ATTACHMENT I
ANNUAL FORM
INDIVIDUAL 1770 S
INCOME TAX RETURN
FOR INDIVIDUALS WHO DO NOT CONDUCT BUSINESS / INDEPENDENT WORK
TAX YEAR :
DETAILS OF NET INCOME AND LIST OF
WITHHOLDING/COLLECTION OF TAX BY OTHER PARTIES AND INCOME TAX BORNE BY THE GOVERNMENT
TAX ID (NPWP) :
NAME OF TAXPAYER : ...
PART A : INCOME FROM EMPLOYMENT
NO. NAME / TAX ID (NPWP) OF EMPLOYER
REVENUE / GROSS INCOME
(RUPIAH)
DEDUCTIONS
(RUPIAH)
NET INCOME (RUPIAH)
(1) (2) (3) (4) (5)
TOTAL
PART B : OTHER DOMESTIC NET INCOME (EXCLUDING FINAL TAXED INCOME)
N O
TYPE OF INCOME GROSS INCOME
(RUPIAH)
COSTS
(RUPIAH)
NET INCOME
(RUPIAH)
(1) (2) (3) (4) (5)
1 INTEREST
2 DIVIDEND
3 ROYALTY
4 RENTAL
5 AWARDS AND GIFTS
6 GAIN ON SALE/TRANSFER OF ASSETS
7 OTHERS
TOTAL
PART C : LIST OF WITHHOLDING / COLLECTION OF INCOME TAX BY OTHER PARTIES AND INCOME TAX BORNE BY THE GOVERNMENT
No. NAME AND TAX ID (NPWP) OF WITHHOLDER / COLLECTOR OF TAX
REF. NO. AND DATE OF TAX WITHHOLDING /
COLLECTION SLIPS
INCOME TAX ART. 21 / 22 / 23 /
BORNE BY THE GOVERNMENT
TOTAL INCOME TAX WITHHELD/COLLECTED/B
ORNE BY THE GOVERNMENT
(RUPIAH)
(1) (2) (3) (4) (5)
TOTAL
D.1.1.32.52
Note :
(1) Forward total Part A column (5) to Form 1770S (A) (1).
(2) Forward total Part B column (5) to Form 1770S (A) (2).
(3) Forward total Part C column (5) to Form 1770S (D) (12).
(4) If this form is insufficient, prepare a separate form in the same format.
FINANCE DEPARTMENT OF RI DIREKTORATE GENERAL OF TAX
