TAXABLE YEAR

ATTACHMENT - II
FORM
2 0
1770 - II INDIVIDUAL ANNUAL INCOME TAX RETURN
to
LIST OF INCOME TAX WITHHELD BY OTHER PARTY, PAID/WITHHELD
MINISTRY OF FINANCE MM YY MM YY
IN FOREIGN COUNTRY AND BORNE BY THE GOVERNMENT
DIRECTORATE GENERAL OF TAXES DEEMED ACCOUNTING

ATTENTION
• FOLLOW INSTRUCTION IN THE MANUAL
• PRINT OR TYPE WITH CAPITAL LETTER OR BLACK INK
• MARK " X " IN THE APPROPRIATE BOX

TIN :

TAXPAYER'S NAME :

PART A : LIST OF INCOME TAX WITHHELD BY OTHER PARTIES, PAID/WITHHELD IN FOREIGN COUNTRY AND BORNE BY THE GOVERNMENT

WITHHOLDING TAX RECEIPT TYPE OF TAX : INCOME TAX

NAME OF WITHHOLDING TIN OF WITHHOLDING TOTAL OF INCOME TAX WITHHELD
NO ARTICLE 21/
AGENT AGENT (IDR)
22/23/24/26/DTP *)
NUMBER DATE
(1) (2) (3) (4) (5) (6) (7)

1.

2.

3.

4.

5.

6.

7.

8.

10.

11.

12.

13.

14.

15.
etc

TOTAL PART A TPA

Copy Total Part A Column 7 to Formulir 1770 line 15

*) - DTP = BORNE BY THE GOVERNMENT

- Fill column (6) with following options: 21/22/23/24/26/DTP (Example: 21, 22, 23, 24, 26, DTP)
- If there is a Tax Credit of Income Tax Article 24, the column should be filled with maximum creditable amount according to separate attachment
(Follow the Instruction Book related to Part A of Attachment II and Annual Tax Return line 4)

IF NEEDED, ADDITIONAL PAGES MAY BE ADDED Page - from pages of Attachment-II