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Form PBK1

FORM PBK

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Shifyatuz Zaini
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21 views2 pages

Form PBK1

FORM PBK

Uploaded by

Shifyatuz Zaini
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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No : ……………………………………………………………………. ……………………………………………….

Lampiran : …………………………………………………………………….
Hal : Permohonan Pemindahbukuan
Yth. Direktur Jendral Pajak
u.b. Kepala KPP Pratama Kisaran ……………………………………………

Yang bertanda tangan di bawah ini :


Nama : …………………………………………………………………………………………………………………………………….
NPWP : …………………………………………………………………………………………………………………………………….
Alamat : …………………………………………………………………………………………………………………………………….
Nomor Telepon : …………………………………………………………………………………………………………………………………….
Bertindak selaku : Penyetor/Wajib pajak
Pemungut Pajak

Menyatakan telah melakukan pembayaran atau penyetoran pajak sebagai berikut :


Nama : …………………………………………………………………………………………………………………………………….
NPWP : …………………………………………………………………………………………………………………………………….
Alamat : …………………………………………………………………………………………………………………………………….
Jenis Pajak : …………………………………………………………………………………………………………………………………….
Masa/Tahun Pajak : …………………………………………………………………………………………………………………………………….
Nomor Ketetapan
Keputusan/Putusan : …………………………………………………………………………………………………………………………………….
Nomor Objek Pajak : …………………………………………………………………………………………………………………………………….
Jumlah Bayar/Setor : …………………………………………………………………………………………………………………………………….

Terhadap pembayaran atau penyetoran tersebut, saya mengajukan permohonan pemindahbukuan kepada :
Nama : …………………………………………………………………………………………………….………………….
NPWP : …………………………………………………………………………………………………….………………….
Alamat : …………………………………………………………………………………………………….………………….
Jenis Pajak : …………………………………………………………………………………………………….………………….
Masa/Tahun Pajak : …………………………………………………………………………………………………….………………….
Nomor Ketetapan
Keputusan/Putusan : …………………………………………………………………………………………………….………………….
Nomor Objek Pajak : …………………………………………………………………………………………………….………………….
Jumlah yang dimohonkan
Pemindahbukuan : …………………………………………………………………………………………………….………………….

Adapun permohonan pemindahbukuan dimaksud sebagai akibat adanya ………………………………………………………….


…………………………………………………………………………………………………………………………………………………………………………….
Demikian surat permohonan saya sampaikan untuk dapat dipertimbangkan.

Penyetor /Wajib pajak

SUSI
Keterangan
1. Beri tanda X pada yang sesuai.
2. Dalam surat permohonan ditandatangani oleh kuasa harus dilampiri surat kuasa khusus.

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