This document appears to be part of an individual annual income tax return form for a taxpayer applying deemed accounting in Indonesia. It includes sections to report: 1. Domestic net income from business and/or self-employment using deemed percentages of gross income. This is to be copied to line 1 of Form 1770. 2. Domestic net income in respect of employment and other domestic income, with totals to be copied to lines 2 and 3 of Form 1770 respectively. 3. Other domestic net income such as rent, gratuities and prizes, gains from property sales, and royalties, with a total for this section. The taxpayer's name, tax ID number and

1.  to

 DEEMED ACCOUNTING
ATTENTION:
• • PRINT OR TYPE WITH CAPITAL LETTER OF BLACK INK
•
T I N :
TAXPAYER'S NAME :
PART B:
Copy Total Part B column (5) to Form 1770 line 1
PART C: DOMESTIC NET INCOME OF EMPLOYMENT
(NOT INCLUDING INCOME SUBJECT TO FINAL INCOME TAX)
PART D : OTHER DOMESTIC NET INCOME
(NOT INCLUDING INCOME SUBJECT TO FINALIZED INCOMETAX)
RENT
Copy Total Part D to Form 1770 line 3
Copy Total Part C Column (5) to Form 1770 line 2
(IDR)
(5)(4)(3)
TPD
(IDR)
GRATIFICATIONS AND PRIZES
GAIN FROM THE SALE/TRANSFER OF PROPERTY
TOTAL PART D
(2)
4.
TPC
NAME AND TIN EMPLOYER
(IDR)
2.
GROSS INCOME
DEDUCTION GROSS INCOME/
COST
NET INCOME
(3)
TOTAL NET INCOME
(IDR)
(2)
TPB
NO.
DEEMED
(%)
1. INTEREST
OTHERS
(1) (4)
TRADING
SELF-EMPLOYMENT
(3)
3.
4.
1.
2.
NET INCOME
(IDR)
TYPES OF BUSINESS
YY
(5)
TAXABLEYEAR
2 0
(2)
INDIVIDUAL ANNUAL INCOME TAX RETURN
6.
NO.
1.
2.
3.
4.
5.
TOTAL PART C
TYPES OF INCOME
PAGE 2
1770 - I
FORM
DOMESTIC NET INCOME FROM BUSINESS AND/OR SELF-EMPLOYMENT
(FOR TAXPAYER APPLYING DEEMED NET INCOME)
CALCULATION OF DOMESTIC NET INCOME FOR TAXPAYER
APPLYING DEEMED NET INCOME
MARK " X " IN THE APPROPRIATE BOX
MMMM
ATTACHMENT - I
YY
INDUSTRY
SERVICE
MINISTRY OF FINANCE
DIRECTORATE GENERAL OF TAXES
NO.
(1)
IF NEEDED, ADDITIONAL PAGES MAY BE ADDED
ROYALTIES
6. OTHER INCOME
5.
3.
(1)
FOLLOW INSTRUCTION IN THE MANUAL
DOMESTIC NET INCOME IN RESPECT OF EMPLOYMENT
OTHER DOMESTIC INCOME
TOTAL PART B
5.
GROSS INCOME
(IDR)