TIN
:
TAXPAYERS NAME
: I. ELEMENT FROM BALANCE SHEET
NO. NO.
1. CASH AND EQUIVALENT 1. ACCOUNT PAYABLE -THIRD PARTIES
2. TEMPORARY INVESTMENTS 2.
3. ACCOUNT RECEIVABLE - THIRD PARTIES 3. INTEREST PAYABLE
4. 4. TAXES PAYABLE
5. OTHER RECEIVABLE - THIRD PARTIES 5. DIVIDEND PAYABLE
6. 6. ACCRUED EXPENSES
7. ALLOWANCE FOR DOUBTFUL ACCOUNTS 7. SHORT - TERM BANK LOANS
8. INVENTORIES 8.
9. PREPAID EXPENSES 9. ADVANCES
10. ADVANCES 10. OTHER CURRENT LIABILITIES
11. OTHER CURRENT ASSET 11. LONG - TERM DEBT - BANK LOANS
12. LONG - TERM RECEIVABLES 12.
13. LAND AND BUILDINGS 13.
14. OTHER FIXED ASSETS 14. DEFFERED TAX LIABILITIES
15. LESS: ACCUMULATED DEPRECIATION 15. OTHER LONG - TERM LIABILITIES
16. INVESTMENTS IN ASOCIATES 16. CAPITAL STOCK
17. OTHER LONG - TERM INVESTMENTS 17.
18. INTANGIBLE ASSETS 18.
19. DEFERRED TAX ASSET 19. RETAINED EARNINGS
20. OTHER NON - CURRENT ASSET 20. OTHER EQUITY
TOTAL ASSETS
II. ELEMENTS FROM INCOME STATEMENT
NO.
1. NET SALES 2. PURCHASE
3. MERCHANDISE INVENTORY- BEGINNING 4. MERCHANDISE INVENTORY- ENDING
5. COST OF GOOD SOLD 2 + 3 - 4 6. GROSS PROFIT 1 - 5
7. SALES EXPENSE 8. GENERAL AND ADMINISTRATIVE EXPENSES
9. PROFIT 6 - 7 - 8 10. INCOMEEXPENSE OTHER
11. NET EARNINGS OF ASSOCIATES 12. INCOME BEFORE INCOME TAX 9 + 10 + 11
13. INCOME TAX BENEFIT EXPENSE 14. NET EARNINGS FROM NORMAL ACTIVITIES 12 - 13
15. EXTRAORDINARY ITEMS 16. GAINLOSS BEFORE MINORITY INTEREST 14 + 15
17. MINORITY INTEREST IN NET EARNIGS OF SUBSIDIARIES 18. NET PROFIT 16 - 17
III. TRANSACTION WITH RELATED PARTIES UNDER FINANCIAL ACCOUNTING STANDARD GUIDELINES PSAK NUMBER 7 NO.
a.
….…………………………………, 2
Place
b.
TAXPAYER AUTHORIZEDREPRESENTATIVE
c.
FULL NAME OF MANAGEMENTREPRESENTATIVE
2
ACCOUNT PAYABLE - RELATED PARTIES
LONG - TERM DEBTS-CURRENT MATURITIES
LONG - TERM DEBT - THIRD PARTIES LONG -TERM DEBT - RELATED PARTIES
RETAINED EARNINGS FROM PREVIOUS YEARS
TOTAL LIABILITIES AND OWNERS EQUITY ADDITIONAL PAID-IN CAPITAL
DESCRIPTION VALUE US
ACCOUNT RECEIVABLE - RELATED PARTIES OTHER RECEIVABLE - RELATED PARTIES
DESCRIPTION VALUE US
DESCRIPTION VALUE US
FOR CORPORATION PERMITTED TO MAINTAIN BOOKKEEPING IN ENGLISH LANGUAGE AND UNITED STATE DOLLAR CURRENCY
TRANSCRIPT OF ELEMENTS CITATION OF FINANCIAL STATEMENT
TYPES OF TRANSACTION TRANSACTION VALUE US
DECLARATION
d. Signature and Company Seal date
month year
PARTIES
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.
TAXABLE YEAR
TIN
:
TAXPAYERS NAME
: I. ELEMENTS FROM BALANCE SHEET
NO. NO.
1. CASH 1. OBLIGATION DUE IMMEDIATELY
2. GIRO AT CENTRAL BANK 2.
3. GIRO AT OTHER BANK - NET 3.
4. 4. DEPOSITS FROM OTHER BANKS
5. 5.
6. 6. DERIVATIVE PAYABLES
7. 7. ACCEPTANCE PAYABLES
8. 8. TAXES PAYABLE
9. DERIVATIVE RECEIVABLES, NET OF ALLOWANCE 9. MARKETABLE SECURITIES ISSUED
10. LOANS, NET OF ALLOWANCE 10. LOAN RECEIVED
11. 11.
12. ACCEPTANCE RECEIVABLES, NET OF ALLOWANCE 12. DEFFERED TAX LIABILITIES
13. GOVERNMENT BONDS 13. ACCRUALS LIABILITIES
14. INVESTMENTS, NET OF ALLOWANCE 14. OTHER LIABILITIES
15. GOODWILL - NET OF ACCUMULATED AMORTIZATION 15. SUBORDINATED DEBTS
16. FIXED ASSET 16. CAPITAL STOCK
17. LESS: ACCUMULATED DEPRECIATION 17.
18. DEFFERED TAX ASSET 18.
19. PREPAID EXPENSES 19. RETAINED EARNINGS
20. OTHER ASSETS 20. OTHER EQUITY
TOTAL ASSETS II. ELEMENTS FROM INCOME STATEMENT
NO. 1. INTEREST INCOME
2. INTEREST EXPENSE 3. NET INTEREST INCOME 1 - 2
4. OTHER OPERATING INCOME 5. OTHER OPERATING EXPENSES
6. INCOME FROM OPERATIONS 3 + 4 - 5 7. NON-OPERATING INCOME
