1771 - V/$ CORPORATE ANNUAL INCOME TAX...
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• LIST OF SHAREHOLDERS/CAPITAL OWNERS AND TOTAL DIVIDENDS DISTRIBUTED • LIST OF DIRECTORS AND COMMISSIONERS T I N : TAXPAYER'S NAME : ACCOUNTING PERIOD : PART A: LIST OF SHAREHOLDERS/CAPITAL OWNERS AND TOTAL DIVIDENDS DISTRIBUTED (3) (4) PART B: LIST OF DIRECTORS AND COMMISSIONERS (3) (4) Page page Attachment-V D.1.1.32.41 DIRECTORATE GENERAL OF TAXES IF NEEDED, ADDITIONAL PAGES MAY BE ADDED (6) 100% TPA TOTAL PART A CORPORATE ANNUAL INCOME TAX RETURN to TAXABLE YEAR (7) (US$) % DIVIDEND FORM T I N (2) NAME ADDRESS 1771 - V/$ MINISTRY OF FINANCE OF THE REPUBLIC ON INDONESIA NO (1) ATTACHMENT - V TOTAL PAID IN SHARES (US$) from FOR CORPORATE PERMITTED TO MAINTAIN BOOKS IN ACCOUNT IN ENGLISH LANGUAGE AND US DOLLAR CURRENCY IDENTITY NO (1) (5) POSITION T I N NAME ADDRESS (2) (5) 2 0 A A
Transcript of 1771 - V/$ CORPORATE ANNUAL INCOME TAX...
• LIST OF SHAREHOLDERS/CAPITAL OWNERS AND TOTAL DIVIDENDS DISTRIBUTED
• LIST OF DIRECTORS AND COMMISSIONERS
T I N :
TAXPAYER'S NAME :
ACCOUNTING PERIOD :
PART A: LIST OF SHAREHOLDERS/CAPITAL OWNERS AND TOTAL DIVIDENDS DISTRIBUTED
(3) (4)
PART B: LIST OF DIRECTORS AND COMMISSIONERS
(3) (4)
Page page Attachment-V
D.1.1.32.41
DIRECTORATE GENERAL OF TAXES
IF NEEDED, ADDITIONAL PAGES MAY BE ADDED
(6)
100%TPATOTAL PART A
CORPORATE ANNUAL INCOME TAX RETURN
to
TA
XA
BL
E Y
EA
R
(7)(US$)%
DIVIDEND
FO
RM
T I N
(2)
NAME ADDRESS
1771 - V/$MINISTRY OF FINANCE OF THE
REPUBLIC ON INDONESIA
NO
(1)
ATTACHMENT - V
TOTAL PAID IN SHARES(US$)
from
FOR CORPORATE PERMITTED TO MAINTAIN BOOKS IN ACCOUNT IN ENGLISH LANGUAGE AND US DOLLAR CURRENCY
IDE
NT
ITY
NO
(1)
(5)
POSITIONT I NNAME ADDRESS(2) (5)
2 0 A A
• DAFTAR PEMEGANG SAHAM/PEMILIK MODAL DAN JUMLAH DIVIDEN YANG DIBAGIKAN
• DAFTAR SUSUNAN PENGURUS DAN KOMISARIS
N P W P :
NAMA WAJIB PAJAK :
PERIODE PEMBUKUAN :
BAGIAN A : DAFTAR PEMEGANG SAHAM / PEMILIK MODAL DAN JUMLAH DIVIDEN YANG DIBAGIKAN
(1)
JBA
BAGIAN B : DAFTAR SUSUNAN PENGURUS DAN KOMISARIS
NO
(1)
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D.1.1.32.41
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9.
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3.
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1.
NAMA ALAMAT NPWP JABATAN
(2) (3) (4) (5)
JUMLAH BAGIAN A
(5)(2) (3) (4)
NO NAMA ALAMAT NPWPJUMLAH MODAL DISETOR
(US$)
IDE
NT
ITA
S
s.d.
FO
RM
UL
IR
(US$)%
DIVIDEN
TA
HU
N P
AJ
AK
BAGI WAJIB PAJAK YANG DIIZINKAN MENYELENGGARAKAN PEMBUKUAN
DALAM BAHASA INGGRIS DAN MATA UANG DOLLAR AMERIKA SERIKAT
LAMPIRAN - V
KEMENTERIAN KEUANGAN RI
DIREKTORAT JENDERAL PAJAK
1771 - V/$SPT TAHUNAN PAJAK PENGHASILAN WAJIB PAJAK BADAN
(7)
JIKA FORMULIR INI TIDAK MENCUKUPI, DAPAT DIBUAT SENDIRI SESUAI DENGAN BENTUK INI
(6)
100%
2 0A A
