GENERAL INSTRUCTIONS FOR THE COMPLETION SPT 1770 S 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/2015. 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 todo a recount;

6. <AUTO> sign shows the calculation results automatically. There are times when automaticcalculation is too late to execute, to make sure it runs well, point the cursor pointer tothe field where the calculation formula should be run, block the numbers there, then pressDELETE key followed by ENTER. However, Taxpayer is expected to keep doing re-checkingthe results of calculations on this tax return, especially in the field <AUTO> ;

7. If additional form of 1770S-I and 1770S-II are needed because the information to be loadedis more than one page, that forms now are available in the directory (folder). These files canbe reproduced to adjust the needs in a way to copy and replace file name (rename), forexample: 1770S-I-1, 1770S-I-2 etc;

8. After all attachments completed, then complete the main form up to the box "Total NetIncome after Zakat/ Obligated Charity",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 ofIncome Tax Payable Calculation for Taxpayers with PH and MT Status”. After theworkpaper completed, complete the main form on the "Adjustment for Foreign TaxCredits Refunded and had been Credited in The Previous Year Return (Income TaxArticle 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 thefile;

11. The HIDE button used to hide the calculation formula so that it can be printed blank form ifyou want to complete it manually;

12. Detailed description of the completing income tax annual tax return please read theInstruction Book.

FOR TAXPAYER WHO HAVE INCOME:• FROM ONE OR MORE EMPLOYER; ST/ND/RD/TH

AMENDED RETURN• OTHER DOMESTIC INCOME; AND/OR• SUBJECTED TO FINAL AND/OR FINALIZED TAX.

• FOLLOW INSTRUCTION IN THE INSTRUCTION BOOK • • MARK " X " IN THE APPROPRIATE BOX

:

TAXPAYER'S NAME :

OCCUPATION : KLU :

PHONE NUMBER : - FAX. NUMBER : -

: KK HB PH MT

SPOUSE'S TIN :

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

1 …….……………………………………………..[Total net income from each Form 1721-A1 and/or 1721-A2 attached or other Withholding Tax Receipt]

2 OTHER DOMESTIC NET INCOME ………………………………………………………………………………………………………………………….[From Form 1770 S-I Total Part A ]

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

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

……………………………………………………………………………

………………………………………………………………………………………

7 PERSONAL EXEMPTIONS TK / K / K / I /

8 TAXABLE INCOME (6-7) ……………………………………………………………………………………………. 8

……………………………………………………………………

……………………………………………………………………………………………

[From Form 1770 S-I Total Part C column (7)]

13 a. TAX DUE AFTER CREDIT ……………………………………………………..b. TAX OVERLY WITHHELD

14 a. MONTHLY INSTALLMENT OF INCOME TAX ARTICLE 25

15 TOTAL TAX CREDIT (14a + 14b)

16 a. UNDERPAID TAX (INCOME TAX ARTICLE 29)

b. OVERPAID TAX (INCOME TAX ARTICLE 28 A)

17 REQUEST: Overpaid amount stated in 16.b would be :

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

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

18 MONTHLY INSTALLMENT FOR THE SUBSEQUENT YEAR 18

THE AMOUNT IS CALCULATED BY:a. 1/12 X THE TOTAL OF LINE 13

b. CALCULATION IN SEPARATE ATTACHMENT

a. Copy of Form 1721-A1 and/or 1721-A2 or Withholding Receipt of Income Tax Art.21 d.

b. Tax Payment Slip of Income Tax Article 29 e. …………………………………………………………..

c. Power of Attorney (If Needed)

TAXPAYER PROXY DATE

FULL NAME :

TIN :

F.1.1.32.18

D. T

AX

CR

EDIT

1

3

4

2

5

6

B.T

AXA

BLE

IN

CO

ME

…………………………………………………………………………………………

13

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

14a

14b

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

10

2 0C

. TA

X PA

YAB

LEFO

RM

OF THE REPUBLIC OF INDONESIA

PRINT OR TYPE WITH CAPITAL LETTER AND BLACK INKATTENTION:

1770 SMINISTRY OF FINANCE

ANNUAL INDIVIDUAL INCOME TAX RETURN

TAXPAYER IDENTIFICATION NUMBER (TIN)

6

SIGNATURE

A. N

ET IN

CO

ME

IDEN

TITY

15

12

COMPENSATED WITH OUTSTANDING TAX PAYABLE

TAX LIABILITY STATUS OF MARRIED INDIVIDUAL

(13-15)

……………………………………………………………………………………………………………………..

SETTLED ON

PREPAID TAX:

10

DIRECTORATE GENERAL OF TAXES

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

11

DOMESTIC NET INCOME IN RESPECT OF EMPLOYMENT

(11-12)

TAXA

BLE

YEA

R

RUPIAH *)

9

7

16

NOTICES OF TAX COLLECTION ON INCOME TAX ARTICLE25 (PRINCIPAL ONLY)

b.

DD MM

YYMMDD

YY

Understanding all consequencesincluding all penalties imposed by the prevailing law and regulations, I hereby declare that the information on this tax return, including all attachments provided, are correct, complete, and clear.

F. M

ON

THLY

IN

STA

LLM

ENT

OF

INC

OM

E TA

X A

RTI

CLE

25

FO

R T

HE

SUB

SEQ

UEN

T YE

AR

G. A

TTA

CH

-M

ENTS

DECLARATION

E.IN

CO

ME

TAX

OVE

R/U

ND

ERPA

ID

Income Tax Calculation For Married Taxpayer with Separation of Property and Income (PH) or Has Her Own TIN (MT)

•••

TIN :

TAXPAYER'S NAME :

PART A : OTHER DOMESTIC NET INCOME(NOT INCLUDING INCOME SUBJECT TO FINAL INCOME TAX AND/OR FINAL IN NATURE)

(1)

PART B : NON TAXABLE INCOME

(1)

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

(1)

5.etc

Copy Total Part C to Form 1770 S Part D Line 12Catatan :*) - DTP : BORNE BY THE GOVERNMENT

- 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 C of Attachment I and Annual Tax Return line 3)

Page from pages Attachment-IIF NEEDED, ADDITIONAL PAGES MAY BE ADDED

TPCTOTAL PART C

1.

2.

3.

4.

(3)

TPA

6.

3.

4.

1.

5.

2.

NO

1.

RENT

ROYALTIES

AWARDS AND PRIZES

5.

6.

TYPES OF INCOME

GAIN FROM THE SALE/TRANSFER OF PROPERTY

OTHER INCOMES

2.

3.

4.

NO.

1770 S - IMINISTRY OF FINANCE

(7)(6)(2) (5)(3) (4)

TOTAL PART B

DATE

TPB

SCHOLARSHIP

NUMBER

Copy Total Part A to Form 1770 S Part A line 2

TOTAL PART A

INTEREST

INHERITANCE

FOR

M

(3)

TOTAL NET INCOME(Rupiah)

TAXA

BLE

YEA

R

OF THE REPUBLIC OF INDONESIA2 0

NO. TYPES OF INCOME

DIRECTORATE GENERAL OF TAXES

ATTACHMENT - IANNUAL INDIVIDUAL INCOME TAX RETURN

OTHER DOMESTIC NET INCOMESNON TAXABLE INCOMELIST OF INCOME TAX WITHHELD BY OTHER PARTIES, PAID/WITHHELD IN FOREIGN AND BORNED BY THE GOVERNMENT

(2)

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

NAME OF WITHHOLDING AGENT TIN OF WITHHOLDING AGENTWITHHOLDING TAX RECEIPT TYPES OF TAX :

INCOME TAX ARTICLE 21/22/23/24/26/DTP *)

TOTAL OF INCOME TAX WITHHELD

(Rupiah)

(2)(Rupiah)

GROSS INCOME

OTHER NON TAXABLE INCOME

• INCOME SUBJECT TO FINAL TAX AND/OR FINALIZED TAX• ASSETS AT YEAR-END• LIABILITIES AT YEAR- END• LIST OF MEMBER OF FAMILY'S DEPENDENT

TIN :

TAXPAYER'S NAME :

PART A : INCOME SUBJECT TO FINAL TAX AND/OR FINALIZED TAX

(1)

: ASSETS AT YEAR-END

NO.

(1)

5.etc

PART C : LIABILITIES AT YEAR- END

(1)

5dst

PART D : LIST OF MEMBER OF FAMILY'S DEPENDENT

NO.

(1)

1

2

3

4

5

Page from pages Attachment-II

TOTAL

4

3

IF NEEDED, ADDITIONAL PAGES MAY BE ADDED

OCCUPATION

(5)

NAME

(2)

IDENTITY NUMBER (NIK)

(3)

RELATIONSHIP IN FAMILY

(4)

2.

YEAR OF ACQUISITION DESCRIPTION

(6)(5)

1.

13. WIFE INCOME FROM ONE EMPLOYER

INCOME FROM DERIVATIVE TRANSACTION

NO.

2.

5.

3.

4.

11.

TRANSFERS OF RIGHTS ON LAND AND BUILDING

6.

7.

9.

8.

12.

TAXA

BLE

YEA

R

(4)

INCOME TAX PAYABLE

(Rupiah)

CODE TYPE OF ASSETS

(2) (3)

LOTTERY PRIZES

COST OF ACQUISITION (Rupiah)

3.

4.

FOR

M

OF THE REPUBLIC OF INDONESIA

TYPES OF INCOME

ANNUAL INDIVIDUAL INCOME TAX RETURN

DIRECTORATE GENERAL OF TAXES

ATTACHMENT - II

(2) (3)

1.

(Rupiah)

2 0

TOTAL PART A TPA

(4)

NO. CODE

(3)(2)

14.

PART B

10.

DIVIDEND

LEASE/RENT VALUE ON LAND OR BUILDING

TPB

LENDER ADDRESS YEAR LENDING

TOTAL PART B

NAME OF LENDER

JUMLAH BAGIAN C

(4) (5) (6)

JBC

2

1

1770 S - IIMINISTRY OF FINANCE

TAX BASE/GROSS INCOME

INTEREST FROM DEPOSIT, SAVINGS, DISCOUNT ON BANK INDONESIA CERTIFICATES, STATE SECURITIES

INTEREST/DISCOUNT OF BOND

PROPERTY RECEIVED FROM BUILD OPERATE TRANSFER SCHEME

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[From Form 1770 Part A line 4 or Form 1770 S Part A line 3]

5 ZAKAT/OBLIGATED CHARITY[From Form 1770 Part A line 6 or Form 1770 S Part A line 5]

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]

PRINT INCOME TAX ANNUAL TAX RETURN (BAHASA VERSION) ON THE NEXT PAGES

BAGI WAJIB PAJAK YANG MEMPUNYAI PENGHASILAN :• DARI SATU ATAU LEBIH PEMBERI KERJA; SPT PEMBETULAN KE - • DALAM NEGERI LAINNYA; DAN/ATAU• YANG DIKENAKAN PPh FINAL DAN/ATAU BERSIFAT FINAL.

• SEBELUM MENGISI BACA DAHULU PETUNJUK PENGISIAN • • BERI TANDA "X" PADA (KOTAK PILIHAN) YANG SESUAI

NPWP :

NAMA WAJIB PAJAK :

PEKERJAAN : KLU :

NO. TELEPON : - NO. FAKS : -

: KK HB PH MT

NPWP ISTERI / SUAMI :

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

1 …….……………………………………………..[Diisi akumulasi jumlah penghasilan neto pada setiap Formulir 1721-A1 dan/atau 1721-A2 yang dilampirkan atau Bukti Potong Lain]

2 PENGHASILAN NETO DALAM NEGERI LAINNYA ………………………………………………………………………………………………………………………….[Diisi sesuai dengan Formulir 1770 S-I Jumlah Bagian A ]

3 PENGHASILAN NETO LUAR NEGERI ………………………………………………………………………………………………………………………….[Apabila memiliki penghasilan dari luar negeri agar diisi dari Lampiran Tersendiri, lihat petunjuk pengisian]

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

5 ZAKAT/SUMBANGAN KEAGAMAAN YANG SIFATNYA WAJIB ……………………………………………………………………………

6 ………………………………………………………………………………………

7 PENGHASILAN TIDAK KENA PAJAK TK / K / K / I /

8 PENGHASILAN KENA PAJAK (6-7) ……………………………………………………………………………………………. 8

9 PPh TERUTANG (TARIF PASAL 17 UU PPh x ANGKA 8) ……………………………………………………………………

10 PENGEMBALIAN / PENGURANGAN PPh PASAL 24 YANG TELAH DIKREDITKAN ………………………………………

11 JUMLAH PPh TERUTANG (9+10) ……………………………………………………………………………………………

12NEGERI DAN/ATAU TERUTANG DI LUAR NEGERI [Diisi dari Formulir 1770 S-I Jumlah Bagian C Kolom (7)]

13 a. PPh YANG HARUS DIBAYAR SENDIRI ……………………………………………………..b. PPh YANG LEBIH DIPOTONG/DIPUNGUT

14 a. PPh PASAL 25 ……………………………………………………………………………………………………………………………………………

b. STP PPh Pasal 25 (Hanya Pokok Pajak) ………………………………………………………

15 JUMLAH KREDIT PAJAK (14a + 14b)

16 a. PPh YANG KURANG DIBAYAR (PPh PASAL 29)

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

17 PERMOHONAN : PPh Lebih Bayar pada 16b mohon :

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

b. d. DIKEMBALIKAN DENGAN SKKPP PASAL 17D (WP yang Memenuhi Persyaratan Tertentu)

18 ANGSURAN PPh PASAL 25 TAHUN PAJAK BERIKUTNYA SEBESAR 18

DIHITUNG BERDASARKAN :a. 1/12 x JUMLAH PADA ANGKA 13

b. PENGHITUNGAN DALAM LAMPIRAN TERSENDIRI

a. Fotokopi Formulir 1721-A1 atau 1721-A2 atau Bukti Potong PPh Pasal 21 d.

b. Surat Setoran Pajak Lembar Ke-3 PPh Pasal 29 e.

c. Surat Kuasa Khusus (Bila dikuasakan)

WAJIB PAJAK KUASA TANGGAL

NAMA LENGKAP :

N P W P :

F.1.1.32.18

D. K

RED

IT P

AJA

K

1

3

4

JUMLAH PENGHASILAN NETO SETELAH PENGURANGAN ZAKAT /SUMBANGAN KEAGAMAAN YANG SIFATNYA WAJIB (4-5)

2

5

6

B.P

ENG

HA

SILA

N

KEN

A P

AJA

K

…………………………………………………………………………………………

13

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

14a

14b

2 0SPT TAHUNAN

C. P

Ph T

ERU

TAN

GFO

RM

ULI

R

KEMENTERIAN KEUANGAN RI

PAJAK PENGHASILAN WAJIB PAJAK ORANG PRIBADI

ISI DENGAN HURUF CETAK /DIKETIK DENGAN TINTA HITAMPERHATIAN

1770 S

TANDA TANGAN

A. P

ENG

HA

SILA

N N

ETO

IDEN

TITA

S

15

12

DIPERHITUNGKAN DENGAN UTANG PAJAK

STATUS KEWAJIBAN PERPAJAKAN SUAMI-ISTERI

(13-15)

……………………………………………………………………………………………………………………..

TGL LUNAS

PPh YANG DIBAYAR SENDIRI

10

DIREKTORAT JENDERAL PAJAK

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.

11

PENGHASILAN NETO DALAM NEGERI SEHUBUNGAN DENGAN PEKERJAAN

(11-12)

PPh YANG DIPOTONG/DIPUNGUT PIHAK LAIN/DITANGGUNG PEMERINTAH DAN/ATAU KREDIT PAJAK LUAR

TAH

UN

PA

JAK

16

RUPIAH *)

9

7

TGL BLN

THNBLNTGL

THN

Dengan menyadari sepenuhnya akan segala akibatnya termasuk sanksi-sanksi sesuai dengan ketentuan peraturanperundang-undangan yang berlaku, saya menyatakan bahwa yang telah beritahukan diatas beserta lampiran-lampirannyaadalah benar, lengkap dan jelas.

F. A

NG

SUR

AN

PPh

PA

SAL

25 T

AH

UN

PA

JAK

BER

IKU

TNYA

G. L

AM

PIR

AN

PERNYATAAN

E. P

Ph K

UR

AN

G/L

EBIH

BA

YAR

Perhitungan PPh Terutang bagi Wajib Pajak dengan status perpajakan PH atau MT

•••

N P W P :

NAMA WAJIB PAJAK :

BAGIAN A : PENGHASILAN NETO DALAM NEGERI LAINNYA(TIDAK TERMASUK PENGHASILAN DIKENAKAN PPh FINAL DAN/ATAU BERSIFAT FINAL)

(1)

angka (2)

BAGIAN B : PENGHASILAN YANG TIDAK TERMASUK OBJEK PAJAK

(1)

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

BAGIAN C : DAFTAR PEMOTONGAN/PEMUNGUTAN PPh OLEH PIHAK LAIN DAN PPh YANG DITANGGUNG PEMERINTAH

(1)

5.dst

Pindahkan Jumlah Bagian C ke Formulir Catatan : Induk 1770 S Bagian D angka 12*) - DTP : Ditanggung Pemerintah

- Kolom (6) diisi dengan pilihan PPh Pasal 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 I Bagian C dan Induk SPT angka 3)

Halaman ke- dari halaman Lampiran-IJIKA FORMULIR INI TIDAK MENCUKUPI, DAPAT DIBUAT SENDIRI SESUAI DENGAN BENTUK INI

JBCJUMLAH BAGIAN C

1.

2.

3.

4.

(3)

BANTUAN/SUMBANGAN/HIBAH

JBA

6.

3.

4.

1.

5.

2.

NO

KLAIM ASURANSI KESEHATAN, KECELAKAAN, JIWA, DWIGUNA, BEASISWA

PEMUNGUT PAJAK

1.

SEWA

ROYALTI

PENGHARGAAN DAN HADIAH

5.

6.

JENIS PENGHASILAN

KEUNTUNGAN DARI PENJUALAN/PENGALIHAN HARTA

PENGHASILAN LAINNYA

2.

3.

4.

NO.

TANGGALPEMUNGUTAN

JBB

BEASISWA

NOMOR

PENGHASILAN LAINNYA YANG TIDAK TERMASUK OBJEK PAJAK

BUKTI PEMOTONGAN/

PEMUNGUT PAJAK

(7)(6)

DIPOTONG / DIPUNGUTPPh PASAL 21/

(2) (5)(3) (4)22/23/24/26/DTP*

JENIS PAJAK : JUMLAH PPh YANG

JUMLAH BAGIAN B

NPWP PEMOTONG/NAMA PEMOTONG/

FOR

MU

LIR

(3)

JUMLAH PENGHASILAN (Rupiah)

TAH

UN

PA

JAK

1770 S - IKEMENTERIAN KEUANGAN RI

2 0

NO. JENIS PENGHASILAN

DIREKTORAT JENDERAL PAJAK

LAMPIRAN - ISPT TAHUNAN PPh WAJIB PAJAK ORANG PRIBADI

PENGHASILAN NETO DALAM NEGERI LAINNYAPENGHASILAN YANG TIDAK TERMASUK OBJEK PAJAKDAFTAR PEMOTONGAN/PEMUNGUTAN PPh OLEH PIHAK LAIN DAN PPh YANG DITANGGUNG PEMERINTAH

(2)

(2)

WARISAN

(Rupiah)JUMLAH PENGHASILAN

Pindahkan Jumlah Bagian A ke Formulir Induk 1770 S Bagian A

JUMLAH BAGIAN A

BUNGA

• PENGHASILAN YANG DIKENAKAN PPh FINAL DAN/ATAU BERSIFAT FINAL• HARTA PADA AKHIR TAHUN• KEWAJIBAN/UTANG PADA AKHIR TAHUN• DAFTAR SUSUNAN ANGGOTA KELUARGA

N P W P :

NAMA WAJIB PAJAK :

BAGIAN A : PENGHASILAN YANG DIKENAKAN PPh FINAL DAN/ATAU BERSIFAT FINAL

(1)BUNGA DEPOSITO, TABUNGAN, DISKONTO SBI, SURAT BERHARGA NEGARA

PESANGON, TUNJANGAN HARI TUA DAN TEBUSAN PENSIUNYANG DIBAYARKAN SEKALIGUS

BANGUNAN YANG DITERIMA DALAM RANGKA BANGUN GUNASERAHBUNGA SIMPANAN YANG DIBAYARKAN OLEH KOPERASI KEPADA ANGGOTA KOPERASI

PENGHASILAN LAIN YANG DIKENAKAN PAJAK FINAL DAN/ATAU BERSIFAT FINAL

: HARTA PADA AKHIR TAHUN

NO.

(1)

5.dst

BAGIAN C : KEWAJIBAN/UTANG PADA AKHIR TAHUN

(1)

5dst

BAGIAN D : DAFTAR SUSUNAN ANGGOTA KELUARGA

NO.

(1)

1

2

3

4

5

Halaman ke- dari halaman Lampiran-II

4

3

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

PEKERJAAN

(5)

NAMA

(2)

NIK

(3)

HUBUNGAN KELUARGA

(4)

6.

7.

9.

8.

12.

JUMLAH BAGIAN B

NAMA PEMBERI PINJAMAN

2.

TAHUN PEROLEHAN KETERANGAN

(6)(5)

1.

JUMLAHPEMBERI PINJAMAN

13. PENGHASILAN ISTERI DARI SATU PEMBERI KERJA

PENGHASILAN DARI TRANSAKSI DERIVATIF

NO.

2.

5.

3.

4.

11.

PENGALIHAN HAK ATAS TANAH DAN/ATAU BANGUNAN

2 0

JUMLAH BAGIAN A JBA

(4)

(Rupiah)

KODE HARTA NAMA HARTA

(2) (3)

HADIAH UNDIAN

TAH

UN

PA

JAK

(4)

PPh TERUTANG

HONORARIUM ATAS BEBAN APBN/APBD

HARGA PEROLEHAN (Rupiah)

3.

4.

FOR

MU

LIR

KEMENTERIAN KEUANGAN RI

SUMBER/JENIS PENGHASILAN

SPT TAHUNAN PPh WAJIB PAJAK ORANG PRIBADI

DIREKTORAT JENDERAL PAJAK

1770 S - IILAMPIRAN - II

PENJUALAN SAHAM DI BURSA EFEK

(2) (3)

DASAR PENGENAAN PAJAK/ PENGHASILAN BRUTO

1.

(Rupiah)

BUNGA/DISKONTO OBLIGASI

NO. KODE UTANG

(3)(2)

14.

BAGIAN B

10.

DIVIDEN

SEWA ATAS TANAH DAN/ATAU BANGUNAN

JBB

PEMINJAMANTAHUN ALAMAT

JUMLAH BAGIAN C

(4) (5) (6)

JBC

2

1

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[Diisi dari Formulir 1770 Bagian A angka 3 atau Formulir 1770 S Bagian A angka 2]

4 PENGHASILAN NETO LUAR NEGERI[Diisi dari Formulir 1770 Bagian A angka 4 atau Formulir 1770 S Bagian A angka 3]

5 ZAKAT / SUMBANGAN KEAGAMAAN YANG BERSIFAT WAJIB[Diisi dari Formulir 1770 Bagian A angka 6 atau Formulir 1770 S Bagian A angka 5]

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

ISTERI YANG MENGHENDAKI UNTUK MENJALANKAN HAK DAN KEWAJIBAN PERPAJAKANNYA SENDIRI (MT)

Uraian Penghasilan Neto