Finance department of ri direktorate general of tax ttachment III




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A

FINANCE DEPARTMENT OF RI

DIREKTORATE GENERAL OF TAX



TTACHMENT - III





FORM







ANNUAL

INDIVIDUAL

TAX RETURN


1770 - III





TAX YEAR :




INCOME SUBJECT TO FINAL TAX, SEPARATE TAX, INCOME OF CERTAIN ENTREPRENEURS, AND NON TAXABLE INCOME




























MO TH MO YR






















to

















































































TAX ID (NPWP) :



































































NAME OF TAXPAYER :

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










PART A : INCOME SUBJECT TO FINAL TAX, SEPARATE TAX, AND INCOME OF CERTAIN ENTREPRENEURS

No

TYPE OF INCOME

TAX BASE / GROSS INCOME

(RUPIAH)


INCOME TAX PAYABLE



(RUPIAH)













(1)

(2)

(3)

(4)













I.

SUBJECT TO FINAL TAX :



















1.

a.

INTEREST ON TIME AND SAVING DEPOSITS






















b.

INTEREST/DISCOUNT ON BONDS SOLD IN STOCK EXCHANGE AND DISCOUNTS ON BANK INDONESIA CERTIFICATE (SBI)






















2.

SALE VALUE OF SHARES SOLD IN STOCK EXCHANGE






















3.

a.

LOTTERY PRIZES

























b.

LUMPSUM PAYMENT OF SEVERANCE, OLD AGE ALLOWANCE AND PENSION








































c.

HONORARIUM PAID FROM STATE / REGIONAL BUDGET






















4.

a.

TRANSFER VALUE OF LAND AND OR BUILDING








































b.

VALUE OF BUILDING RECEIVED FOR BUILD OPERATE TRANSFER (BOT)

























c.

RENTAL OF LAND AND/OR BUILDING






















5.

CONSTRUCTION SERVICES






















6.

BUSINESS INCOME:

a. SUPPLIER / DEALER / AGENT OF



PERTAMINA GASOLINE PRODUCTS







b. SUPPLIER / DISTRIBUTOR OF CIGARETTES.






















7.


OTHER INCOME SUBJECT TO FINAL TAX






















II.

SUBJECT TO SEPARATE TAX :




































1.

WIFE’S INCOME FROM ONE EMPLOYER






















2.

SON’S/DAUGHTER’S INCOME FROM WORK


































TOTAL











































III
INCOME OF CERTAIN ENTREPRENEURS




















































PART B : NON TAXABLE OBJECTS





No.

TYPE OF INCOME

GROSS INCOME









(RUPIAH)










(1)

(2)

(3)










1.

AID / DONATION / BEQUEST













2.

INHERITANCE













3.

PROFIT DISTRIBUTION FROM LIMITED PARTNERSHIPS, PARTNERSHIPS, GROUPS, FIRMS, JOINT COMPANIES













4.

CLAIM OF HEALTH, ACCIDENT, LIFE, DUAL FUNCTION (DWIGUNA) INSURANCE, SCHOLARSHIP













5.

OTHER NON TAXABLE INCOME

























TOTAL












D.1.1.32.45





Note :




(1)

Forward total in Part A I and II column (4) to Form 1770 (I) (a) column (2).

(2)

Forward total in Part A III column (3) to Form 1770 (I) (b) column (1).

(3)

Forward total in Part A III column (4) to Form 1770 (I) (b) column (2).

(4)

Forward total in Part B column (3) to Form 1770 (I) (c) column (1).


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