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7/26/2019 Form Permintaan No FP

1/1

Lampiran IVDPeraturan Direktur Jenderal PajakNomor : PER - 24/PJ/2012an!!al : 22 No"em#er 2012

Nomor : $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$%$$$$$$$$$$$$$$$$$$$$$$$$$&al : Permintaan Nomor 'eri (aktur Pajak

)t*$ +epala +antor Pela,anan Pajak$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$

Den!an ini% a,a:

Nama : $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$

Ja#atan : $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$

Nama P+P : $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$

NP.P : $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$lamat : $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$

Pen,ampaian 'P : e-'P/e-(illin! manual/hardcopy

en!ajukan permo*onan Permintaan Nomor 'eri (aktur Pajak #erdaarkan Peraturan Direktur Jenderal Pajak

Nomor PER-$$$$$$/PJ/2012 e#an,ak $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ Nomor 'eri (aktur Pajak$

3erama ini kami ampaikan data pen,ampaian 'P aa PPN untuk ti!a #ulan terak*ir #erturut-turut ,an!tela* jatu* tempo pada tan!!al permintaan ini diajukan #erikut jumla* pener#itan (aktur Pajakn,a$

No aa Pajak Jumla* Pener#itan (aktur Pajak

12

Demikian diampaikan% ata per*atian 'audara kami u5apkan terima kai*$

Pemo*on

$$$$$$$$$$$$$$$$$$

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