overpaid amount stated in 19.b would be

THE AMOUNT IS CALCULATED BY:

a. 1/12 X THE TOTAL OF LINE 16 c. CALCULATION IN SEPARATE ATTACHMENT

b. CALCULATION OF INDIVIDUAL TAXPAYER AS CERTAIN ENTERPRENEUR

OTHER THAN FORM OF 1770 - I TO 1770 - IV (WHETHER FILLED OR THAT ARE NOT FILLED) WITH THIS ALSO ATTACHED:

a. POWER OF ATTORNEY (IF NEEDED) _g.

b. THIRD COPY OF TAX PAYMENT SLIP OF INCOME TAX ARTICLE 29 _h.

c. i.

d. CALCULATION OF FISCAL LOSS CARRY FORWARD _j.

e. k.

f. COPY OF FORM 1721-A1 AND/OR 1721-A2 ( Pages) l.

TAXPAYER PROXY F.1.1.32.16 D . T A X C R ED IT PREPAID TAX:

TAX LIABILITY STATUS OF MARRIED INDIVIDUAL

to

21. MONTHLY INSTALLMENT FOR THE SUBSEQUENT YEAR TAXABLE INCOME (9 -10)

*) The filing columns of Rupiah value must be without decimal value (see example in page 3 of instructions)

NET INCOME

[Complete it from separate attachment, if any foreign income, see instruction book]

TAX PAYABLE (TAX RATE ON ARTICLE 17 X LINE 11)

[For Taxpayers with status PH/MT filled from Attachment Calculation of Income Tax Payable as referred to in Section G: Attachments letter i]

C . T A X PA YA B LE B . T A XA B LE IN C O M

E TOTAL NET INCOME AFTER LOSS CARRY FORWARD (7 - 8)

TOTAL TAX CREDIT (17a+17b) 13.

TOTAL NET INCOME (1 + 2 + 3 + 4)

NOTICES OF TAX COLLECTION ON INCOME TAX ARTICLE 25 (PRINCIPAL ONLY)

16

(14-15)

c.

RECEIPTS OF WITHHOLDING TAX/TAX BORNED BY THE GOVERNMENT/TAX PAID AND WITHHELD IN FOREIGN

a. REFUNDED WITH SKPPKP ARTICLE 17 C (COMPLIANCE TAXPAYER)

REFUNDED WITH SKPPKP ARTICLE 17 D (TAXPAYER WHICH MEETS CERTAIN REQUIREMENTS)

d. MONTHLY INSTALLMENT OF INCOME TAX ARTICLE 25

LIST OF INCOME AND PAYMENT OF INCOME TAX ARTICLE 25 (ONLY FOR INDIVIDUAL TAXPAYER AS CERTAIN ENTERPRENEUR)

(16-18)

BALANCE SHEET AND INCOME STATEMENT, OR RECAPITULATION OF MONTHLY GROSS REVENUE REFUNDED

LIST OF TOTAL GROSS INCOME AND FINAL TAX PAYMENT BASED ON GR 46/2013 FOR EACH TAX PERIOD AND PLACE OF BUSINESS

1770

2

OF THE REPUBLIC OF INDONESIA

ID

EN

TI

TY

FROM BUSINESS ACTIVITY/INDEPENDENT PERSONAL SERVICES;

YY

FO

R

M

ATTENTION: FOLLOW INSTRUCTION IN THE INSTRUCTION BOOK DIRECTORATE GENERAL OF TAXES

BUSINESS FIELD CLASSIFICATION/ INDEPENDENT PERSONAL SERVICE

TAXPAYER IDENTIFICATION NUMBER (TIN)

INCOME TAX CALCULATION FOR MARRIED TAXPAYER WITH SEPARATION OF PROPERTY AND INCOME (PH) OR HAS HER OWN TIN (MT)

21 b.

7

TAX WITHHELD BY OTHER PARTY, PAID /WITHHELD IN FOREIGN AND BORNED BY THE GOVERNMENT [From Form 1770 -II Total Part A column 7]

MM

13 LOSS CARRY FORWARD

OTHER DOMESTIC NET INCOME

[From Form 1770 - I page 2 Total Part D column 3]

DOMESTIC NET INCOME IN RESPECT OF EMPLOYMENT

[From Form 1770 - I page 2 Total Part C column 5]

MM

MINISTRY OF FINANCE

A . N ET IN C O M E YY

Data changes application submitted apart from this Tax Return, by using the Taxpayer Data Change Form and attached with the

required documents.

TIN :

Understanding all the sanctions provided by the law and regulations, i hereby declare that the information stated in this return, including all attachments provided, are true, complete, clear, and under no circumtances whatsoever.

E. IN C O ME T A X O VE R /U N D ER P A ID 19. DATE: 19 dd mm SETTLED ON SIGNATURE DECLARATION

FULL NAME :

F. M O N TH LY IN ST A LL M EN T O F IN C O ME T A X A R TI C LE 25 F O R T H E SU B SE Q U EN T YE A R

G

.

A

TT

A

C

H

M

EN

TS

yy DOMESTIC NET INCOME FROM BUSINESS ACTIVITIES AND/OR INDEPENDENT PERSONAL SERVICE

[From Form 1770 - I page 1 total part A or Form 1770 - I page 2 Total Part B column 5]

ADJUSTMENT FOR FOREIGN TAX CREDITS REFUNDED AND HAD BEEN CREDITED IN THE PREVIOUS YEAR RETURN (Income Tax Article 24)

COMPENSATED WITH OUTSTANDING TAX PAYABLE

CALCULATION OF INSTALLMENT OF INCOME TAX ARTICLE 25 FOR THE SUBSEQUENT YEAR

APPROPRIATE BOX MARK " X " IN THE

TA XA B LE Y EA R

0

KLU : RUPIAH *)

ANNUAL INDIVIDUAL INCOME TAX RETURN

0

0 6. ZAKAT/COMPULSORY RELIGIOUS DONATION

(3)

to

BOOKKEEPING RECORDING

•

TIN

:

TAXPAYER'S NAME

:

DOMESTIC NET INCOME FROM BUSINESS ACTIVITIES AND/OR INDEPENDENT PERSONAL SERVICE

: AUDITED ACCOUNTANT OPINION: UNAUDITED

NAME OF PUBLIC ACCOUNTANT :

TIN OF PUBLIC ACCOUNTANT :

NAME OF CPA :

TIN OF CPA :

NAME OF TAX CONSULTANT :

TIN OF TAX CONSULTANT :

NAME OF TAX CONSULTING FIRM

:

TIN OF TAX CONSULTING FIRM

:

a.

_1a

b.

_1b

c.

_1c

d.

_1d

e.

_1e

2.

a.

_2a

b.

_2b

c.

_2c

d.

2d

e.

_2e

f.

_2f

g.

_2g

h.

_2h

i.

_2i

j.

_2j

k.

_2k

l.

2l

a.

_3a

b.

_3b

c.

_3c

d.

_3d

4 4

Copy total part A (line 4) to Form 1770 line 1

OF THE REPUBLIC OF INDONESIA DIRECTORATE GENERAL OF TAXES

PAGE 1

2

₀

TA

XA

B

LE

YEA

R

MM

ANNUAL INDIVIDUAL INCOME TAX RETURN

ATTACHMENT - I

YY

CALCULATION OF DOMESTIC NET INCOME FROM BUSINESS ACTIVITIES

AND/OR INDEPENDENT PERSONAL SERVICE FOR TAXPAYER APPLYING

BOOKKEEPING SYSTEM

YY

GROSS INCOME

RUPIAH

ATTENTION: MARK " X " IN THE

1.

INCOME FROM BUSINESS ACTIVITIES AND/OR INDEPENDENT PERSONAL

SERVICE BASED ON COMMERCIAL FINANCIAL STATEMENT:

PART A:

(FOR TAXPAYER APPLYING BOOKKEEPING SYSTEM)

APPROPRIATE BOX FOLLOW INSTRUCTION IN THE INSTRUCTION BOOK

MM

ADMINISTRATIVE PENALTY

POSSITIVE DIFFERENCE OF COMMERCIAL OVER FISCAL DEPRECIATION/AMORTIZATION

EXPENSES TO EARN, TO COLLECT AND SECURE INCOME SUBJECT TO FINALIZED INCOME TAX AND NON TAXABLE INCOME

OTHERS POSITIVE FISCAL ADJUSTMENT

TOTAL (2a to 2k)

INCOME SUBJECT TO FINAL WITHHOLDING TAX AND NON TAXABLE INCOME BUT INCLUDED IN GROSS INCOME

TOTAL (3a to 3c)

TOTAL PART A (1e + 2l - 3d)

NEGATIVE DIFFERENCE OF COMMERCIAL OVER FISCAL DEPRECIATION/AMORTIZATION COST OF GOOD SOLD

OPERATING INCOME (1a - 1b)

POSITIVE FISCAL ADJUSTMENTS

COST INCURRED FOR THE PERSONAL BENEFIT OF A TAXPAYER OR HIS DEPENDENTS OPERATING EXPENSE

3.

NEGATIVE FISCAL ADJUSTMENT:

GIFTS, AID AND DONATIONS

INSURANCE PREMIUMS FOR HEALTH, ACCIDENT, LIFE, DUAL PURPOSE AND EDUCATION INSURANCE WHICH ARE PAID BY AN INDIVIDUAL TAXPAYER

CONSIDERATION OR REMUNERATION RELATED TO EMPLOYMENT OR SERVICES GIVEN IN THE FORM OF BENEFIT IN KIND

INCOME TAX

OTHERS NEGATIVE FISCAL ADJUSTMENT

SALARIES PAID TO BUSINESS OWNER/TAXPAYERS DEPENDENT

EXCESSIVE COMPENSATIONAM PAID TO ASSOCIATED PARTIES AS A CONSIDERATION OF WORK PERFORMED

NET INCOME (1c - 1d)

1770 - I

BOOKKEEPING SYSTEM/ FINANCIAL STATEMENT

FO

R

M

MINISTRY OF FINANCE

0

(4)

•

to

•

CALCULATION OF OTHER DOMESTIC INCOME BOOKKEEPING RECORDING

ATTENTION:

•

TIN

:

TAXPAYER'S NAME

:

PART B:

DOMESTIC NET INCOME FROM BUSINESS ACTIVITIES AND/OR INDEPENDENT PERSONAL SERVICE

Copy Total Part B column (5) to Form 1770 line 1

PART C :

DOMESTIC NET INCOME IN RESPECT OF EMPLOYMENT

(NOT INCLUDING INCOME SUBJECT TO FINALIZED INCOME TAX)

Copy Total Part C Column (5) to Form 1770 line 2

PART D :

OTHER DOMESTIC NET INCOMES

(NOT INCLUDING INCOME SUBJECT TO FINALIZED INCOME TAX)

Copy Total Part D to Form 1770 line 3

OF THE REPUBLIC OF INDONESIA

2

pages Page from

IF NEEDED, ADDITIONAL PAGES MAY BE ADDED

3 6

INTEREST

TOTAL PART D

OTHER INCOMES

YY

TA

XA

B

LE

Y

EA

R

MM

0

YY

DIRECTORATE GENERAL OF TAXES

PAGE 2

(FOR TAXPAYER APPLYING RECORDING)

(3)

MARK " X " IN THE APPROPRIATE BOX CALCULATION OF DOMESTIC NET INCOME IN RESPECT OF EMPLOYMENT

2

CALCULATION OF DOMESTIC NET INCOME FROM BUSINESS ACTIVITIES AND/OR

INDEPENDENT PERSONAL SERVICE FOR TAXPAYER APPLYING RECORDING

ANNUAL INDIVIDUAL INCOME TAX RETURN

MM

ATTACHMENT - I

1

FOLLOW INSTRUCTION IN THE INSTRUCTION BOOK

4

NO.

2

5

(1)

(2)

TYPES OF INCOME

3

4

5

(1)

RENT

AWARDS AND PRIZES

TOTAL PART C

(4)

(5)

GROSS INCOME

(4)

NET INCOME

(Rupiah)

NO.

TRADING

INDUSTRY

SERVICE

INDEPENDENT PERSONAL SERVICE

(Rupiah)

NAME AND TIN OF EMPLOYER NET INCOME

(Rupiah)

TYPES OF BUSINESS

GROSS INCOME

(Rupiah)

DEEMED

(%)

TPB

(3)

2

NO.

(2)

DEDUCTION GROSS INCOME/COST

TPD

GAIN FROM THE SALE/TRANSFER OF PROPERTY ROYALTIES

OTHERS

TOTAL PART B

1

5

6

(1)

1 3

4

1770 - I

FO

R

M

MINISTRY OF FINANCE

(Rupiah)

(2) (5)

TPC

(3)

TOTAL NET INCOME

(Rupiah)

0

(5)

to

BOOKKEEPING RECORDING

ATTENTION:

•

TIN

:

TAXPAYER'S NAME

:

PART A :

(1)

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15 etc

*)

-

=

-

Fill column (6) with following options: 21/22/23/24/26/DTP (Example: 21, 22, 23, 24, 26, DTP)

-

If there is a Tax Credit of Income Tax Article 24, the column should be filled with maximum creditable amount according to separate attachment (Follow the Instruction related to Part A of Attachment II and Annual Tax Return line 4)

from

pages of Attachment-II

0

2

FOLLOW INSTRUCTION IN THE INSTRUCTION BOOK

Page

IF NEEDED, ADDITIONAL PAGES MAY BE ADDED

TPA

DTP

TOTAL PART A

Copy Total Part A Column 7 to Formulir 1770 line 15

BORNE BY THE GOVERNMENT

(2) (3)

NO NAME OF WITHHOLDING

AGENT

LIST OF INCOME TAX WITHHELD BY OTHER PARTIES, PAID/WITHHELD IN FOREIGN AND BORNE BY THE GOVERNMENT

APPROPRIATE BOX

DIRECTORATE GENERAL OF TAXES

MM

WITHHOLDING TAX RECEIPT

DATE

TOTAL OF INCOME TAX WITHHELD (Rupiah)

1770 - II

ANNUAL INDIVIDUAL INCOME TAX RETURN

ATTACHMENT - II

TYPES OF TAX : INCOME TAX ARTICLE 21/22/23/24/26/DTP *) TIN OF WITHHOLDING

AGENT

LIST OF INCOME TAX WITHHELD BY OTHER PARTY, PAID/WITHHELD

IN FOREIGN AND BORNED BY THE GOVERNMENT

_TAXA

B

LE

Y

EA

R

YY MM

NUMBER

(7) (6)

(4) (5)

MARK " X " IN THE

YY

FO

R

M

MINISTRY OF FINANCE OF THE REPUBLIC OF INDONESIA

(6)

•

to

•

ATTENTION:

•

TIN

:

TAXPAYER'S NAME

:

PART A :

NO (1)

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

PART B :

NON TAXABLE INCOME

NO

(1)

1.

2.

3.

4.

5.

6.

PART C :

SPOUSE'S INCOME SHALL BE TAXED SEPARATELY

APPROPRIATE BOX MARK " X " IN THE

PROPERTY RECEIVED FROM BUILD OPERATE TRANSFER SCHEME

LEASE/RENT ON LAND OR BUILDING

TYPES OF INCOME TAX BASE/GROSS INCOME

(2)

TRANSFERS OF RIGHTS ON LAND AND BUILDING

YY

MM YY MM

LOTTERY PRIZES

SEVERANCE PAYMENT, RETIREMENT ALLOWANCE AND PENSIONS PAID IN LUMP SUM

HONORARIA DERIVED FROM STATE AND/OR LOCAL BUDGET INTEREST/DISCOUNT OF BOND

(3)

INCOME TAX PAYABLE (Rupiah)

0

2

INDIVIDUAL ANNUAL INCOME TAX RETURN

ATTACHMENT - III

TA

XA

B

LE

Y

EA

R

NON TAXABLE INCOME

SPOUSE'S INCOME SHALL BE TAXED SEPARATELY

DIVIDEND

CONSTRUCTION FEES

DISTRIBUTOR/DEALER/AGENTS OF OIL PRODUCTS

1770 - III

DIRECTORATE GENERAL OF TAXES

FOLLOW INSTRUCTION IN THE INSTRUCTION BOOK

FO

R

M

MINISTRY OF FINANCE OF THE REPUBLIC OF INDONESIA

(4)

SPOUSE'S NET INCOME SHALL BE TAXED SEPARATELY

GROSS INCOME (Rupiah)

(3)

TOTAL (1 to 16)

(2)

(Rupiah)

SCHOLARSHIP

TOTAL PART B

INHERITANCE

TPB

OTHER NON TAXABLE INCOME AID / DONATION / GIFT

DISTRIBUTION OF PROFIT RECEIVED BY A MEMBER OF A LIMITED PARTNERSHIP WHOSE CAPITAL DOES NOT CONSIST OF SHARES, PARTNERSHIP, ASSOCIATION, FIRM AND KONGSI

WIFE INCOME FROM ONE EMPLOYER

TYPES OF INCOME

INCOME FROM DERIVATIVE TRANSACTION

0

CLAIM ON HEALTH, ACCIDENT, LIFE, DUAL PURPOSES AND EDUCATION INSURANCE

INTEREST OF DEPOSIT, SAVINGS, DISCOUNT ON BANK INDONESIA

CERTIFICATES, STATE SECURITIES

SALES OF SHARES TRADED IN THE STOCK EXCHANGE

SAVING INTEREST PAID BY COOPERATIVE TO ITS INDIVIDUAL MEMBER

INCOME SUBJECT TO FINAL TAX AND/OR FINAL IN NATURE

OTHER INCOME SUBJECT TO FINAL TAX AND OR FINAL IN NATURE

(7)

•

to

•

ATTENTION:

•

FOLLOW INSTRUCTION IN THE INSTRUCTION BOOK

•

MARK " X " IN THE

TIN

:

TAXPAYER'S NAME

:

PART A :

PART B :

LIABILITIES AT YEAR- END

(3)

PART C :

LIST OF MEMBER OF FAMILY'S DEPENDENT

from pages of Attachment-IV (5)

5 etc

4 1

(4)

(1) (3)

ASSETS AT YEAR-END

ATTACHMENT - IV

TA

XA

B

LE

YEA

R

(2)

TOTAL

(Rupiah)

LIST OF MEMBER OF FAMILY'S DEPENDENT

MM YY

YY

YEAR LENDING

TOTAL PART A

8

9

1770 - IV

APPROPRIATE BOX

ASSETS AT YEAR-END

(6) (5)

(5)

TPA

NAME OF LENDER

0

2

(4)

LENDER ADDRESS

(6)

NAME

•

DIRECTORATE GENERAL OF TAXES

LIABILITIES AT YEAR- END

MM

CODE

TYPE OF ASSETS

4

5

COST OF ACQUISITION

(Rupiah)

DESCRIPTION

1

(2)

OCCUPATION

NO.

TOTAL PART B

TPB

RELATIONSHIP IN FAMILY

3

IDENTITY NUMBER (NIK)

7 (1)

NO.

YEAR OF ACQUISITION

(3)

6

10 etc

FO

R

M

MINISTRY OF FINANCE OF THE REPUBLIC OF INDONESIA

ANNUAL INDIVIDUAL INCOME TAX RETURN

Page 8

9

10 etc

NO.

(1) 1

2

3

4

5

6

7 2

3

(4)

2

IF NEEDED, ADDITIONAL PAGES MAY BE ADDED

CODE

(2)

069 other

0

(8)

No.

's Net Income

(1) (3)

A

1

DOMESTIC NET INCOME FROM BUSINESS ACTIVITIES AND/OR INDEPENDENT PERSONAL SERVICE [From Form 1770 Part A line 1]

2 DOMESTIC NET INCOME IN RESPECT OF EMPLOYMENT

[From Form 1770 Part A Line 2 or Form 1770 S Part A Line 1]

3 OTHER DOMESTIC NET INCOME

[From Form 1770 Part A line 3 or Form 1770 S Part A line 2]

4 FOREIGN NET INCOME

5 ZAKAT/OBLIGATED CHARITY

6 TOTAL

( 1 + 2 + 3 + 4 - 5 )

7 LOSS CARRY FORWARD

[Only for Individual Taxpayer who applying bookkeeping system. From Form 1770 Part A line 8]

8 TOTAL NET INCOME

( 6 - 7 )

No

(1)

B

C

D

E

1 5% x

2 15% x

3 25% x

4 30% x

F

G

Name :

TIN

:

Signature

Name :

TIN

:

Signature

(2) (4)

WORKPAPER OF INCOME TAX PAYABLE CALCULATION

Description

's Net Income

FOR MARRIED INDIVIDUAL WHO HAVE TAX LIABILITY STATUS MARRIED WITH AN AGREEMENT FOR THE SEPARATION OF PROPERTY AND

INCOME (PH) OR THE WIFE CHOOSE TO MEET HER TAX RIGHT AND OBLIGATION SEPARATELY (MT)

NET INCOME

Description

Value

(2) (3)

TOTAL HUSBAND AND WIFE'S NET INCOME

[ A.8.(3) + A.8.(4) ]

PERSONAL EXEMPTIONS

TAXABLE INCOME

[ B - C ]

INCOME TAX PAYABLE (COMBINED)

TOTAL INCOME TAX PAYABLE (COMBINED)

PORTION INCOME TAX PAYABLE FOR

[ (A.8.(3) / B) x E ]

[Copy to 's Tax Return Part C Line 12 Form 1770 or Part C Line 9 Form 1770 S]

PORTION INCOME TAX PAYABLE FOR

[ (A.8.(4) / B) x E ]

[Copy to 's Tax Return Part C Line 12 Form 1770 or Part C Line 9 Form 1770 S]

Husband

Wife

0

Husband

0

Wife

0

Husband

(9)

(10)

BAGI WAJIB PAJAK YANG MEMPUNYAI PENGHASILAN :

•

DARI SATU ATAU LEBIH PEMBERI KERJA;

•

YANG DIKENAKAN PPh FINAL DAN/ATAU BERSIFAT FINAL; DAN/ATAU PEMBUKUAN PENCATATAN

•

DALAM NEGERI LAINNYA/LUAR NEGERI.

SPT PEMBETULAN KE -

•

ISI DENGAN HURUF CETAK / DIKETIK DENGAN TINTA HITAM

•

NPWP :

NAMA WAJIB PAJAK :

JENIS USAHA/PEKERJAAN BEBAS :

NO. TELEPON/FAKSIMILI : /

: KK HB PH MT

NPWP ISTERI/SUAMI :

1. ₁

2. ₂

3. ₃

4 4. ₄

5. ₅

………..

6. ₆

7. JUMLAH PENGHASILAN NETO SETELAH PENGURANGAN ZAKAT /SUMBANGAN KEAGAMAAN YANG SIFATNYA WAJIB ( 5- 6)

8. ₈

9. ₉

10. PENGHASILAN TIDAK KENA PAJAK TK / K / K / I / 10

11. ₁₁

12. ₁₂

14. ₁₄

15. ₁₅

16. a. PPh YANG HARUS DIBAYAR SENDIRI

b. PPh YANG LEBIH DIPOTONG/DIPUNGUT

17. a. _17a

b. _17b

18. ₁₈

a. PPh YANG KURANG DIBAYAR (PPh PASAL 29)

b. PPh YANG LEBIH DIBAYAR (PPh PASAL 28 A)

20. PERMOHONAN : PPh Lebih Bayar pada 19.b mohon

DIPERHITUNGKAN DENGAN UTANG PAJAK

DIHITUNG BERDASARKAN :

a. 1/12 X JUMLAH PADA ANGKA 16 c. PERHITUNGAN DALAM LAMPIRAN TERSENDIRI

b. PERHITUNGAN WAJIB PAJAK ORANG PRIBADI PENGUSAHA TERTENTU

SELAIN FORMULIR 1770 - I SAMPAI DENGAN 1770 - IV (BAIK YANG DIISI MAUPUN YANG TIDAK DIISI) HARUS DILAMPIRKAN PULA :

a. SURAT KUASA KHUSUS (BILA DIKUASAKAN) _g. PERHITUNGAN ANGSURAN PPh PASAL 25 TAHUN PAJAK BERIKUTNYA

b. SSP LEMBAR KE-3 PPh PASAL 29 h.

c. i.

d. PERHITUNGAN KOMPENSASI KERUGIAN FISKAL j.

e. k.

f. FOTOKOPI FORMULIR 1721-A1 DAN/ATAU 1721-A2 (...LEMBAR) l.

WAJIB PAJAK KUASA

F.1.1.32.16

(KOTAK PILIHAN) YANG SESUAI BERI TANDA " X " DALAM

TA H U N P A JA K

0

KLU : RUPIAH *)

SPT TAHUNAN PPh WAJIB PAJAK ORANG PRIBADI

NPWP :

Dengan menyadari sepenuhnya akan segala akibatnya termasuk sanksi-sanksi sesuai dengan ketentuan perundang-undangan yang berlaku, saya menyatakan bahwa apa yang telah saya beritahukan di atas beserta lampiran-lampirannya adalah benar, lengkap dan jelas.

E. P Ph K U R A N G / L EB IH B A YA R 19. TANGGAL: 19 tgl bln TGL LUNAS TANDA TANGAN PERNYATAAN

NAMA LENGKAP :

F. A N G SU R A N P Ph PA SA L 25 T A H U N P A JA K B ER IK U TN YA

G

. L

A

MP

IR

A

N

thn

PERHITUNGAN PPh TERUTANG BAGI WAJIB PAJAK DENGAN STATUS PERPAJAKAN PH ATAU MT

21 b.

7

PPh YANG DIPOTONG / DIPUNGUT OLEH PIHAK LAIN, PPh YANG DIBAYAR / DIPOTONG DI LUAR NEGERI DAN PPh DITANGGUNG PEMERINTAH [Diisi dari formulir 1770 -II Jumlah Bagian A Kolom 7]

BL

13 KOMPENSASI KERUGIAN

PENGHASILAN NETO DALAM NEGERI DARI USAHA DAN/ATAU PEKERJAAN BEBAS

[Diisi dari Formulir 1770 - I Halaman 1 Jumlah Bagian A atau Formulir 1770 - I Halaman 2 Jumlah Bagian B Kolom 5]

PENGHASILAN NETO DALAM NEGERI LAINNYA

[Diisi dari Formulir 1770 - I Halaman 2 Jumlah Bagian D Kolom 3]

PENGHASILAN NETO DALAM NEGERI SEHUBUNGAN DENGAN PEKERJAAN

[Diisi dari Formulir 1770 - I Halaman 2 Jumlah Bagian C Kolom 5]

BL

KEMENTERIAN KEUANGAN RI

A . P EN G H A SI LA N N ET O TH

Permohonan perubahan data disampaikan terpisah dari pelaporan SPT Tahunan PPh Orang Pribadi ini, dengan menggunakan

Formulir Perubahan Data Wajib Pajak dan dilengkapi dokumen yang disyaratkan.

1770

2

DIREKTORAT JENDERAL PAJAK

ID

EN

TI

TA

S

DARI USAHA/PEKERJAAN BEBAS;

TH FO R MU LI R

PERHATIAN SEBELUM MENGISI BACALAH PETUNJUK PENGISIAN

c.

BUKTI PEMOTONGAN/PEMUNGUTAN OLEH PIHAK LAIN/DITANGGUNG PEMERINTAH DAN YANG DIBAYAR/DIPOTONG DI LUAR NEGERI

a. DIKEMBALIKAN DENGAN SKPPKP PASAL 17C (WP dengan Kriteria Tertentu)

DIKEMBALIKAN DENGAN SKPPKP PASAL 17D (WP yang Memenuhi Persyaratan Tertentu)

d. PPh PASAL 25 BULANAN

DAFTAR JUMLAH PENGHASILAN DAN PEMBAYARAN PPh PASAL 25 (KHUSUS UNTUK ORANG PRIBADI PENGUSAHA TERTENTU)

(16-18)

NERACA DAN LAP. LABA RUGI / REKAPITULASI BULANAN PEREDARAN BRUTO DAN/ATAU PENGHASILAN LAIN DAN BIAYA

DIRESTITUSIKAN

DAFTAR JUMLAH PEREDARAN BRUTO DAN PEMBAYARAN PPh FINAL BERDASARKAN PP 46 TAHUN 2013 PER MASA PAJAK DAN PER TEMPAT USAHA

D . K R ED IT P A JA K

PPh YANG DIBAYAR SENDIRI

STATUS KEWAJIBAN PERPAJAKAN SUAMI-ISTERI

s.d

21. ANGSURAN PPh PASAL 25 TAHUN PAJAK BERIKUTNYA DIHITUNG SEBESAR PENGHASILAN KENA PAJAK (9 -10)

ZAKAT / SUMBANGAN KEAGAMAAN YANG BERSIFAT WAJIB

*) Pengisian kolom-kolom yang berisi nilai rupiah harus tanpa nilai desimal (contoh penulisan lihat petunjuk pengisian halaman 3)

PENGHASILAN NETO LUAR NEGERI

[Apabila memiliki penghasilan dari luar negeri agar diisi dari Lampiran Tersendiri, lihat petunjuk pengisian]

PPh TERUTANG (TARIF PASAL 17 UU PPh X ANGKA 11)

[Bagi Wajib Pajak dengan status PH / MT diisi dari Lampiran Perhitungan PPh Terutang sebagaimana dimaksud dalam bagian G: Lampiran huruf i]

PENGEMBALIAN/PENGURANGAN PPh PASAL 24 YANG TELAH DIKREDITKAN

C . P Ph TE R U TA N G B . P EN G H A SI LA N K EN A P A JA K

JUMLAH PPh TERUTANG ( 12 + 13)

JUMLAH PENGHASILAN NETO SETELAH KOMPENSASI KERUGIAN (7 - 8)

JUMLAH KREDIT PAJAK (17a+17b) 13.

JUMLAH PENGHASILAN NETO (1 + 2 + 3 + 4)

STP PPh PASAL 25 (HANYA POKOK PAJAK)

(11)

s.d

PEMBUKUAN PENCATATAN

•

NPWP

:

NAMA WAJIB PAJAK

:

PENGHASILAN NETO DALAM NEGERI DARI USAHA DAN/ATAU PEKERJAAN BEBAS

PEMBUKUAN / LAPORAN KEUANGAN : DIAUDIT OPINI AKUNTAN : TIDAK DIAUDIT

NAMA AKUNTAN PUBLIK :

NPWP AKUNTAN PUBLIK :

NAMA KANTOR AKUNTAN PUBLIK :

NPWP KANTOR AKUNTAN PUBLIK :

NAMA KONSULTAN PAJAK :

NPWP KONSULTAN PAJAK :

NAMA KANTOR KONSULTAN PAJAK

:

NPWP KANTOR KONSULTAN PAJAK

:

a.

_1a

b.

_1b

c.

_1c

d.

_1d

e.

_1e

2.

a.

_2a

b.

_2b

c.

_2c

d.

2d

e.

_2e

f.

_2f

g.

_2g

h.

_2h

i.

_2i

j.

_2j

k.

_2k

l.

_2l

a.

_3a

b.

_3b

c.

_3c

d.

_3d

4 4

Pindahkan Jumlah Bagian A (angka 4) ke Formulir 1770 Angka 1

PENGHASILAN NETO (1c - 1d)

PENYESUAIAN FISKAL NEGATIF LAINNYA

GAJI YANG DIBAYARKAN KEPADA PEMILIK / ORANG YANG MENJADI TANGGUNGANNYA JUMLAH YANG MELEBIHI KEWAJARAN YANG DIBAYARKAN KEPADA PIHAK YANG MEMPUNYAI HUBUNGAN ISTIMEWA SEHUBUNGAN DENGAN PEKERJAAN YANG DILAKUKAN

3.

PENYESUAIAN FISKAL NEGATIF:

HARTA YANG DIHIBAHKAN, BANTUAN ATAU SUMBANGAN

PREMI ASURANSI KESEHATAN, ASURANSI KECELAKAAN, ASURANSI JIWA, ASURANSI DWIGUNA, DAN ASURANSI BEASISWA YANG DIBAYAR OLEH WAJIB PAJAK

PENGGANTIAN ATAU IMBALAN SEHUBUNGAN DENGAN PEKERJAAN ATAU JASA YANG DIBERIKAN DALAM BENTUK NATURA ATAU KENIKMATAN

PAJAK PENGHASILAN

BL

SANKSI ADMINISTRASI

SELISIH PENYUSUTAN/AMORTISASI KOMERSIAL DIATAS PENYUSUTAN/ AMORTISASI FISKAL

BIAYA UNTUK MENDAPATKAN, MENAGIH DAN MEMELIHARA PENGHASILAN YANG DIKENAKAN PPh FINAL DAN PENGHASILAN YANG TIDAK TERMASUK OBJEK PAJAK

PENYESUAIAN FISKAL POSITIF LAINNYA

JUMLAH (2a s.d. 2k)

PENGHASILAN YANG DIKENAKAN PPh FINAL DAN PENGHASILAN YANG TIDAK TERMASUK OBJEK PAJAK TETAPI TERMASUK DALAM PEREDARAN USAHA

JUMLAH (3a s.d. 3c)

JUMLAH BAGIAN A (1e + 2l - 3d)

SELISIH PENYUSUTAN / AMORTISASI KOMERSIAL DI BAWAH PENYUSUTAN AMORTISASI FISKAL

HARGA POKOK PENJUALAN

LABA/RUGI BRUTO USAHA (1a - 1b)

PENYESUAIAN FISKAL POSITIF

BIAYA YANG DIBEBANKAN/DIKELUARKAN UNTUK KEPENTINGAN PRIBADI WAJIB PAJAK ATAU ORANG YANG MENJADI TANGGUNGANNYA

BIAYA USAHA PEREDARAN USAHA

RUPIAH

PERHATIAN: BERI TANDA " X " DALAM

1.

PENGHASILAN DARI USAHA DAN/ATAU PEKERJAAN BEBAS BERDASARKAN

LAPORAN KEUANGAN KOMERSIAL :

BAGIAN A:

(BAGI WAJIB PAJAK YANG MENYELENGGARAKAN PEMBUKUAN)

(KOTAK PILIHAN) YANG SESUAI SEBELUM MENGISI BACALAH PETUNJUK PENGISIAN

KEMENTERIAN KEUANGAN RI DIREKTORAT JENDERAL PAJAK

FO

R

M

U

LI

R

HALAMAN 1

1770 - I

2

0

TA

H

U

N

P

A

JA

K

BL

SPT TAHUNAN PPh WAJIB PAJAK ORANG PRIBADI

LAMPIRAN - I

TH

PENGHITUNGAN PENGHASILAN NETO DALAM NEGERI DARI USAHA

DAN/ATAU PEKERJAAN BEBAS BAGI WAJIB PAJAK YANG

MENYELENGGARAKAN PEMBUKUAN

TH

0

(12)

•

s.d

•

PENGHITUNGAN PENGHASILAN DALAM NEGERI LAINNYA PEMBUKUAN PENCATATAN PERHATIAN :

•

NPWP

:

NAMA WAJIB PAJAK

:

BAGIAN B: PENGHASILAN NETO DALAM NEGERI DARI USAHA DAN/ATAU PEKERJAAN BEBAS

Pindahkan Jumlah Bagian BKolom (5)ke Formulir 1770 Angka 1

BAGIAN C : PENGHASILAN NETO DALAM NEGERI SEHUBUNGAN DENGAN PEKERJAAN

(TIDAK TERMASUK PENGHASILAN YANG DIKENAKAN PPh BERSIFAT FINAL)

Pindahkan Jumlah Bagian CKolom (5)ke Formulir 1770 Angka 2

BAGIAN D : PENGHASILAN NETO DALAM NEGERI LAINNYA

(TIDAK TERMASUK PENGHASILAN YANG DIKENAKAN PPh BERSIFAT FINAL)

Pindahkan Jumlah Bagian D ke Formulir 1770 Angka 3

(Rupiah)

(2) (5)

JBC

(3)

JUMLAH PENGHASILAN NETO

(Rupiah)

PENGURANGAN PENGHASILAN BRUTO/BIAYA

JBD

KEUNTUNGAN DARI PENJUALAN/PENGALIHAN HARTA ROYALTI

USAHA LAINNYA

JUMLAH BAGIAN B

1

5

6

(1)

1 3

4

2

NO.

(2)

PENGHASILAN NETO

(Rupiah)

NO.

DAGANG

INDUSTRI

JASA

PEKERJAAN BEBAS

(Rupiah) NAMA DAN NPWP

PEMBERI KERJA PENGHASILAN NETO

(Rupiah)

JENIS USAHA

PEREDARAN USAHA

(Rupiah)

NORMA

(%)

JBB

(3)

4

NO.

2

5

(1)

(2)

JENIS PENGHASILAN

3

4

5

(1)

SEWA

PENGHARGAAN DAN HADIAH

JUMLAH BAGIAN C

(4)

(5)

PENGHASILAN BRUTO

(4)

TA

H

U

N

P

A

JA

K

BL

0

TH

DIREKTORAT JENDERAL PAJAK

HALAMAN 2

(BAGI WAJIB PAJAK YANG MENYELENGGARAKAN PENCATATAN)

(3)

BERI TANDA " X " DALAM (KOTAK PILIHAN) YANG SESUAI

PENGHITUNGAN PENGHASILAN NETO DALAM NEGERI SEHUBUNGAN DENGAN PEKERJAAN

1770 - I

PENGHITUNGAN PENGHASILAN NETO DALAM NEGERI DARI USAHA DAN/ATAU PEKERJAAN

2

BEBAS BAGI WAJIB PAJAK YANG MENYELENGGARAKAN PENCATATAN

BL

LAMPIRAN - I

1

SEBELUM MENGISI BACALAH PETUNJUK PENGISIAN

FO

R

MU

LI

R

KEMENTERIAN KEUANGAN RI

2

halaman Lampiran -I Halaman ke - dari

JIKA FORMULIR INI TIDAK MENCUKUPI, DAPAT DIBUAT SENDIRI SESUAI DENGAN BENTUK INI

3 6

BUNGA

JUMLAH BAGIAN D

PENGHASILAN LAINNYA

TH

0

(13)

s.d

PEMBUKUAN PENCATATAN

PERHATIAN :

•

NPWP

:

NAMA WAJIB PAJAK

:

BAGIAN A :

(1)

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15 dst

*)

-

=

-

Kolom (6) diisi dengan pilihan sebagai berikut : 21 / 22 / 23 / 24 /26/ DTP (Contoh : ditulis 21, 22, 23, 24, 26, DTP)

-

Jika terdapat kredit pajak PPh Pasal 24, maka jumlah yang diisi adalah maksimum yang dapat dikreditkan sesuai lampiran tersendiri (lihat petunjuk pengisian tentang Lampiran II Bagian A dan Induk SPT angka 4)

dari

halaman Lampiran-II

TH

BL

NOMOR

(7) (6)

(4) (5)

BERI TANDA " X " DALAM

TH

1770 - II

LAMPIRAN - II

FO

R

M

U

LI

R

JENIS PAJAK : PPh PASAL 21/ 22/23/24/26/DTP *) NPWP

PEMOTONG/PEMUNGUT PAJAK

KEMENTERIAN KEUANGAN RI

DAFTAR PEMOTONGAN/PEMUNGUTAN PPh OLEH PIHAK LAIN,

PPh YANG DIBAYAR/DIPOTONG DI LUAR NEGERI DAN

PPh DITANGGUNG PEMERINTAH

TA

H

U

N

P

A

JA

K

NO PEMOTONG/PEMUNGUT NAMA PAJAK

DAFTAR PEMOTONGAN/PEMUNGUTAN PPh OLEH PIHAK LAIN, PPh YANG DIBAYAR / DIPOTONG DI LUAR NEGERI DAN PPh

DITANGGUNG PEMERINTAH

(KOTAK PILIHAN) YANG SESUAI

DIREKTORAT JENDERAL PAJAK

BL

BUKTI

PEMOTONGAN/PEMUNGUTAN TANGGAL

JUMLAH PPh YANG DIPOTONG / DIPUNGUT

(Rupiah)

0

2

SEBELUM MENGISI BACALAH PETUNJUK PENGISIAN

Halaman ke

-JIKA FORMULIR INI TIDAK MENCUKUPI, DAPAT DIBUAT SENDIRI SESUAI DENGAN BENTUK INI

JBA

DTP

JUMLAH BAGIAN A

Pindahkan Jumlah Bagian A Kolom 7 ke Formulir 1770 Angka 15

PPh Ditanggung Pemerintah

(2) (3)

(14)

•

s.d

•

PEMBUKUAN PENCATATAN

PERHATIAN :

•

NPWP

:

NAMA WAJIB PAJAK

:

BAGIAN A :

NO

(1)

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

BAGIAN B :

PENGHASILAN YANG TIDAK TERMASUK OBJEK PAJAK

NO

(1)

1.

2.

3.

4.

5.

6.

BAGIAN C :

PENGHASILAN ISTERI/SUAMI YANG DIKENAKAN PAJAK SECARA TERPISAH

PENGHASILAN LAIN YANG TIDAK TERMASUK OBJEK PAJAK BANTUAN / SUMBANGAN / HIBAH

BAGIAN LABA ANGGOTA PERSEROAN KOMANDITER TIDAK ATAS SAHAM, PERSEKUTUAN, PERKUMPULAN, FIRMA, KONGSI

PENGHASILAN ISTERI DARI SATU PEMBERI KERJA

SUMBER/JENIS PENGHASILAN

PENGHASILAN DARI TRANSAKSI DERIVATIF

PENGHASILAN NETO ISTERI/SUAMI YANG DIKENAKAN PAJAK SECARA TERPISAH

PENGHASILAN LAIN YANG DIKENAKAN PAJAK FINAL DAN/ATAU BERSIFAT FINAL

PENGHASILAN BRUTO (Rupiah)

(3)

JUMLAH (1 s.d. 16)

(2)

(Rupiah)

BEASISWA

JUMLAH BAGIAN B

WARISAN

KLAIM ASURANSI KESEHATAN, KECELAKAAN, JIWA, DWIGUNA, BEASISWA

JBB

(4)

BUNGA SIMPANAN YANG DIBAYARKAN OLEH KOPERASI KEPADA ANGGOTA KOPERASI

DIVIDEN

USAHA JASA KONSTRUKSI

PENYALUR/DEALER/AGEN PRODUK BBM

FO

R

MU

LI

R

1770 - III

DIREKTORAT JENDERAL PAJAKKEMENTERIAN KEUANGAN RI

SEBELUM MENGISI BACALAH PETUNJUK PENGISIAN

0

2

SPT TAHUNAN PPh WAJIB PAJAK ORANG PRIBADI

LAMPIRAN - III

TA

H

U

N

P

A

JA

K

PENGHASILAN YANG TIDAK TERMASUK OBJEK PAJAK

PENGHASILAN ISTERI/SUAMI YANG DIKENAKAN PAJAK SECARA TERPISAH

PENGHASILAN YANG DIKENAKAN PAJAK FINAL DAN/ATAU BERSIFAT FINAL

PENGALIHAN HAK ATAS TANAH DAN/ATAU BANGUNAN

TH

BL TH BL

HADIAH UNDIAN

PESANGON, TUNJANGAN HARI TUA DAN TEBUSAN PENSIUN YANG DIBAYAR SEKALIGUS

BUNGA DEPOSITO, TABUNGAN, DISKONTO SBI, SURAT BERHARGA NEGARA

HONORARIUM ATAS BEBAN APBN / APBD BUNGA/DISKONTO OBLIGASI

(3)

PPh TERUTANG (Rupiah)

PENGHASILAN YANG DIKENAKAN PAJAK FINAL DAN/ATAU BERSIFAT FINAL

(KOTAK PILIHAN) YANG SESUAI BERI TANDA " X " DALAM

BANGUNAN YANG DITERIMA DALAM RANGKA BANGUNAN GUNA SERAH

SEWA ATAS TANAH DAN/ATAU BANGUNAN PENJUALAN SAHAM DI BURSA EFEK

JENIS PENGHASILAN _{PAJAK/PENGHASILAN BRUTO}DASAR PENGENAAN

(2)

0

(15)

SPT TAHUNAN PPh WAJIB PAJAK ORANG PRIBADI

•

s.d

•

PEMBUKUAN PENCATATAN

PERHATIAN

•

SEBELUM MENGISI BACALAH PETUNJUK PENGISIAN

•

BERI TANDA " X " DALAM

NPWP

:

NAMA WAJIB PAJAK

:

BAGIAN A :

BAGIAN B :

KEWAJIBAN/UTANG PADA AKHIR TAHUN

(3)

BAGIAN C :

DAFTAR SUSUNAN ANGGOTA KELUARGA

Halaman ke- dari halaman Lampiran-IV 8

9

10 dst

NO.

(1)

1

2

3

4

5

6

7 2

3

(4)

7

(1)

NO.

TAHUN PEROLEHAN

(3)

6

10 dst

2

PEKERJAAN

NO.

JUMLAH BAGIAN B

JBB

HUBUNGAN KELUARGA

3

0

2

(4)

ALAMAT PEMBERI PINJAMAN

(6)

NAMA ANGGOTA KELUARGA

•

KEMENTERIAN KEUANGAN RI

DIREKTORAT JENDERAL PAJAK

KEWAJIBAN/UTANG PADA AKHIR TAHUN

BL

KODE

HARTA

NAMA HARTA

4

5

HARGA PEROLEHAN

(Rupiah)

KETERANGAN

1

(2)

NIK

HARTA PADA AKHIR TAHUN

(6) (5)

(5)

JBA

HARTA PADA AKHIR TAHUN

LAMPIRAN - IV

TA

H

U

N

P

A

JA

K

(2)

JUMLAH

(Rupiah)

DAFTAR SUSUNAN ANGGOTA KELUARGA

BL TH TH

TAHUN

PEMINJAMAN

JUMLAH BAGIAN A

8

9

FO

R

M

U

LI

R

1770 - IV

(KOTAK PILIHAN) YANG SESUAI

JIKA FORMULIR INI TIDAK MENCUKUPI, DAPAT DIBUAT SENDIRI SESUAI DENGAN BENTUK INI

NAMA PEMBERI PINJAMAN

KODE

UTANG

(2)

(5)

5 dst

4 1

(4)

(1) (3)

069 other

0

(16)

No.

Penghasilan Neto

(1) (3)

A

1 PENGHASILAN NETO DALAM NEGERI DARI USAHA DAN/ATAU PEKERJAAN BEBAS

[Diisi dari Formulir 1770 Bagian A angka 1]

2 PENGHASILAN NETO DALAM NEGERI SEHUBUNGAN DENGAN PEKERJAAN

[Diisi dari Formulir 1770 Bagian A angka 2 atau Formulir 1770 S Bagian A angka 1]

3 PENGHASILAN NETO DALAM NEGERI LAINNYA

4 PENGHASILAN NETO LUAR NEGERI

5 ZAKAT / SUMBANGAN KEAGAMAAN YANG BERSIFAT WAJIB

6 JUMLAH

( 1 + 2 + 3 + 4 - 5 )

7 KOMPENSASI KERUGIAN

[Khusus Bagi WP OP yang menyelenggarakan pembukuan. Diisi dari Formulir 1770 Bagian A angka 8]

8 JUMLAH PENGHASILAN NETO

( 6 - 7 )

No

(1)

B

C

D

E

1 5% x

2 15% x

3 25% x

4 30% x

F

G

Nama :

NPWP :

Tanda Tangan

Nama :

NPWP :

Tanda Tangan

JUMLAH PAJAK PENGHASILAN TERUTANG (GABUNGAN)

PPh TERUTANG YANG DITANGGUNG

[ (A.8.(3) / B) x E ]

[Pindahkan nilai pada bagian ini ke SPT bagian C angka 12 Formulir 1770 atau ke bagian C angka 9 Formulir 1770 S]

PPh TERUTANG YANG DITANGGUNG

[ (A.8.(4) / B) x E ]

[Pindahkan nilai pada bagian ini ke SPT bagian C angka 12 Formulir 1770 atau ke bagian C angka 9 Formulir 1770 S]

,

(2) (3)

JUMLAH PENGHASILAN NETO SUAMI DAN ISTERI

[ A.8.(3) + A.8.(4) ]

PENGHASILAN TIDAK KENA PAJAK

PENGHASILAN KENA PAJAK

[ B - C ]

PAJAK PENGHASILAN TERUTANG (GABUNGAN)

Uraian

Nilai

PENGHASILAN NETO

(2) (4)

LEMBAR PENGHITUNGAN PAJAK PENGHASILAN TERUTANG

BAGI WAJIB PAJAK YANG KAWIN DENGAN STATUS PERPAJAKAN SUAMI-ISTERI PISAH HARTA DAN PENGHASILAN (PH) ATAU