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Tabel Penyusutan

Economic useful life Annual Depreciation Commercial


Assets Acquisition Book Value at
No Assets type Cost Residual Value Depreciation method Commercial Fiscal Commercial Fiscal Difference Accumulated
Group year Begininning
Fiscal Accumulated Depreciation Depreciation
a b c d e f= (a-b)/d g= a/e h = f-g i j= a-i

1 Offiice Builldings Permanent 2013 2 145 000 000 100 000 000 Straight-line 20 20 ( 102 250 000) ( 107 250 000)( (5 000 000) ( 429 000 000) ( 1 716 000 000)( 306 750 000)
2 Warehouse 1 Permanent 2014 2 000 000 000 100 000 000 Straight-line 20 20 ( 95 000 000) ( 100 000 000)( (5 000 000) ( 300 000 000) ( 1 700 000 000)( 285 000 000)
3 Warehouse 2 Permanent 2014 1 000 000 000 100 000 000 Straight-line 20 20 ( 45 000 000) ( 50 000 000) ( (5 000 000) ( 150 000 000) ( 850 000 000) ( 135 000 000)
4 Type 1 Car Box Group 2 2013 300 000 000 25 000 000 Straight-line 8 8 ( 34 375 000) ( 37 500 000) ( (3 125 000) ( 150 000 000) ( 150 000 000) ( 137 500 000)
5 Type 2 Car Box Group 2 2013 400 000 000 25 000 000 Straight-line 8 8 ( 46 875 000) ( 50 000 000) ( (3 125 000) ( 200 000 000) ( 200 000 000) ( 187 500 000)
6 Office Cars Group 2 2013 275 000 000 50 000 000 Straight-line 8 8 ( 28 125 000) ( 34 375 000) ( (6 250 000) ( 137 500 000) ( 137 500 000) ( 112 500 000)
7 Warehouse Furniture Group 1 2016 100 000 000 5 000 000 Straight-line 4 4 ( 23 750 000) ( 25 000 000) ( (1 250 000) ( 25 000 000) ( 75 000 000) ( 23 750 000)
8 Office Furnitures Group 1 2016 122 500 000 5 000 000 Straight-line 4 4 ( 29 375 000) ( 30 625 000) ( (1 250 000) ( 30 625 000) ( 91 875 000) ( 29 375 000)
9 Office Equipments Group 1 2016 100 000 000 5 000 000 Straight-line 4 4 ( 23 750 000) ( 25 000 000) ( (1 250 000) ( 25 000 000) ( 75 000 000) ( 23 750 000)
10 Warehouse Equipments Group 1 2015 ( 100 000 000) ( 10 000 000) Straight-line 4 4 ( 22 500 000) 25000000 ( (2 500 000) ( 50 000 000) ( 50 000 000) ( 45 000 000)
Total ( 6 542 500 000) ( 451 000 000) ( 484 750 000)( (33 750 000)( 1 497 125 000) ( 5 045 375 000)( 1 241 125 000)
PT DINAMIKA SALOKA
NPWP : 04.345.005.3-508.000
Fiscal Reconcilliation 2018
1771-II (COGS CALCULATION) 1771-I (TAXABLE INCOME- FISCALE RECONCILLIATION)

Adjustement Purchase POSITIVE ADJUSTMENTS NEGATIVE ADJUSTMENTS


Fiscale (tax Salary, Income Other
Account Commercial Adjusted by tax Office SKP 1771 Transporta TOTAL Non Administrat Different of Other Different of Different of
returns) Wage, Interest Uncollectible Royalty Marketing others Beginnig Ending charged by for the Benefit in Over Fair Grant & Deffered Defferred negative
Positive Negative tion Depreciation & Amortization Rental Service Expense Operating Allowance Income tax ive depreciatio Positive depreciatio amortizatio
Bonus, Expense Debts Expense Expense Expense inventory inventory Final Tax & Stockholder kinds Amounts Donations Expense income tax adjustment
Goods/Materials Epense Income Sanctions n adjustments n n
Gratifikasi Non Tax s
Object
GROSS REVENUES
SALES (75 375 000 000) (75 375 000 000)
SALES RETURN (12 500 000) (12 500 000)
SALES DISCOUNT (250 000 000) (250 000 000)

Total gross Revenues (75 112 500 000) (75 112 500 000) 1771-1 1a

COST OF GOODS SOLD


BEGINNING INVENTORY (20 000 000) (20 000 000)
PURCHASE (61 294 425 000) (61 294 425 000)
GOODS READY FOR SALE (61 314 425 000) (61 314 425 000)
ENDING INVENTORY (35 575 000) (35 575 000)

Total Cost of Goods Sold-Trading (61 278 850 000) (61 278 850 000)


Cost of Goods Sold- Non Operating ( -)
Total COGS (61 278 850 000) (61 278 850 000)
( -  )
GROSS INCOME (13 833 650 000) (13 833 650 000)

OPERATING EXPENSES
SALARIES, WAGES, AND EMPLOYEE BENEFITS (1 750 000 000) (30 000 000) (1 720 000 000) 1771-2 2
INSURANCE (12 500 000) (5 000 000) (7 500 000)
ELECTRICITY AND PDAM (300 000 000) (65 000 000) (235 000 000)
TELEPHONE (97 500 000) (25 000 000) (72 500 000)
OFFICIAL TRAVEL (75 000 000) (15 000 000) (60 000 000)
OFFICE SUPPLIES (62 500 000) (62 500 000)
OFFICE RENTAL (44 700 000) (44 700 000)
WAREHOUSE RENTAL (250 000 000) (250 000 000)
MEETINGS (25 000 000) (25 000 000)
PRINTING AND PHOTOCOPYING (37 500 000) (37 500 000)
DEPRECIATION OF OFFICE BUILDING (102 250 000) (5 000 000) (107 250 000) 5% for permanent buildings
WAREHOUSE 1 AND WAREHOUSE 2 DEPRECIATION (140 000 000) (10 000 000) (150 000 000) 5% for permanent buildings
DEPRECIATION OF EQUIPMENT AND FURNITURES (99 375 000) (6 250 000) (105 625 000) 25% for group 1 assets
DEPRECIATION OF VEHICLES (109 375 000) (12 500 000) (121 875 000) 12.5% for group 2 assets
ENTERTAINMENT (25 000 000) (4 000 000) (25 000 000)
VEHICLE FUEL (250 000 000) (250 000 000)
RENTAL OF A CONTAINER FORKLIFT (25 000 000) (25 000 000)
LAND AND BUILDING TAX AND RETRIBUTION (12 500 000) (12 500 000)
MARKETING AND ADVERTISING (375 000 000) (375 000 000) ( 451 000 000)
CONTRIBUTION TO THE BEVERAGE ORGANIZATION (25 000 000) (25 000 000) ( 484 750 000)
MAINTENANCE OF FIXED ASSETS (12 500 000) (5 000 000) (7 500 000) ( 33 750 000)
RESERVES FOR BAD DEBTS (25 000 000) (10 000 000) (15 000 000)
LONG-TERM DEBT INTEREST (86 000 000) (86 000 000)
ADMINISTRATIVE TAX PENALTIES (2 500 000) (2 500 000) (0)

TOTAL OPERATING EXPENSES (3 944 200 000) (3 820 450 000)


( -) ( -) ( -) ( -) ( -) ( -) ( -) ( -) ( -) ( -)
OPERATING NET INCOME (9 889 450 000) (10 013 200 000)

NON OPERATING REVENUES/EXPENSES


INTEREST ON DEPOSITS (NET) FROM BIRU BANK (417 500 000) (417 500 000) (0) charged with final tax
BOND INTEREST (NET) FROM PT JASA MARGA TBK (50 000 000) (500 000 000) (0) charged with final tax
DIVIDENDS FROM PT KINCIR AGRO (20% OWNERSHIP) (62 500 000) (62 500 000) (0) charged with final tax
LOTTERY PRIZE SAVINGS FOR A CAT FROM SATU BANK (NET) (87 500 000) (87 500 000) (0) charged with final tax

Total non-Operating Revenues/Expenses (617 500 000) (0)


xs
DOMESTIC NET INCOME (10 506 950 000) (10 013 200 000)
FOREIGN NET INCOME
( -)

TOTAL FOREIGN NET INCOME ( -) ( -) ( -) ( -) ( -) ( -) ( -) ( -) ( -) ( -) ( -) ( -) ( -) ( -)

TOTAL NET INCOME (10 506 950 000) (10 013 200 000) ( -) ( -) ( -) ( -) ( -) ( -) ( -) ( -) ( -) ( -) ( -  ) ( -  ) ( -  ) ( -  ) ( -  ) ( -  ) ( -  ) ( -  ) ( -  ) ( -  ) ( -  ) ( -  ) ( -  ) ( -  ) ( -  ) ( -  )
Loss Compensation ( -) ( 10 013 200 000) selisih penyusutan net selisih penyusutan net
Taxable Income ( 10 013 200 000) ( -) ( -  ) 0
( 10 013 200 000) ( -)
Corporate Income Tax ( 2 503 300 000) ( 10 013 200 000) =
( -)
( 10 013 200 000) ( 10 013 200 000 000)

Corporate income tax ( 2 503 300 000 000)

Tax Credits
prize from Hongkong ( 14 000 000)
Tax treaty India ( 50 000 000) Kredit Pajak :
Article 25

( 64 000 000)
Less/Over/Nil Payment ( 2 439 300 000) ( -)
( 2 503 300 000 000)
( -) ( 208 608 333 333)
CORPORATE ANNUAL TAXABLE YEAR
1771 INCOME TAX RETURN
2 0 1 8
FORM

ATTENTION h FOLLOW INSTRUCTION IN THE MANUAL


MINISTRY OF FINANCE h PRINT OR TYPE WITH CAPITAL LETTER OR BLACK INK
DIRECTORATE GENERAL OF TAXES h MARK "X" IN THE APPROPRIATE BOX AMENDED RETURN

TIN : 0 4 3 4 5 0 0 5 3 5 0 8 0 0 0
TAXPAYER'S NAME : P T D I N A M I K A S A L O K A
IDENTITY

BUSINESS CLASIFICATION : T R A D I N G C O M P A N Y KLU : 5 1 2 2 0


TELEPHONE NUMBER : - FACSIMILE NO. -
ACCOUNTING PERIOD : 0 1 1 7 to 1 2 1 7
FOREIGN DOMICILE OF HEAD OFFICE (Permanent Establisment only) :

FINANCIAL STATEMENT : X AUDITED [1] AUDIT OPINION UNAUDITED

NAME OF PUBLIC ACCOUNTANT FIRM K A P R U B I T A


TIN OF PUBLIC ACCOUNTANT FIRM :
NAME OF CPA : R U B II T A
TIN OF CPA :
NAME OF TAX CONSULTANT FIRM :
TIN OF TAX CONSULTANT FIRM :
NAME OF TAX CONSULTANT :
TIN OF TAX CONSULTANT :
*) The filling of coloumns of Rupiahs must be without decimal value (see example in the manual book page.3)
IDR *)
(1) (2) (3)
A. TAXABLE INCOME

1. FISCAL NET INCOME 1 ( 9 869 700 000)


(Copy from Form 1771-1 line 8 column 3)…………………………………..

2. FISCAL LOSS CARRIED FORWARD 2


(Copy from Special Attachment 2A Total of Column B) …………………..

3. TAXABLE INCOME (1 - 2) ………………………………………………………


3 ( 9 869 700 000)

4. INCOME TAX DUE (Choose one of these Rates according to Taxpayer criteria. See manual book)

a. X Tax Rate Article 17 paragraph (1) letter b X line 3) …………………


B. INCOME TAX DUE

b. Tax Rate Article 17 paragraph (2b) X line 3…………………. 4 ( 2 763 516 000)


c. Tax Rate Article 31E paragraph (1)
5. ADJUSTMENT FOR FOREIGN TAX CREDIT REFUNDED THAT HAD 5
BEEN CREDITED IN THE PREVIOUS YEAR'S RETURN
(Income Tax Art.24)

6. TOTAL TAX DUE (4 + 5) …………………………………………………………


6 ( 2 763 516 000)

7
7. INCOME TAX BORNE BY THE GOVERNMENT (Foreign Aid Project)

8. a. DOMESTIC TAX CREDIT 8a


(Copy from Form 1771-III Total of Column 5)

b. FOREIGN TAX CREDIT 8b ( 59 000 000)


(Copy from Special Attachment 7A Total of column 7)

8c ( 59 000 000)
C. TAX CREDITS

c. TOTAL (8a + 8b) ……………………………………………………………….

9. a. X TAX DUE AFTER CREDIT


(6 - 7 - 8c) 9 ( 2 704 516 000)
b. TAX OVERLY WITHHELD

10. PREPAID TAX : 10a


a. MONTHLY INSTALLMENT TAX ARTICLE 25………………………………

10b
b. NOTICE OF TAX COLLECTION (Principal only)
C. T
10c
c. TAX ARTICLE POINT 8 / DEPARTURE TAX ………………………………….

d. TOTAL (10a + 10b + 10c) ………………………………..


10d ( 2 704 516 000)

11. a. X UNDERPAID TAX (INCOME TAX ARTICLE 29)


D. INCOME TAX UNDER/OVER

(9 - 10d) 11 ( 2 704 516 000)
b. OVERPAID TAX (INCOME TAX ARTICLE 28A)

12. UNDERPAID TAX ON NUMBER 11.a SETTLED ON………………………………………………… 3 1 1 2 2 0 1 8


PAID

TGL BLN THN


13. OVERPAID AMOUNT STATED IN 11.b WOULD BE :

a. REFUNDED b. x COMPENSATED WITH OUTSTANDING TAX PAYABLE

Refund for a Taxpayer with Certain Criteria only : Preliminary Refund (Tax Law on Article 17C or 17D)

F.1.1.32.14

FORM 1771
IDR
(1) (2) (3)
E. MONTHLY INSTALLMENT OF ART.25 FOR CURRENT YEAR

14. a. INCOME BASE FOR CALCULATION OF MONTHLY TAX 14a


INSTALLMENT ……………………………………………………..

b. FISCALL LOSS CARRIED FORWARD : 14b


(From Special Attachment 2A Total of Column 9)

14c
c. TAXABLE INCOME (14a - 14b) ……………………………………………

d. TAX DUE
14d
(Tax Rate from Part B line 4 X 14c) …………………………………………..

e. WITHOLDING TAX PAID BASED ON NUMBER 14a 14e

14f
f. INCOME TAX MUST BE PAID (14d - 14e) ……………………….

14g
g. INCOME TAX ARTICLE 25 : (1/12 x 14f) ……………………………………………………….
F.FINAL TAX AND NON-

15. a. FINAL TAX :


TAXABLE INCOME

15a
(From Form 1771-IV Total Part A Column 5) …………………………… ( 91 000 000)

b. NON-TAXABLE INCOME :
GROSS INCOME 15b
(From Form 1771-IV Total Part B of Column 3) ………………………………. ( 62 500 000)
RELATED PARTIES
G. STATEMENT OF
TRANSACTION IN

16. a. There is a Transaction in Related Parties and/or with Tax Haven Country Resident
(Compulsory to submit Special Attachment 3A, 3A-1. and 3A-2 Manual Book of Annual Return)*

b. x There is not a Transaction in Related Parties and/or with Tax Heaven Country Resident.

17. OTHER THAN FORM OF 1771-I, 1771-II, 1771-III, 1771-IV, 1771-V, AND 1771-VI
WITH THIS ALSO ATTACHED :

a. THIRD COPY OF TAX PAYMENT RECEIPT OF INCOME TAX ARTICLE 29

b. FINANCIAL STATEMENTS

c. x TRANSCRIPT OF ELEMENTS FROM FINANCIAL STATEMENT (Special Attachment 8A-1 /8A-2 /8A-3 /8A-4 /8A-5 /8A-6)*

d. x DEPRECIATION AND AMORTIZATION TABLES (Special Attachment 1A of the Annual Income Tax Return Manual)*

x
H. ATTACHMENTS

e. CALCULATION OF FISCAL LOSS CARRIED FORWARD (Special Attachment 2A of Income Tax Return Manual)*
H. ATTACHMENTS
f. INVESTMENT FACILITIES PROVIDED (Special Attachment 4A of the Income Tax Return Manual)

g. LIST OF MAJOR BRANCHES (Special Attachment 5A of the Income Tax Return Manual)

h. THIRD COPY OF PAYMENT RECEIPT OF INCOME TAX ARTICLE 26 PARAGRAPH (4) (For Permanent Establishment only)

i. x CALCULATION OF INCOME TAX ART.26 PARAGRAPH (4) (Permanent Establishment only) (Special Attachment 6A of Income Tax Return Manual)*

j. x FOREIGN TAX CREDITS (Special Attachment 7A Income Tax Return Manual)*

k. POWER OF ATTORNEY (if needed)

l. ……………………………………………………………………………………………………………………..

m. ………………………………………………………………………………………………………………………

n. ………………………………………………………………………………………………………………………

DECLARATION

Understanding All The Sanctions Provided by The Law and Regulations, I Hereby Declare that The Information Stated in this Return, Including
All Attachments Provided, are True, Complete, Clear, and Under No Circumstances Wharsoever.

a. x TAX PAYER b. AUTHORIZED c. SEMARANG d. 3 1 1 2 2 0 1 8


REPRESENTATIVE (place) date month year

SIGNATURE AND COMPANY SEAL

FULL NAME MANAGEMENT/ : e.


REPRESENTATI VE

TIN : f. 0 7 6 6 6 0 0 3 5 5 0 8 0 0 0

F.1.1.32.14
ATTACHMENT-I

TAXABLE YEAR
1771 - I
FORM

CORPORATE ANNUAL INCOME TAX RETURN


MINISTRY OF FINANCE
2 0 18
DIRECTORATE GENERAL OF TAXES CALCULATION OF FISCAL NET INCOME

:0 4 3 4 5 0 0 5 3 5 0 8 0 0 0
IDENTITY

:P T D I N A M I K A S A L O K A
: to

NO DESCRIPTIONS IDR
(1) (2) (3)
1. DOMESTIC COMMERCIAL NET INCOME :

a. .
1a
GROSS INCOME ………………………………………………………………………………….
( 75 112 500 000)

b. .
1b (
COST OF GOOD SOLD ……………………………………………………………………………………
61 278 850 000)

c. .
1c (
OTHER EXPENSE ………………………………………………………………………………………………..
3 944 200 000)

d. .
1d (
NET INCOME FROM BUSINESS (1a - 1b - 1c) …………………………………………………………………..
9 889 450 000)
1e
e. .
INCOME FROM SIDE BUSINESS ……………………………………………………………………………

f. .
1f (
EXPENSE FROM SIDE BUSINESS ………………………………………………………………………………………….
-)

g. .
1g (
NET INCOME FROM SIDE BUSINESS (1e - 1f) ……………………………………………………………
-)

h. .
1h (
TOTAL (1d + 1g) ………………………………………………………………………………………………..
9 889 450 000)

2. FOREIGN COMMERCIAL NET INCOME 2 ( 470 000 000)


(From Special Attachment 7A Column 4)……………………………………………….. .

3. TOTAL OF COMMERCIAL NET INCOME (1h + 2) ……………………………………… .


3 ( 10 359 450 000)

4. INCOME SUBJECT TO FINAL TAX


4
AND NON-TAXABLE INCOME………………………………………………………….. . ( 617 500 000)

5. POSITIVE FISCAL ADJUSTMENT :

a. EXPENSE CHARGED OR INCURRED FOR THE PERSONAL BENEFIT OF


5a
.
SHAREHOLDERS, PARTNERSHIP OR MEMBERS... ………………………………………..

5b
b. FORMATION OR ACCUMULATION OF ALLOWANCES ……………………….. .
c. CONSIDERATION OR REMUNERATION RELATED TO EMPLOYMENT OR
5c
SERVICES GIVEN IN THE FORM OF A BENEFIT IN KIND…………………………...

d. EXCESSIVE COMPENSATION PAID TO SHAREHOLDERS OR OTHER


5d
.
ASSOCIATED PARTIES AS A CONSIDERATION OF WORK PERFOMED………….

5e
e. GIFTS, AIDS, OR DONATION ………………………………………… .
5f
f. INCOME TAX …………………………………………………………………………… .
g. SALARIES PAID TO A MEMBER OF AN ASSOCIATION, FIRMA, OR LIMITED
5g
.
PARTNERSHIP WHICH CAPTAL DOES NOT CONSIST OF STOCKS……………….

5h
h. . (
ADMINISTRATION SANCTION ……………………………………………………………………………………………. 2 500 000)
5i
i. .
LESS COMMERCIAL DEPRECIATION OVER FISCAL DEPRECIATION ………………………………..

5j
j. .
LESS COMMERCIAL AMORTIZATION OVER FISCAL AMORTIZATION ………………………………..

5k
k. DEFERRED EXPENSES ……………………………………………………………….. .

5l
l. .
OTHER POSITIVE FISCAL ADJUSTMENTS ………………………………………………….. ( 159 000 000)
5m
.
m. TOTAL 5a s.d. 5l ………………………………………………………………………………… ( 161 500 000)

6. NEGATIVE FISCAL ADJUSTMENT :

6a
a. . ( 33 750 000)
LESS COMMERCIAL DEPRECIATION UNDER FISCAL DEPRECIATION ………………………………………………………………………………….

6b
b. .
ESS COMMERCIAL AMORTIZATION UNDER FISCAL AMORTIZATION ………………………………..

6c
c. .
DEFERRED INCOME ………………………………………………………………………………………………..

6d
d. .
OTHER NEGATIVE FISCAL ADJUSTMENTS …………………………………………………..

6e
e. .
TOTAL 6a s.d. 6d …………………………………………………………………………… ( 33 750 000)

7. FACILITIES OF INVESTMENT ALLOWANCES


7b
…… YEAR 7a .
(From Special Attachment 4A line 5b) ……………………….. ( -)

8
8. FISCAL NET INCOME (3 - 4 + 5m - 6e - 7b) …………………………………………. . ( 9 869 700 000)

NOTES : Copy Total of Line 8 to Form 1771 Letter A Line 1.


D.1.1.32.31
ATTACHMENT-II

TAXABLE YEAR
1771 - II
FORM

CORPORATE ANNUAL INCOME TAX RETURN


MINISTRY OF FINANCE
2 0 1 8
DIRECTORATE GENERAL OF TAXES DETAILS OF COST OF GOOD SOLD, OTHER OPERATING EXPENSE AND COMMERCIAL NON-OPERATING EXPENSE

0 4 3 4 5 0 0 5 3 5 0 8 0 0 0 P T D I N A M I K A S A L O K A
IDENTITY

: TAXPAYER'S NAME :

: s.d.

NO DETAILS COST OF GOOD SOLD (IDR) OTHER OPERATING EXPENSE (IDR) NON-OPERATING EXPENSE (IDR) TOTAL (IDR)
(1) (2) (3) (4) (5) (6) = (3) + (4) + (5)

( 61 294 425 000) ( 61 294 425 000)
1. PURCHASE OF MATERIAL/MERCHANDISE

SALARIES, WAGES, BONUSES,


2.
GRATIFICATION, HONORARIUM, AND
( 1 750 000 000) ( 1 750 000 000)
OTHERS

3. TRANSPORTATION EXPENSE ( -)
DEPRECIATION AND AMORTIZATION
4.
EXPENSE ( 451 000 000) ( 451 000 000)

5. RENT EXPENSES ( -)

6. INTEREST EXPENSES ( -)

7. EXPENSE RELATED TO SERVICE ( -)

8. BAD DEBT EXPENSE ( 25 000 000) ( 25 000 000)

9. ROYALTIES EXPENSE

10. MARKETING AND PROMOTION EXPENSE

11. OTHER EXPENSES ( 1 718 200 000) ( 1 718 200 000)

12. BEGINNING INVENTORY ( 20 000 000) ( 20 000 000)

13. ENDING INVENTORY (-/-) ( 35 575 000) ( 35 575 000)

14. TOTAL OF LINE 1 TO 12 MINUS LINE 13 ( 61 278 850 000) ( 3 944 200 000) ( 65 223 050 000)

h Number 1 for Trading Company fill with Inventory, for industry fill with purchase of material, indirect material and finished good.
h Number 7 includes management fee, technical assistance fee, and other services.
h Line 11 includes total expenses not covered in Line 1 to 10.
h Line 12 and 13 for tradingcompanies, filled with beginning/ending balances of merchandise inventory, for industrial companies, filled with beginning/ending balances of raw materials,
indirect materials, work in process, and finished goods inventory.

h
ATTACHMENT- III

TAXABLE YEAR
1771 - III
FORM

CORPORATE ANNUAL INCOME TAX RETURN


MINISTRY OF FINANCE
2 0 1 8
DIRECTORATE GENERAL OF TAXES FOREIGN TAX CREDIT

0 4 3 4 5 0 0 5 3 5 0 8 0 0 0 P T D I N A M I K A S A L O K A
IDENTITY

: TAXPAYER'S NAME

: to

WITHHOLDING OBJECT WITHHOLDING RECEIPT/TAX PAYMENT SLIP (SSP)/SSPCP


NO NAME AND TIN WITHHOLDING AGENT TYPES OF INCOME TAX WITHHELD (IDR)
(IDR) NUMBER DATE
INCOME/TRANSACTION
(1) (2) (3) (4) (5) (6) (7)

1. HONG KONG GRANT ( 270 000 000) ( 9 000 000)


2. INDIA EXPERT INCOME ( 200 000 000) ( 50 000 000)
3.

4.

5.

6.

7.

8.

9.

10.

11.

12.
13.
14.
dst
TOTAL TTL ( 470 000 000) ( 59 000 000)

h Filled with calculation of each Withholding Tax Receipt. Page - from page Attachment-III
h Copy of Total Income Tax Article 22, Income Tax Article 23 and Income Tax Article 26 column (5) to Form 1771 Letter C Line 8.a.
IF NEEDED. ADDITIONAL PAGES MAY BE ADDEED

h
ATTACHMENT - IV

TAXABLE YEAR
1771 - IV
FORM

CORPORATE ANNUAL INCOME TAX RETURN


MINISTRY OF FINANCE
2 0 1 8
DIRECTORATE GENERAL OF TAXES FINAL INCOME TAX AND NON-TAXABLE INCOME

: 0 4 3 4 5 0 0 5 3 5 0 8 0 0 0
IDENTITY

: P T D I N A M I K A S A L O K A

: to

PART A : FINAL INCOME TAX

NO TYPES OF INCOME TAX BASE (IDR) RATE (%) INCOME TAX PAYABLE (IDR)

(1) (2) (3) (4) (5)


INTEREST INCOME ON TIME
DEPOSITS/OTHER SAVINGS AND
1.
DISCOUNT OF CENTRAL BANK'S ( 417 500 000) ( 20) ( 83 500 000)
SERTIFICATE/SECURITIES STATE

2. INTEREST/DISCOUNT OF BOND ( 50 000 000) ( 15) ( 7 500 000)

3. INCOME FROM SALES VALUES OF


SHARE TRADED IN STOCK EXCHANGE

4. INCOME FROM SALES VALUE OF


VENTURE CAPITAL SHARE
INCOME FROM
5. DISTRIBUTOR/DEALER/AGENT OF OIL
PRODUCTS
6. INCOME FROM TRANSFER VALUE OF
RIGHT ON LAND/BUILDING

7. INCOME FROM LEASE/RENT VALUE


OF LAND/BUILDING
8. CONSTRUCTION RELATED FEE :

a. CONTRUCTOR

b. DESIGNER

c. CONSTRUCTION SUPERVISOR

GROSS SALES OF REPRESENTATIVE


9.
OFFICE

GROSS INCOME OF FOREIGN


10.
SHIPPING/AIRLINES COMPANY
GROSS INCOME OF DOMESTIC
11.
SHIPPING COMPANY

12. REVALUATION OF FIXED ASSETS\

DERIVATIVE TRANSACTION TRADE IN


13.
CAPITAL MARKET

14.
etc

TOTAL PART A TPA ( 91 000 000)


Copy of Form 1771 letter F line 15 point a
PART B : NON-TAXABLE INCOME

NO TYPES OF INCOME GROSS INCOME (IDR)

(1) (2) (3)

1. AID/DONATION

2. GRANT

3. DIVIDEND FROM INVESTMENT/OWNERSHIP OF SHARES OF THE INDONESIAN


BUSINESS ENTITIES (Article 4 Paragraph (3) Item f of Income Tax Law) ( 65 500 000)
4. CONTRIBUTION AND SPECIFIC INCOME RECEIVED BY A PENSION FUND

5.
SHARES OF PROFIT RECEIVED BY VENTURE CAPITAL COMPANIES FROM
ITS PARTNERS
6. EXCESS INCOME RECEIVED BY NONPROFIT AND REGISTERED EDUCATION
INSTITUTION OR RESEARCH AND DEVELOPMENT ESTABLISHMENT WHICH
ARE REINVESTED IN THE FORM OF FACILITIES AND IN INFRASTRUCTURE
FOR EDUCATIONAL AND/OR R&D ACTIVITIES

7.
etc

TOTAL PART B TPB

Copy to Form 1771 letter F line 15 point b


IF NEEDED. ADDITIONAL PAGES MAY BE ADDEED Page - page Attachment-IV

D.1.1.32.34
ATTACHMENT - V

TAXABLE YEAR
1771 - V
FORM

CORPORATE ANNUAL INCOME TAX RETURN


MINISTRY OF FINANCEh LIST OF SHAREHOLDERS/CAPITAL OWNERS AND TOTAL DIVIDENDS DISTRIBUTED
2 0 1 8
DIRECTORATE GENERAL OF TAXESh LIST OF DIRECTORS AND COMMISSIONERS

: 0 4 3 4 5 0 0 5 3 5 0 8 0 0 0
IDENTITY

: P T D I N A M I K A S A L O K A
: to

PART A : LIST OF SHAREHOLDERS/CAPITAL OWNERS AND TOTAL DIVIDENDS DISTRIBUTED


TOTAL PAID IN SHARES
NO NAME AND ADDRESS TIN DIVIDEND (IDR)
(IDR) %
(1) (2) (3) (4) (5) (6)

1. THE CIK SANG (CHINA) 00.000.000.0-000.000 ( 3 817 500 000) (25) ( 548 506 750)

PARIMAN WIDYO BROTO


2. 00.000.000.0-000.000 ( 3 817 500 000) (25) ( 548 506 750)
(SEMARANG)
BIANCA SUNANDAR
3. ( 1 527 000 000) (10) ( 219 402 700)
(SEMARANG)
OSKAR SIGALINGGING
4. ( 3 054 000 000) ( 20) ( 438 805 000)
(SEMARANG)
DARMIN WAMENA
( 1 527 000 000) ( 10) ( 219 402 700)
5. (SEMARANG)
I NYOMAN RONI SUKIRMAN
6. ( 1 527 000 000) ( 10) ( 219 402 700)
(BALI)

7.

8.

9.

10.
dst

TOTAL PART A TPA ( 15 270 000 000) 100% ( 2 194 027 000)

PART B : LIST OF DIRECTORS AND COMMISSIONERS

NO NAME AND ADDRESS TIN POSITION

(1) (2) (3) (4)

1. PARIMAN WIDYO BROTO 00.000.000.0-000.000 PRESIDENT BOARD OF DIRECTOR

2. BIANCA SUNANDAR 66.422.976.2-405.000 DIRECTOR

3. SATRIO WARODY 31.598.323.9-424.000 MANAGER

4.
5.

6.

7.

8.

9.

10.
dst

IF NEEDED. ADDITIONAL PAGES MAY BE ADDEED Page - page Attachment-V

D.1.1.32.35
ATTACHMENT - VI
1771 - VI

TAXABLE YEAR
CORPORATE ANNUAL INCOME TAX RETURN
FORM

MINISTRY OF FINANCE h LIST OF CAPITAL CONTRIBUTION IN AFFILIATION COMPANIES


2 0
DIRECTORATE GENERAL OF TAXESh LIST OF ACCOUNT PAYABLE FROM SHAREHOLDERS AND/OR AFFILIATION COMPANIES
h LIST OF ACCOUNT RECEIVABLE TO SHAREHOLDERS AND/OR AFFILIATION COMPANIES

:
IDENTITY

: to

PART A : LIST OF CAPITAL CONTRIBUTION IN AFFILIATION COMPANIES


AMOUNT OF CAPITAL CONTRIBUTION
NO NAME AND ADDRESS TIN
(IDR) %
(1) (2) (3) (4) (5)

1.

2.

3.

4.

5.
etc

TOTAL TTL nihil

PART B : LIST OF ACCOUNT PAYABLE FROM SHAREHOLDERS AND/OR AFFILIATION COMPANIES


INTERES
NO NAME AND ADDRESS TIN TOTAL LOAN (IDR) YEAR
T/YR %

(1) (2) (3) (4) (5) (6)

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12

etc

PART C : LIST OF ACCOUNT RECEIVABLE TO SHAREHOLDERS AND/OR AFFILIATION COMPANIES


INTERES
NO NAME AND ADDRESS TIN TOTAL LOAN (IDR) YEAR
T/YR %

(1) (2) (3) (4) (5) (6)

1.

2.
3.

4.

5.

6.

7.

8.

9.

10.

11.

12

dst

IF NEEDED. ADDITIONAL PAGES MAY BE ADDEED Page - page Attachment-VI

D.1.1.32.36
SPECIAL ATTACHMENT 1A
CORPORATE ANNUAL INCOME TAX RETURN
FOR TAXABLE YEAR 2 0 1 8

LIST OF FISCAL DEPRECIATION AND AMORTIZATION

TIN : 0 4 3 4 5 0 0 5 3 5 0 8 0 0 0 TAXPAYER'S NAME : P T W E D A N G M O J O

MONTH/ COST OF DEPRECIATION/AMORTIZATION FISCAL DEPRECIATION/AMORTIZATION


BEGINNING BALANCE
GROUP / TYPES OF ASSETS YEAR OF ACQUISITION METHOD IN CURRENT YEAR NOTE
ACQUISITION (IDR) (IDR) COMMERCIAL VALUE FISCAL (IDR)
TANGIBLE ASSETS
Group 1 :
Furniture janv.-16 100.000.000 75.000.000 Straight-Line Straight-Line 25.000.000 Warehouse Furniture
Furniture janv.-16 122.500.000 91.875.000 Straight-Line Straight-Line 30.625.000 Office Furniture
Office Equipments janv.-16 100.000.000 75.000.000 Straight-Line Straight-Line 25.000.000 Office Equipments
Equipment Tools janv.-15 100.000.000 50.000.000 Straight-Line Straight-Line 25.000.000 Warehouse Equipments
Group 2 :
Car janv.-13 275.000.000 137.500.000 Straight-Line Straight-Line 34.375.000 Office Car
Car janv.-13 300.000.000 150.000.000 Straight-Line Straight-Line 37.500.000 Type 1 Car Box
Car janv.-13 400.000.000 200.000.000 Straight-Line Straight-Line 50.000.000 Type 2 Car Box

Group 3 :
………………………………………………….
Group 4 :
………………………………………………….
BUILDINGS
Permanent :
Warehouse janv.-14 2.000.000.000 1.700.000.000 Straight-Line Straight-Line 100.000.000 Warehouse 1
Warehouse janv.-14 1.000.000.000 850.000.000 Straight-Line Straight-Line 50.000.000 Warehouse 2
Office janv.-13 2.145.000.000 1.716.000.000 Straight-Line Straight-Line 107.250.000 Office Buildings
Not Permanent :
………………………………………………….
TOTAL DEPRECIATION (For Tax Purpose)……………..……………..……………..……………..……………..……………..……………..……………..……………..……………..…………………………………..…………..………………..……………………………..
484750000
TOTAL COMMERCIAL DEPRECIATION……………..……………..……………..……………..……………..……………..……………..……………..……………..………………….………………………….………..……………………………………….. 451000000
DIFFERENCE (COPY TO FORM 1771-I LINE 5 LETTER I OR LINE 6 LETTER a)……………..……………..……………..……………..……………….………………………..……………………….. 33750000
INTANGIBLE ASSETS
Group 1 :
………………………………………………….
Group 2 :
………………………………………………….
Group 3 :
………………………………………………….

Group 4 :

………………………………………………….
Other Group
………………………………………………….
TOTAL AMORTIZATION (For Tax Purpose)……………..……………..……………..……………..……………..……………..……………..……………..………………………………...…..……………..……………..……………………………………………………..
TOTAL COMMERCIAL AMORTIZATION……………..……………..……………..……………..……………..……………..……………..……………..……………………….………………...……………..……………..………………………………………..
DIFFERENCE (COPY TO FORM 1771-I LINE 5 LETTER j OR LINE 6 LETTER b)……………..……………..……………..……………..……………….………………………..………………………..

…………………………………………..

TAXPAYER/AUTHORIZED REPRESENTATIVE

( ………………………………………………………….)
SPECIAL ATTACHMENT 2A
CORPORATE ANNUAL INCOME TAX RETURN
TAXABLE YEAR 2 0
FISCAL LOSS CARRIED FORWARD CALCULATION FOR TAX PURPOSE
FOR TAXABLE YEAR AND CURRENT TAXABLE YEAR

TIN : TAXPAYER'S NAME :

LOSS AND FISCAL NET INCOME KOMPENSASI KERUGIAN FISKAL

NO YEAR. YEAR. YEAR. YEAR. YEAR. YEAR.


YEAR IDR (CURRENT TAXABLE YEAR)
(THIS TAXABLE YEAR)
(IDR) (IDR) (IDR) (IDR)
IDR*) IDR**)
(1) (2) (3) (4) (5) (6) (7) (8) (9)

5
etc

TOTAL TTL

NOTE : ……………….,
*) COPY THE AMOUNT OF THISS COLUMN TO FORM 1771 LETTER A LINE 2
**) COPY THE AMOUNT OF THIS COLUMN TO FORM 1771 LETTER E LINE 14 POINT b TAXPAYER/AUTHORIZED REPRESENTATIVE

(…………………………………………..)
SPECIAL ATTACHMENT 3A
CORPORATE ANNUAL INCOME TAX RETURN
TAXABLE YEAR
STATEMENT OF TRANSACTION WITH RELATED PARTIES
TIN :

TAXPAYER'S NAME
: :

I LIST OF RELATED PARTIES

No Name Address Tax Identification Number (TIN) Business Activities Types of Relationship with
Taxpayer

1 1 2 3 4

2 1 2 3 4

3 1 2 3 4

4 1 2 3 4

5 1 2 3 4

II DETAILS OF TRANSACTION WITH RELATED PARTIES

No Name Types of Transaction Transaction's Value Determination of Price Method shall be used Determination of Methods

1 a b c d e f g

2 a b c d e f g

3 a b c d e f g

4 a b c d e f g

5 a b c d e f g

………………………………,
IF NEEDED. ADDITIONAL PAGES MAY BE ADDEED TAXPAYER/AUTHORIZED REPRESENTATIVE

(………………………………………………)
SPECIAL ATTACHMENT 3A-1
CORPORATE ANNUAL INCOME TAX RETURN
TAXABLE YEAR

STATEMENT OF TRANSACTION IN RELATED PARTIES

TIN :

TAXPAYER'S NAME/PERMANENT
: ESTABLISHMENT

I DOCUMENTATION OF ARM'S LENGTH TRANSACTION DETERMINATION

These are some particular notes that we made to support the fact that transactions that have been made with related parties are in accordance with the arm's length

principle and the common practice.

1 Concerning of Company's description in detail

That we have made note about :

Yes No

Ownership structure that refer to the dependability between all company in a one group of multinational company.

Organizational structure of Taxpayer Company

Operating aspects from Taxpayers business operations including details of functions which is delivered by units in the Taxpayers organization

Description of business environment in detail

2 Concerning of Transaction

That we have made note about :

Yes No

Transaction with related parties

Taxpayer's transaction with company which is not influenced by related parties or information about comparing transaction.

In case, tax payers act as the selling, rendering, or borrowing party in the above transactions, we have conducted record as follows :

- Pricing Policy and price list for the last 5 (five) years.

- Details of manufacturing cost or acquisition cost or service preparation on cost.

3 Concerning of Comparation Analysis Result Notes

That we have made note about :

Yes No

Characteristic of product (goods, service, loans, finance instrument, etc) which has been transacted

Functional Analysis which is the primary consideration of tax payer's transactions with related parties companies, all risks assumed and assets are being used

in those transactions.

The economic conditions when transactions happened.

Term of transactions, including agreement between taxpayer's with related parties from foreign countries.

Taxpayer business strategy at the time when carry out the affiliation transaction

4 Concerning of determination of Fair Price

That we have made note about :

Yes No

Methodology of price determination which applicable by Taxpayer, which shows how the fair price is acquired, and the reasons why this method is chosen,

compared to other methods.

Comparator Data used by the Taxpayer to determine of transfer price


The Application of the determination methodology of transfer price and the use of comparing data in the determination or tansfer price.

…………………………………………….

TAXPAYER/AUTHORIZED REPRESENTATIVE

________________________________
SPECIAL ATTACHMENT 3A-2
CORPORATE ANNUAL INCOME TAX RETURN
TAXABLE YEAR
STATEMENT OF TRANSACTION WITH PARTIES OF TAX HAVEN COUNTRY RESIDENT
TIN :

TAXPAYER'S: NAME

I IN CASE THE COMPANY HAS MADE TRANSACTION WITH PARTIES OF TAX HAVEN COUNTRY RESIDENT IN THIS TAXABLE YEAR

No Name of Transaction Colleagues Types of Transaction Country Transaction Value

1 a b c d e f g

2 a b c d e f g

3 a b c d e f g

4 a b c d e f g

5 a b c d e f g

II DETERMINATION OF TRANSACTION VALUE ABOVE, SHALL BE REFERRED TO THE TERM ARMS LENGTH ANG ORDINARY BUSINESS PRINCIPLE

YES NO

……………………………………………………

TAXPAYER/AUTHORIZED REPRESENTATIVE

( ………………………….. )

IF NEEDED. ADDITIONAL PAGES MAY BE ADDEED


SPECIAL ATTACHMENT 4A
CORPORATE ANNUAL INCOME TAX RETURN
TAXABLE YEAR 2 0
LIST OF INVESTMENT FACILITIES

TIN :

TAXPAYER'S NAME :

1. IN CASE THE COMPANY HAS BEEN GRANTED TAX FACILITIES ON INVESTMENT, PLEASE EXPLAIN :

a. LETTER OF APPROVAL FROM BKPM b. MINISTER OF FINANCE DECREE

1 NUIMBER : ……………………………………………………….. 1 NUIMBER : ………………………………………………………..

2 DATE : ……………………………………………………….. 2 DATE : ………………………………………………………..

2. a. AMOUNT OF INVESTMENT APPROVED : 1. a. IN FOREX : 2a1a

b. EQUIVALENT IDR : 2a1b *)

2. IND IDR. : 2a2

3. TOTAL IDR. : 2a3

b. INVESTMENT : 1 NEW 2 EXPANSION

c. FIELD AND/OR REGION OF : ……………………………………………………………………………………………………………………………….

INVESTMENT

d. FACILITIES GRANTED : 1 INVESTMENT ALLOWANCE

2 ACCELERATED DEPRECIATION/AMORTIZATION

3 LOSS CARRIED FORWARD 4 YEAR

10% TAX ON DIVIDENDS PAID TO FOREIGN SHAREHOLDERS


5

3. INVESTMENT REALIZATION

a. THIS YEAR : Rp. a

b. UP TO THIS YEAR : Rp. b

4. TIME WHEN COMMERCIAL PRODUCTION STARTED (CPS), DATE


:

5. FACILITIES OF INVESTMENT ALLOWANCE : YEAR a b IDR. **)

(5% X REALIZATION OF INVESTMENT UP TO CPS)

NOTE :
*) PLEASE USE ACTUAL CONVERTION RATE AT THE TIME OF …………………..………,
TRANSFER TO THE COMPANY'S ACCOUNT
**) COPY THE AMOUNT IN LINE 5 b TO FORM 1771-I TAXPAYER/AUTHORIZED REPRESENTATIVE

LINE 7 COLUMN (3)

( ………………………………………………….…………….. )
SPECIAL ATTACHMENT 5A
CORPORATE ANNUAL INCOME TAX RETURN
TAXABLE YEAR 2 0

LIST OF BRANCH MAJOR

TIN :

TAXPAYER'S NAME :

NUMBER
NO ADDRESS OF MAIN BRANCHES OFFICE TIN LOCATION OF MAIN
BRANCHES
(1) (2) (3) (4)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
dst.

NOTE :
IF NEEDED, ADDITIONAL PAGES MAY BE ADDED …………………,

TAXPAYER/AUTHORIZED REPRESENTATIVE
(……………………………………………………….)
SPECIAL ATTACHMENT 6A
CORPORATE ANNUAL INCOME TAX RETURN
TAXABLE YEAR 2 0 1 8
CALCULATION OF INCOME TAX ARTICLE 26 PARAGRAPH (4)
TIN : 0 4 3 4 5 0 0 5 3 5 0 8 0 0 0

TAXPAYER'S NAME/PERMANENT ESTABLISHMENT


: P T D I N A M I K A S A L O K A

IDR
1. COMMERCIAL NET INCOME : ……………………………………………………………………………
1 10359450000
(BASED ON FINANCIAL STATEMENT)
2. FISCAL ADJUSTMENTS :

a. POSITIVE : IDR. 2a 157500000

b. NEGATIVE : IDR. 2b 33750000

c. TOTAL (a – b) : ………………………………………………………………………………… 2c 123750000


3. FISCAL NET INCOME : (1 + 2c) …………………………...………………………………………… 3 10483200001
4. CORPORATE INCOME TAX PAYABLE : ……………………………………………………………… 4 2762396000
5. TAX BASE FOR INCOME TAX ART.26 PARAGRAPH (4) : (3 - 4) ……………………………………………………
5 7720084000
6. INCOME TAX ARTICLE 26 PARAGRAPH (4) 6 1476480000
a X PAYABLE : …… *) % X AMOUNT IN LINE 5 ………………………………………………………

b NOT PAYABLE, BECAUSE :

c PROVISIONS OF TAX TREATY INDONESIA - ……………………………………..……

d REINVESTED WHOLLY IN INDONESIA IN A NEW LIMITED COMPANY : **)


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

TIN : e
ADDRESS : f …………………………………………………………………………………………………………………....…

…………………………………………………………………………………………………………………....…
g CITY : ………………………………………………..………
POSTAL CODE : h

NOTE : …………………..,
*) TAX RATE OF 20% RATE STIPULATED IN TAX TREATY
**) PLEASE ATTACH THE DOCUMENTATION OF REINVESTMENT TAXPAYER/AUTHORIZED REPRESENTATIVE

(…………………………………………………)
SPECIAL ATTACHMENT 7A
CORPORATE ANNUAL INCOME TAX RETURN
TAXABLE YEAR
2 0 1 8
FOREIGN TAX CREDIT
TIN : TAXPAYER'S NAME : P T D I N A M I K A S A L O K A

NET AMOUNT TAX DUE/PAID IN TAX CREDITABLE


NO. NAME AND ADDRESS OF FOREIGN WITHHOLDING AGENT TYPE OF INCOME (IDR) FOREIGN COUNTRY
RUPIAH VALAS (IDR)

(1) (2) (3) (4) (5) (6) (7)

1 SINGAPORE HEALTHY FOOD FESTIVAL (SINGAPORE) GRANT 270000000 9 000 000 1000 9000000

2 JAPAN EXPERT INCOME 200 000 000 50 000 000 306 122,5 50 000 000

10

dst.

JUMLAH JML 59 000 000 1000 59000000

………………………,
NOTE :
* PLEASE FILL WITH THE DETAIL OF EACH WITHHOLDING RECEIPT/TAX PAYMENT TAXPAYER/AUTHORIZED REPRESENTATIVE
* COLUMN (5) IDR FILL WITH CONVERTION VALUR\E FROM THE NUMBER IN COLUMN (6) FOREX WITH USING EXCHANGE RATE
PREVAILING AT THE TIME OF TAX PAYMENT/DUE IN FOREIGN COUNTRY
* TAX CREDIT THAT CAN BE CREDITED IN COLUMN (7) SHALL BE CALCULATED USING ORDINARY CREDIT PER COUNTRY BASIS METHOD
* PLEASE COPY THE TOTAL AMOUNT OF COLUMN (7) TO FORM 1771 LETTER C LINE 8.b.
* PLEASE COPY THE TOTAL AMOUNT OF COLUMN (4) TO FORM 1771-I LINE 2.
* IF NEEDED, ADDITIONAL PAGES MAY BE ADDED. (………………………………………………….)
SPECIAL ATTACHMENT 8A-1
INDUSTRIAL CORPORATE ANNUAL INCOME TAX RETURN TAXABLE YEAR
8A-1
COMPANIES TRANSCRIPT OF ELEMENTS CITATION
2 0
OF FINANCIAL STATEMENT

TIN :

TAXPAYER'S NAME :

I. ELEMENTS FROM BALANCE SHEET

NO. DESCRIPTION VALUE (IDR) NO. DESCRIPTION VALUE (IDR)


1. CASH AND EQUIVALENT 1. ACCOUNT PAYABLE - THIRD PARTIES

2. TEMPORARY INVESTMENTS 2. ACCOUNTS PAYABLE-RELATED PARTIES

3. ACCOUNT RECEIVABLES-THIRD PARTIES 3. INTEREST PAYABLE

4. ACCOUNT RECEIVABLES-RELATED PARTIES 4. TAXES PAYABLE

5. ACCOUNT RECEIVABLE-THIRD PARTIES 5. DIVIDENDS PAYABLE

6. OTHER RECEIVABLE - RELATED PARTIES 6. ACCRUED EXPENSES

7. ALLOWANCE FOR DOUBTFUL ACCOUNTS 7. SHORT-TERM BANK LOANS

8. INVENTORIES 8. LONG TERM DEBTS-CURRENT MATURITIES

9. PREPAID EXPENSES 9. ADVANCES


10. ADVANCES 10. OTHER CURRENT-LIABILITIES
11. OTHER CURRENT ASSETS 11. LONG-TERM DEBT-BANK LOANS
12. LONG - TERM RECEIVABLES 12. LONG-TERM DEBT-THIRD PARTIES

13. LAND AND BUILDINGS 13. LONG-TERM DEBT-RELATED PARTIES

14. OTHER FIXED ASSETS 14. DEFERRED TAX LIABILITIES


15. LESS : ACCUMULATED DEPRECIATION 15. OTHER NON-CURRENT LIABILITIES
16. INVESTMENT IN ASSOCIATES 16. CAPITAL STOCK
17. OTHER LONG -TERM INVESTMENTS 17. ADDITIONAL PAID-IN CAPITAL
18. INTANGIBLE ASSETS 18. RETAINED EARNING FROM PREVIOUS YEAR
19. DEFERRED TAX ASSETS 19. RETAINED EARNINGS
20. OTHER NON-CURRENT ASSETS 20. OTHER EQUITY
TOTAL ASSETS TOTAL LIABILITIES AND OWNER'S EQUITY

II. ELEMENTS FOM INCOME STATEMENT

NO. DESCRIPTION VALUE (IDR)


1. NET SALES
2. MATERIALS
3. DIRECT LABOUR
4. FACTORY OVERHEAD
5. MANUFACTURING COST (2 + 3 + 4)
6. WORK IN PROCESS-BEGINNING
7. WORK IN PROCESS-ENDING
8. COST OF GOOD MANUFACTURE (5 + 6 - 7)
9. FINISHED GOODS-BEGINNING
10. FINISHED GOODS-ENDING
11. COST OF GOOD SOLD (8 + 9 - 10)
12. GROSS PROFIT (1 - 11)
13. SELLING EXPENSES
14. GENERAL AND ADMINISTRATIVE EXPENSES
15. PROFIT (12 - 13 - 14)
16. OTHERS INCOME (EXPENSES)
17. NET EARNINGS OF ASSOCIATES
18. INCOME BEFORE INCOME TAX BENEFIT/(EXPENSE) (15 + 16 + 17)
19. INCOME TAX BENEFIT/(EXPENSE)
20. NET EARNINGS FROM NORMAL ACTIVITIES (18 - 19)
21. EXTRAORDINARY ITEMS
22. INCOME BEFORE MINORITY INTEREST IN NET EARNINGS OF SUBSIDIARIES (20 + 21)
23. MINORITY INTEREST IN NET EARNINGS OF SUBSIDIARIES
24. NET PROFIT (22 - 23)

III. TRANSACTION ELEMENTS WITH RELATED PARTIES UNDER FINANCIAL ACCOUNTING STANDARD GUIDELINES (PSAK) NUMBER 7

NO. PARTIES TYPES OF TRANSACTION TRANSACTION VALUE (IDR)


DECLARATION

Understanding All The Sanctions Provided by The Law and Regulations, I Hereby Declare that The Information Stated in this Return, Including All
Attachments Provided, are True, Complete, Clear, and Under No Circumstances Whatsoever.

a.
……………………………………., (date) (month) (year)

(Place)

b. TAXPAYER AUTHORIZED/REPRESENTATIVE

c. FULL NAME OF MANAGEMENT/REPRESENTATIVE

(d. Signature and Company Seal)


SPECIAL ATTACHMENT 8A-2
TRADING CORPORATE ANNUAL INCOME TAX RETURN TAXABLE YEAR
8A-2
COMPANIES TRANSCRIPT OF ELEMENTS CITATION
2 0 1 8
OF FINANCIAL STATEMENT

TIN : 0 4 3 4 5 0 0 5 3 5 0 8 0 0 0

TAXPAYER'S NAME : P T D N A M I K A S A L O K A

I. ELEMENTS FROM BALANCE SHEET

NO. DESCRIPTION VALUE (IDR) NO. DESCRIPTION VALUE (IDR)


1. CASH AND EQUIVALENT 8125058000 1. ACCOUNT PAYABLE - THIRD PARTIES 5000000
2. TEMPORARY INVESTMENTS 2. ACCOUNTS PAYABLE-RELATED PARTIES

3. ACCOUNT RECEIVABLES-THIRD PARTIES 200500000 3. INTEREST PAYABLE

4. ACCOUNT RECEIVABLES-RELATED PARTIES 4. TAXES PAYABLE

5. ACCOUNT RECEIVABLE-THIRD PARTIES 5. DIVIDENDS PAYABLE

6. OTHER RECEIVABLE - RELATED PARTIES 6. ACCRUED EXPENSES

7. ALLOWANCE FOR DOUBTFUL ACCOUNTS 7. SHORT-TERM BANK LOANS

8. INVENTORIES 35575000 8. LONG TERM DEBTS-CURRENT MATURITIES

9. PREPAID EXPENSES 9. ADVANCES


10. ADVANCES 10. OTHER CURRENT-LIABILITIES
11. OTHER CURRENT ASSETS 11. LONG-TERM DEBT-BANK LOANS 1 100 000 000
12. LONG - TERM RECEIVABLES 12. LONG-TERM DEBT-THIRD PARTIES 1 000 000 000
13. LAND AND BUILDINGS 13. LONG-TERM DEBT-RELATED PARTIES

14. OTHER FIXED ASSETS 9878700000 14. DEFERRED TAX LIABILITIES


15. LESS : ACCUMULATED DEPRECIATION -1804000000 15. OTHER LONG - TERM LIABILITIES 1 031 000
16. INVESTMENT IN ASSOCIATES 1100500000 16. CAPITAL STOCK 13 270 000 000
17. OTHER LONG -TERM INVESTMENTS 17. ADDITIONAL PAID-IN CAPITAL 2 000 000 000
18. INTANGIBLE ASSETS 9325000 18. RETAINED EARNING FROM PREVIOUS YEAR
19. DEFERRED TAX ASSETS 19. RETAINED EARNINGS 2 194 027 000
20. OTHER NON-CURRENT ASSETS 20. OTHER EQUITY
TOTAL ASSETS 17545658000 TOTAL LIABILITIES AND OWNER'S EQUITY 19570058000

II. ELEMENTS FOM INCOME STATEMENT

NO. DESCRIPTION VALUE (IDR)


1. NET SALES 75112500000
2. PURCHASE 61294425000
3. MERCHANDISE INVENTORY - BEGINNING 20000000
4. MERCHANDISE INVENTORY - ENDING 35575000
5. COST OF GOOD SOLD (2 + 3 - 4) 61278850000
6. GROSS PROFIT (1 - 5) 13833650000
7. SALES EXPENSE 3944200000
8. GENERAL AND ADMINISTRATIVE EXPENSES
9. PROFIT (6 - 7 - 8) 9889450000
10. INCOME/(EXPENSE) OTHER
11. NET EARNINGS OF ASSOCIATES
12. INCOME BEFORE INCOME TAX (9 + 10 +11) 9889450000
13. INCOME TAX BENEFIT (EXPENSE)
14. NET EARNINGS FROM NORMAL ACTIVITIES (12 - 13) 9889450000
15. EXTRAORDINARY ITEMS
16. GAIN/LOSS BEFORE MINORITY INTEREST (14 + 15) 9889450000
17. MINORITY INTEREST IN NET EARNINGS OF SUBSIDIARIES
18. NET PROFIT (16 - 17) 9889450000

III. TRANSACTION ELEMENTS WITH RELATED PARTIES UNDER FINANCIAL ACCOUNTING STANDARD GUIDELINES (PSAK) NUMBER 7

NO. PARTIES TYPES OF TRANSACTION TRANSACTION VALUE (IDR)


DECLARATION

Understanding All The Sanctions Provided by The Law and Regulations, I Hereby Declare that The Information Stated in this Return, Including All
Attachments Provided, are True, Complete, Clear, and Under No Circumstances Whatsoever.

a.
……………………………………., (date) (month) (year)

(Place)

b. TAXPAYER AUTHORIZED/REPRESENTATIVE

c. FULL NAME OF MANAGEMENT/REPRESENTATIVE

(d. Signature and Company Seal)


SPECIAL ATTACHMENT 8A-3
CONVENTIONAL CORPORATE ANNUAL INCOME TAX RETURN TAXABLE YEAR
8A-3
BANKS TRANSCRIPT OF ELEMENTS CITATION
2 0
OF FINANCIAL STATEMENT

TIN :

TAXPAYER'S NAME :

I. ELEMENTS FROM BALANCE SHEET

NO. DESCRIPTION VALUE (IDR) NO. DESCRIPTION VALUE (IDR)


1. CASH 1. OBLIGATION DUE IMMEDIATELY
DEPOSITS FROM CUSTOMERS - RELATED
2. GIRO AT CENTRAL BANK 2.
PARTIES
3. GIRO AT OTHER BANK - NET 3. DEPOSITS FROM CUSTOMERS - THIRD PARTIES

4. PLACEMENTS ON CENTRAL BANK - NET 4. DEPOSITS FROM OTHER BANKS

MARKETABLE SECURITIES SOLD UNDER


5. PLACEMENT ON OTHER BANKS- NET 5. REPURCHASE AGREEMENTS, NET OF
ALLOWANCE
6. MARKETABLE SECURITIES - RELATED PARTIES 6. DERIVATIVE PAYABLES

7. MARKETABLE SECURITIES - THIRD PARTIES 7. ACCEPTANCE PAYABLES


MARKETABLE SECUTIRIES PURCHASED UNDER
8. 8. TAXES PAYABLE
RESALE AGREEMENT, NET OF ALLOWANCE
9. DERIVATIVE RECEIVABLES, NET OF ALLOWANCE 9. MARKETABLE SECURITIES ISSUED
10. LOANS, NET OF ALLOWANCE 10. LOAN RECEIVED
CONSUMER FINANCING RECEIVABLES, NET OF ESTIMATED LOSSES ON COMMITMENTS AND
11. 11.
ALLOWANCE CONTIGENCIES
ACCEPTANCE RECEIVABLES, NET OF
12. 12. DEFERRED TAX LIABILITY
ALLOWANCE
13. GOVERNMENT BONDS 13. ACCRUALS LIABILITIES
14. INVESTMENTS, NET OF ALLOWANCE 14. OTHER LIABILITIES
GOODWILL - NET OF ACCUMULATED
15. 15. SUBORDINATED DEBTS
AMORTIZATION
16. FIXED ASSET 16. CAPITAL STOCK
17. LESS : ACCUMULATED DEPRECIATION 17. ADDITIONAL-PAID IN CAPITAL
18. DEFERRED TAX ASSETS 18. RETAINED EARNING FROM PREVIOUS YEAR
19. PREPAID EXPENSES 19. RETAINED EARNINGS
20. OTHER ASSETS 20. OTHER EQUITY
TOTAL ASSETS TOTAL LIABILITIES AND OWNER'S EQUITY

II. ELEMENTS FOM INCOME STATEMENT

NO. DESCRIPTION VALUE (IDR)


1. INTEREST INCOME
2. INTEREST EXPENSE
3. NET INTEREST INCOME (1 - 2)
4. OTHER OPERATING INCOME
5. OTHER OPERATING EXPENSES
6. INCOME FROM OPERATIONS(4 - 5)
7. NON-OPERATING INCOME
8. NON-OPERATING EXPENSE
9. NON-OPERATING INCOME-NET (7 - 8)
10. NET EARNINGS OF ASSOCIATES
11. INCOME BEFORE INCOME TAX (3 + 6 + 9 + 10)
12. INCOME TAX BENEFIT (EXPENSE)
13. GAIN (LOSS) FROM NORMAL ACTIVITIES (12 - 13)
14. EXTRAORDINARY ITEMS
15. INCOME BEFORE MINORITY INTEREST IN NET EARNINGS OF SUBSIDIARIES (13-14)
16. MINORITY INTEREST IN NET EARNINGS OF SUBSIDIARIES
17. NET PROFIT (15 - 16)

III. TRANSACTION ELEMENTS WITH RELATED PARTIES UNDER FINANCIAL ACCOUNTING STANDARD GUIDELINES (PSAK) NUMBER 7

NO. PARTIES TYPES OF TRANSACTION TRANSACTION VALUE (IDR)


DECLARATION

Understanding All The Sanctions Provided by The Law and Regulations, I Hereby Declare that The Information Stated in this Return, Including All
Attachments Provided, are True, Complete, Clear, and Under No Circumstances Whatsoever.

a.
……………………………………., (date) (month) (year)

(Place)

b. TAXPAYER AUTHORIZED/REPRESENTATIVE

c. FULL NAME OF MANAGEMENT/REPRESENTATIVE

(d. Signature and Company Seal)


SPECIAL ATTACHMENT 8A-4
SHARIA CORPORATE ANNUAL INCOME TAX RETURN TAXABLE YEAR
8A-4
BANKS TRANSCRIPT OF ELEMENTS CITATION
2 0
OF FINANCIAL STATEMENT

TIN :

TAXPAYER'S NAME :

I. ELEMENTS FROM BALANCE SHEET

NO. DESCRIPTION VALUE (IDR) NO. DESCRIPTION VALUE (IDR)


1. CASH AND CASH EQUIVALENT 1. OBLIGATION DUE IMMEDIATELY
2. PALCEMENTS AT CENTRAL BANK 2. DEPOSIT (WADIAH SAVING AND GIRO)
OTHER LIABILITY (SALAM LIABILITY AND ISTISHNA
3. GIRO AT OTEHRS BANK - NET 3.
LIABILITY)
4. PLACEMENT AT OTHER BANK - NET 4. LIABILITY TO OTHER BANK
5. SECURITIES 5. RECEIVED FINANCING
RECEIVABLES (MURABAHAH, SALAM ISTISHNA,
6. 6. UNDISTRIBUTED OF PROFIT ANNOUNCED
IJAROH, ETC)
7. MUDHARABAH FINANCING 7. ZAKAT PAYABLE
8. MUSYAROKAH FINANCING 8. TAX PAYABLE
9. INVENTORIES (ASSET FOR RESALES) 9. DFERRED TAX LIABILITIES
10. ASSETS ACQUIRED FOR IJARAH 10. OTHET PAYABLE

11. ISTISHNA ASSET IN COMPLETION 11. (MUDAROBAH DEPOSIT AND SAVING) NON BANK

12. INVESTMENT 12. (MUDHARABAH DEPOSIT AND SAVING) BANK

13. FIXED ASSET 13. CAPITAL STOCK


14. LESS : ACCUMULATED DEPRECIATION 14. ADDITIONAL PAID-IN CAPITAL
15. DEFERRED TAX ASSETS 15. PREVIOUS RETAINED EARNING
16. PREPAID EXPENSES 16. RETAINED EARNING FOR THIS YEAR
17. OTHER ASSETS 17. OTHER EQUITY
TOTAL ASSETS TOTAL LIABILITIES AND OWNER'S EQUITY

II. ELEMENTS FOM INCOME STATEMENT

NO. DESCRIPTION VALUE (IDR)


1. OPERATING AVENUE
2. RIGHT OF THIRD PARTIES ON THE UNRELATED INVESTMENT RETURN]
3. MAJOR OPERATIONS INCOME-NET(1 - 2)
4. OTHER OPERATING AVENUE
5. OTHER OPERATING EXPENSES
6. INCOME FROM OPERATIONS (3 + 4 - 5)
7. NON-OPERATING REVENUE
8. NON-OPERATING EXPENSES
9. NET EARNINGS OF ASSOCIATES
10. INCOME BEFORE INCOME TAX (6 + 7 - 8 + 9)
11. INCOME TAX BENEFIT (EXPENSE)
12. NET EARNINGS FROM NORMAL ACTIVITIES (10 - 11)
13. EXTRAORDINARY ITEMS
14. INCOME BEFORE MINORITY INTEREST IN NET EARNINGS OF SUBSIDIARIES (12-13)
15. MINORITY INTEREST IN NET EARNINGS OF SUBSIDIARIES
16. NET PROFIT (14 - 15)

III. TRANSACTION ELEMENTS WITH RELATED PARTIES UNDER FINANCIAL ACCOUNTING STANDARD GUIDELINES (PSAK) NUMBER 7

NO. PARTIES TYPES OF TRANSACTION TRANSACTION VALUE (IDR)

DECLARATION

Understanding All The Sanctions Provided by The Law and Regulations, I Hereby Declare that The Information Stated in this Return, Including All
Attachments Provided, are True, Complete, Clear, and Under No Circumstances Whatsoever.

a.
……………………………………., (date) (month) (year)
(Place)

b. TAXPAYER AUTHORIZED/REPRESENTATIVE

c. FULL NAME OF MANAGEMENT/REPRESENTATIVE

(d. Signature and Company Seal)


SPECIAL ATTACHMENT 8A-5
INSURANCE CORPORATE ANNUAL INCOME TAX RETURN TAXABLE YEAR
8A-5
COMPANY TRANSCRIPT OF ELEMENTS CITATION
2 0
OF FINANCIAL STATEMENT

TIN :

TAXPAYER'S NAME :

I. ELEMENTS FROM BALANCE SHEET

NO. URAIAN NILAI (RUPIAH) NO. URAIAN NILAI (RUPIAH)


1. INVESTMENTS-TIME DEPOSITS 1. OBLIGATION TO POLICYHOLDERS
2. INVESMENTS IN SHARES OF STOCK 2. OBLIGATION FOR FUTURE POLICY BENEFITS
3. INVESTMENTS-BONDS 3. ESTIMATED OWN RETENTION CLAIMS
4. INVESTMENTS-TRADING SECURITIES 4. CLAIMS PAYABLE
5. INVESTMENTS-DIRECT SHARE 5. UNEARNED PREMIUMS
6. INVESTMENTS-LAND AND BUILDING 6. TOTAL OBLIGATION TO POLICYHOLDER
7. INVESTMENTS-MORTGAGES POLICY LOAN 7. DEPOSIT PREMIUMS
8. INVESTMENTS-INSURANCE POLICY LOANS 8. COMMISION PAYABLES
9. OTHER INVESTMENTS 9. RE-INSURANCE PAYABLES
10. CASH ON HAND AND IN BANKS 10. ACCRUED EXPENSES
11. PREMIUM RECEIVABLES 11. TAXES PAYABLE
12. RE-INSURANCE RECEIVABLES 12. DEFERRED TAX LIABILITY
13. INVESTMENT RETURN RECEIVABLE 13. OTHER LIABILITIES
14. OTHER ACCOUNT RECEIVABLES 14. CAPITAL STOCK
15. PREPAID EXPENSES 15. ADDITIONAL PAID-IN CAPITAL
DIFFERENCE IN VALUE RESULTING FROM
16. DEFERRED TAX ASSET 16. RESTRUCTURING TRANSACTION WITH ENTITIES UNDER
COMMON CONTROL

17. FIXED ASSET 17. DIFFERENCE ON REVALUATION OF FIXED ASSET


NET UNREALIZED GAIN(LOSS) ON INCREASE
18. LESS : ACCUMULATED DEPRECIATION 18. (DECREASE) IN FAIR VALUE OF AVAILABLE FOR SALE
SECURITIES

19. DEFERRED ACQUISITION COST-NET 19. RETAINED EARNINGS


20. OTHER ASSETS 20. OTHER EQUITY
TOTAL ASSETS TOTAL LIABILITIES AND OWNER'S EQUITY

II. ELEMENTS FOM INCOME STATEMENT

NO. DESCRIPTION VALUE (IDR)


1. GROSS PREMIUMS
2. REINSURANCE PREMIUMS
3. DECREASE(INCREASE) IN UNEARNED PREMIUMS
4. TOTAL PREMIUMS INCOME (1 + 2 + 3)
5. NET INCOME FROM INVESTMENTS
6. OTHERS
7. TOTAL INCOME (4 + 5 + 6)
8. CLAIMS AND BENEFITS
9. RE-INSURANCE CLAIMS
10. INCREASE IN FUTURE POLICYHOLDER BENEFIT LIABILITIES AND ESTIMATED CLAIMS LIABILITIES
11. ACQUISITION COST
12. OPERATING EXPENSES
13. SELLING EXPENSES
14. GENERAL AND ADMINISTRATIVE EXPENSE
15. OTHER EXPENSES
16. TOTAL EXPENSES (TOTAL 8 TO 15)
17. INCOME FROM OPERATIONS (7-16)
18. NET EARNINGS OF ASSOCIATES
19. INCOME BEFORE INCOME TAX BENEFIT/(EXPENSE) (17 + 18)
20. INCOME TAX BENEFIT/(EXPENSE)
21. GAINS (LOSSES) FROM NORMAL ACTIVITIES (19 - 20)
22. EXTRAORDINARY ITEMS
23. INCOME BEFORE MINORITY INTEREST IN NET EARNINGS OF SUBSIDIARIES (21+22)
24. MINORITY INTEREST IN NET EARNINGS OF SUBSIDIARIES
25. NET PROFIT (23-24)

III. TRANSACTION ELEMENTS WITH RELATED PARTIES UNDER FINANCIAL ACCOUNTING STANDARD GUIDELINES (PSAK) NUMBER 7

NO. PARTIES TYPES OF TRANSACTION TRANSACTION VALUE (IDR)


DECLARATION

Understanding All The Sanctions Provided by The Law and Regulations, I Hereby Declare that The Information Stated in this Return, Including All
Attachments Provided, are True, Complete, Clear, and Under No Circumstances Whatsoever.

a.
……………………………………., (date) (month) (year)

(Place)

b. TAXPAYER AUTHORIZED/REPRESENTATIVE

c. FULL NAME OF MANAGEMENT/REPRESENTATIVE

(d. Signature and Company Seal)


SPECIAL ATTACHMENT 8A-6
NON- CORPORATE ANNUAL INCOME TAX RETURN TAXABLE YEAR
8A-6
QUALIFICATION TRANSCRIPT OF ELEMENTS CITATION
2 0
OF FINANCIAL STATEMENT

TIN :

TAXPAYER'S NAME :

I. ELEMENTS FROM BALANCE SHEET

NO. DESCRIPTION VALUE (IDR) NO. DESCRIPTION VALUE (IDR)


1. CASH AND EQUIVALENT 1. ACCOUNT PAYABLE - THIRD PARTIES

2. TEMPORARY INVESTMENT 2. ACCOUNT PAYABLE-RELATED PARTIES

3. ACCOUNT RECEIVABLE-THIRD PARTIES 3. INTEREST PAYABLE

4. ACCOUNT RECEIVABLE-RELATED PARTIES 4. INTEREST TAXES

5. ACCOUNT RECEIVABLE-THIRD PARTIES 5. DIVIDEND PAYABLE

6. OTHER RECEIVABLE WITH RELATED PARTIES 6. ACCRUED EXPENSES

7. ALLOWANCE FOR DOUBTFUL ACCOUNTS 7. BANK PAYABLES

8. INVENTORIES 8. LONG-TERM DEBITS-CURRENT MATURITIES

9. PREPAID EXPENSES 9. ADVANCES


10. PURCHASING DOWN PAYMENT 10. OTHER CURRENT-LIABILITIES
11. OTHER CURRENT ASSET 11. LONG-TERM DEBT-BANK LOANS
12. LONG - TERM RECEIVABLE 12. LONG-TERM DEBT-THIRD PARTIES

13. LAND AND BUILDING 13. LONG-TERM DEBT-RELATED PARTIES

14. OTHER FIXED ASSETS 14. DEFERRED TAX LIABILITIES


15. ACCUMULATED DEPRECIATION 15. OTHER NON-CURRENT LIABILITIES

16. INVESTMENT IN ASSOCIATION COMPANY 16. CAPITAL STOCK

17. OTHER LONG -TERM INVESTMENT 17. ADDITIONAL PAID-IN CAPITAL

18. INTANGIBLE ASSET 18. RETAINED EARNING FROM PREVIOUS YEAR

19. DEFERRED TAX ASSETS 19. RETAINED EARNING


20. OTHER NON-CURRENT ASSET 20. OTHER EQUITY
TOTAL ASSETS TOTAL LIABILITIES AND OWNER'S EQUITY

II. ELEMENTS FOM INCOME STATEMENT

NO. DESCRIPTION VALUE (IDR)


1. NET SALES
2. BEGINNING INVENTORY
3. PURCHASE
4. ENDING INVENTORY
5. COST OF GOOD SOLD (2 + 3 -4)
6. GROSS PROFIT (1 - 5)
7. SALES EXPENSE
8. GENERAL AND ADMINISTRATIVE EXPENSE
9. PROFIT (6 - 7 - 8)
10. INCOME/(EXPENSE) OTHER
11. NET EARNINGS FROM ASSOCIATES
12. INCOME BEFORE INCOME TAX (9 + 10 + 11)
13. INCOME TAX BENEFIT (EXPENSE)
14. GAIN (LOSS) FROM NORMAL ACTIVITIES (12 - 13)
15. EXTRAORDINARY ITEMS
16. GAIN/LOSS BEFORE MINORITY INTEREST (14 + 15)
17. MINORITY INTEREST IN NET EARNINGS OF SUBSIDIARIES
18. NET PROFIT (16 - 17)

III. TRANSACTION ELEMENTS WITH RELATED PARTIES UNDER FINANCIAL ACCOUNTING STANDARD GUIDELINES (PSAK) NUMBER 7

NO. PARTIES TYPES OF TRANSACTION TRANSACTION VALUE (IDR)

DECLARATION
Understanding All The Sanctions Provided by The Law and Regulations, I Hereby Declare that The Information Stated in this Return, Including All
Attachments Provided, are True, Complete, Clear, and Under No Circumstances Whatsoever.

a. 2 0
……………………………………., (date) (month) (year)

(Place)

b. TAXPAYER AUTHORIZED/REPRESENTATIVE

c. FULL NAME OF MANAGEMENT/REPRESENTATIVE

(d. Signature and Company Seal)


SURAT SETORAN PAJAK
KEMENTERIAN KEUANGAN R.I. LEMBAR 1
DIREKTORAT JENDERAL PAJAK (SSP)
Untuk Arsip Wajib Pajak

NPWP :
Diisi sesuai dengan Nomor Pokok Wajib Pajak yang dimiliki

NAMA WP : PT WEDANG MOJO

ALAMAT WP :
………….……………………...……………………………………….…………………………………………………………………………………………….

NOP :
Diisi sesuai dengan Nomor Objek Pajak

ALAMAT OP : ………….……………………...……………………………………….…………………………………………………………………………………………….
………….……………………...……………………………………….…………………………………………………………………………………………….

Uraian Pembayaran : PPh pasal 29 kurang bayar badan


Kode Akun Pajak Kode Jenis Setoran
2703396000

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

Masa Pajak
Tahun Pajak
Jan Feb Mar Apr Mei Jun Jul Ags Sep Okt Nov Des

Beri tanda silang (x) pada kolom bulan, sesuai dengan pembayaran untuk masa yang berkenaan Diisi Tahun terutangnya Pajak

Nomor Ketetapan : / / / /
Diisi sesuai Nomor Ketetapan : STP, SKPKB, SKPKBT

Jumlah Pembayaran : Diisi dengan rupiah penuh


Terbilang :
………………………………………………….…….……………...………………………………………………………………………………………………………………………………..
………………………………………………….…….……………...………………………………………………………………………………………………………………………………..

Diterima oleh Kantor Penerima Pembayaran Wajib Pajak/Penyetor


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 Penerima Pembayaran

F.2.0.32.01
[1] Apabila diaudit, diisi :
1 = Wajar Tanpa Pengecualian
2 = Wajar Dengan Pengecualian
3 = Tidak Wajar
4 = Tidak Ada Opini

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