INCOME FROM OPERATIONS 3 + 4 - 5 7. NON-OPERATING INCOME
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
8. NON-OPERATING EXPENSES 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. NET EARNINGS FROM NORMAL ACTIVITIES 11 - 12
14. EXTRAORDINARY ITEMS 15. INCOME BEFORE MINORITY INTEREST IN NET EARNIGS OF SUBSIDIARIES 13-14
16. MINORITY INTEREST IN NET EARNIGS OF SUBSIDIARIES 17. NET PROFIT 15 - 16
III. TRANSACTION WITH RELATED PARTIES UNDER FINANCIAL ACCOUNTING STANDARD GUIDELINES PSAK NUMBER 7 NO.
2 0
a.
….…………………………………,
Place
b. TAXPAYER
AUTHORIZEDREPRESENTATIVE c. FULL NAME OF MANAGEMENTREPRESENTATIVE
2
FOR CORPORATION PERMITTED TO MAINTAIN BOOKKEEPING IN ENGLISH LANGUAGE AND UNITED STATE DOLLAR CURRENCY
TRANSCRIPT OF ELEMENTS CITATION OF FINANCIAL STATEMENT
RETAINED EARNINGS FROM PREVIOUS YEARS
DEPOSITS FROM CUSTOMERS - THIRD PARTIES
DEPOSITS FROM CUSTOMERS - RELATED PARTIES
MARKETABLE SECURITIES SOLD UNDER REPURCHASE AGREEMENTS, NET OF
ALLOWANCE
ESTIMATED LOSSES ON COMMITMENTS AND CONTIGENCIES
TOTAL LIABILITIES AND OWNERS EQUITY DESCRIPTION
VALUE US DESCRIPTION
VALUE US
PLACEMENTS ON CENTRAL BANK - NET PLACEMENTS ON OTHER BANKS - NET
MARKETABLE SECURITIES - RELATED PARTIES MARKETABLE SECURITIES - THIRD PARTIES
MARKETABLE SECURITIES PURCHASED UNDER RESALE AGREEMENT, NET OF ALLOWANCE
CONSUMER FINANCING RECEIVABLES, NET OF ALLOWANCE
ADDITIONAL PAID - IN CAPITAL
d. Signature and Company Seal
PARTIES TYPES OF TRANSACTION
TRANSACTION VALUE US
DECLARATION
date month
year
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.
DESCRIPTION VALUE US
TIN
:
TAXPAYERS NAME
: I. ELEMENTS FROM BALANCE SHEET
NO. NO.
1. CASH AND EQUIVALENT 1. OBLIGATION DUE IMMEDIATELY
2. PLACEMENTS ON CENTRAL BANK 2.
3. GIRO ON OTHER BANKS - NET 3.
4. 4. LIABILITIY TO OTHER BANK
5. 5.
6. 6.
7. 7. ZAKAT PAYABLE
8. 8. TAX PAYABLE
9. INVENTORIES ASSET FOR RESALES 9. DEFERRED TAX LIABILITIES
10. ASSETS ACQUIRED FOR IJARAH 10. OTHER PAYABLE
11. ASSET OF ISTISHNA IN COMPLETION 11.
12. INVESTMENT 12.
13. FIXED ASSET 13. CAPITAL STOCK
14. LESS: ACCUMULATED DEPRECIATION 14.
15. DEFERRED TAX ASSETS 15.
16. PREPAID EXPENSES 16. RETAINED EARNING FOR THIS YEAR
17. OTHER ASSETS 17. OTHER EQUITY
TOTAL ASSETS II. ELEMENTS FROM INCOME STATEMENT
NO. 1. OPERATING REVENUE
2. RIGHT OF THIRD PARTIES ON THE UNRELATED INVESTMENT RETURN 3. MAJOR OPERATIONS INCOME - NET 1 - 2
4. OTHER OPERATING REVENUES 5. OTHER OPERATING EXPENSES
6. INCOME FROM OPERATIONS 3 + 4 - 5 7. NON-OPERATING REVENUE