ATTACHMENT - II FORM

ANNUAL
INDIVIDUAL
1770 – II
INCOME TAX RETURN TAX YEAR:
FINANCE DEPARTMENT OF RI
DIREKTORATE GENERAL OF TAX

LIST OF TAX WITHHELD/COLLECTED BY OTHER

PARTIES, BORNE BY THE GOVERNMENT, NET INCOME MO YR MO TH
AND TAX PAID/WITHHELD/PAYABLE OVERSEAS
to

TAX ID (NPWP) :

NAME OF TAXPAYER : .....................................................................................................................................

PART A : LIST OF INCOME TAX WITHHELD/COLLECTED BY OTHER PARTIES AND BORNE BY THE GOVERNMENT

TOTAL INCOME TAX

NAME AND TAX ID (NPWP) OF REF. NO. AND DATE OF INCOME TAX ART. 21 / WITHHELD / COLLECTED /
TAX WITHHOLDER/COLLECTOR TAX WITHHOLDING / 22/ 23 / BORNE BY BORNE BY THE
No. COLLECTION SLIPS THE GOVERNMENT GOVERNMENT
(RUPIAH)
(1) (2) (3) (4) (5)

TOTAL 

PART B : NET INCOME AND TAX PAID / WITHHELD / PAYABLE OVERSEAS

TAX PAID /
NAME AND ADDRESS OF TYPE OF NET WITHHELD / INCOME TAX
No. SOURCE / INCOME PROVIDER INCOME INCOME PAYABLE ART. 24 *)
OVERSEAS (RUPIAH) OVERSEAS (RUPIAH)
(RUPIAH)
(1) (2) (3) (4) (5) (6)

TOTAL 

*) REQUEST : TOTAL IN COLUMN (6) TO BE ACCOUNTED FOR AS TAX CREDIT

D.1.1.32.44
Note :
( 1 ) Forward total in Part A column (5) plus total in Part B column (6) to Form 1770 (E) (15).
( 2 ) Forward total in Part B column (4) to Form 1770 (B) (4).
( 3 ) If this form is insufficient, prepare a separate form in the same format.