This document is an annual corporate income tax return form for a taxpayer. It requests information about any transactions made by the taxpayer during the tax year with parties residing in a tax haven country. For each such transaction, the taxpayer is asked to provide the name of the transaction partner, type of transaction, country, and transaction value. The form states that the determination of a transaction's value will be based on the arms-length principle and ordinary business standard.

1. 3A-2
FOR TAXABLE YEAR
TIN:
TAXPAYER'S NAME :
I
No
a b c d e f g
a b c d e f g
a b c d e f g
a b c d e f g
a b c d e f g
II DETERMINATION OF TRANSACTION'S VALUE ABOVE , SHALL BE REFERRED TO THE TERM ARMS LENGTH AND ORDINARY BUSINESS PRINCIPLE
YES NO
……………………….., ………………………
TAXPAYER/AUTHORIZED REPRESENTATIVE
( ………………………… )
IF NEEDED, ADDITIONAL PAGES MAY BE ADDED
ANNUAL INCOME TAX RETURN FOR CORPORATE
STATEMENT OF TRANSACTION WITH PARTIES OF TAX HAVEN COUNTRY RESIDENT
5
4
3
2
1
IN CASE OF THE COMPANY HAS MADE TRANSACTIONS WITH PARTIES OF TAX HAVEN COUNTRY RESIDENT IN THIS TAXABLE YEAR
Name of Transaction Colleagues Types of Transaction Country Transaction Value
SPECIAL ATTACHMENT
RESET
IF THIS FORM INADEQUATE PLEASE USE A FILE
ADDITIONAL 3A-2 THAT HAS PROVIDED

2. 3A-2
TAHUN PAJAK
NPWP:
Nama :
I
No
a b c d e f g
a b c d e f g
a b c d e f g
a b c d e f g
a b c d e f g
II PENETAPAN NILAI TRANSAKSI DI ATAS, DITETAPKAN DENGAN MENGGUNAKAN PRINSIP KEWAJARAN DAN KELAZIMAN USAHA
Ya Tidak
……………………….., ………………………
WAJIB PAJAK / KUASA
( ………………………… )
JIKA FORMULIR INI TIDAK MENCUKUPI, DAPAT DIBUAT SENDIRI SESUAI DENGAN BENTUK INI
SPT TAHUNAN PAJAK PENGHASILAN WAJIB PAJAK BADAN
PERNYATAAN TRANSAKSI DENGAN PIHAK YANG MERUPAKAN PENDUDUK NEGARA TAX HAVEN COUNTRY
5
4
3
2
1
DALAM HAL WAJIB PAJAK DALAM TAHUN PAJAK INI MELAKUKAN TRANSAKSI DENGAN PIHAK-PIHAK YANG MERUPAKAN PENDUDUK NEGARA TAX HAVEN COUNTRY
Nama Mitra Transaksi Jenis Transaksi Negara Nilai Transaksi
LAMPIRAN KHUSUS
RESET
JIKA FORMULIR INI TIDAK MENCUKUPI SILAKAN GUNAKAN FILE
TAMBAHAN 3A-2 YANG TELAH DISEDIAKAN