SURAT SETORAN PAJAK LEMBAR

KEMENTERIAN KEUANGAN R.I. 1

DIREKTORAT JENDERAL PAJAK
(SSP) Untuk Arsip Wajib Pajak

NOP: / / / / / /
Diisi sesuai dengan Nomor Objek Pajak
ALAMAT OP: .............................................................................................................................................
.............................................................................................................................................

Uraian Pembayaran : .....................................................

Kode Akun PajakKode Jenis Setoran .......................................................................................
.......................................................................................
.......................................................................................

NPWP:
Jan
Feb
Diisi sesuai dengan Mar Wajib Apr
Nomor Pajak yangMei
dimiliki Jun Jul Ags Sep Okt Nov Des Tahun Pajak
NAMA NPWP: .............................................................................................................................................
Diisi Tahun Terutangnya
ALAMAT NPWP: .............................................................................................................................................
Pajak
.............................................................................................................................................

Nomor Ketetapan: ................................................................................................... Diisi dengan rupiah penuh

Terbilang : ..........................................................................................................................................................
...........................................................................................................................................................................
...........................................................................................................................................................................
Bulan
Diterima oleh Kantor Penerimaan Pembayaran Wajib Pajak/Penyetor
Di ceklis ( )
Tanggal ........................................ .............................. , Tanggal .......................
Cap dan tanda tangan Cap dan tanda tangan

Nama Jelas : ........................................ Nama Jelas : ....................................

“terima Kasih Telah Membayar Pajak – Pajak Untuk Pembangunan Bangsa”
Ruang Validasi Kantor Penerimaan Pembayaran