LampiranIPeraturan DirekturJenderal PajakNemer. PER- 6 1 IPJ1200gTanggal: 5 Nov 2009

TATA CARA PENERAPANPERSETUJUAN PENGHINDARAN PAJAK BERGANDA

A. Ketentuan bagi Pemotong/Pemungut Pajak dan Kustodian

1. Pemolong/Pemungul Pajak melakukan pemolongan atau pemungulan pajak alas seliappenghasilan yang dilerima alau diperoleh WPLN sesuai dengan kelenluan yang dialur dalamUndang-Undang Nomor 7 Tahun 1983 lenlang Pajak Penghasilan sebagaimana le lah beberapakali diubah lerakhir dengan Undang-Undang Nomor 36 Tahun 2008 (UU PPh).

2. Pemolong/Pemungul Pajak

3. Pemolong/Pemungul Pajak wajib membual bukli pemolongan/pemungulan pajak sesuai dengankelentuan yang berlaku. Bukli pemolongan/pemungulan pajak wajib disampaikan kepada WPLN.

4. Sekalipun lidak lerdapal pajak yang dipolong alau dipungul , Pemolong/Pemungul Pajak tetapwajib membual bukli pemolong an/pemungulan pajak dengan mencanlumkan besarnyapenghasilan brulo, dan mencanlumkan " NIHIL" pada kolom jumlah PPh yang dipolong/dipungul,bukti pemolongan/pemungulan pajak dimaksud lidak wajib disampaikan kepada WPLN.

5. Penelilian alas SKD (Formulir pada Lampiran II) unluk memaslikan bahwa penerima penghasilanbukan Subjek Pajak dalam negeri Indonesia harus dilakukan oleh Pemolong/Pemungul Pajak.Dalam hal penerima penghasilan adalah Subiek Pajak dalam negeri Pemolong/Pemungul Pajakwajib memolong atau memungul pajak yang lerulang sesuai dengan kelenluan yang diatur dalamUU PPh. Keberadaan Subjek Pajak dalam negeri dilenlukan dalam hal SKD:

a. dalam Part IV butir 4 lercanlum alamal WPLN di Indonesia; alau

b. dalam Part IV bulir 5 lercanlum bahwa WPLN mempunyai lempal Iinggal lelap di Indonesia;alau

c. dalam Part IV bulir 6 lercanlum lempal kediaman WPLN di Indonesia; alau

d. dalam Part V buli r 1, 2, dan 3 mencanlumkan lempal pendirian, lempal kedudukan, alaualamal kantor pusal WPLN di Indonesia.

6. Dalam hal persyaralan administralif lidak dapal dipenuhi oleh WPLN, Pemolong/Pemungul Pajaklidak dlperkenankan menerapkan kelenluan yang dialur dalam P3B dan wajib memolong alaumemungul pajak yang lerulang sesuai dengan kelenluan yang diatur dalam UU PPh.

7. Unluk dapal menerapkan P3B kepada WPLN, Pemolong/Pemungul Pajak melakukan prosedurpenelitian apakah SKD mencanlumkan jawaban:

a. "No" dalam Bulir 3 Part IV; atau

b. "Yes" dalam Bulir 6 Part V; alau

c. "Yes" unluk seluruh pertanyaan dalam Bulir 7 sampai dengan butir 13 Pada Part V.

P3B lidak dilerapkan dalam hal salah salu jawaban WPLN penerima penghasilan lidak sesuaidengan huruf a, b, alau c di alas.

8. Dalam hal WPLN penerima penghasilan adalah lembaga yang namanya disebulkan secara legasdalam P3B alau yang lelah disepakali oleh pejabal yang berwenang di Indonesia dan di negaramilra P3B, Pemolong/Pemungul Pajak menerapkan kelenluan yang dlatur dalam P3B lanpamemerlukan SKD.

9. Pemolong/Pemungul Pajak wajib menyampaikan SPT Masa dengan dilampiri folokopi SKD danbukli pemolongan/pemungulan pajak ke Kanlor Pelayanan Pajak.

10. Unluk pemolongan alau pemungulan pajak alas penghasilan dari Iransaksi pengalihan sahamalau obligasi yang diperdagangkan alau dilaporkan di bursa efek di Indonesia, selain bunga dandividen, yang dilerima alau diperoleh WPLN melalui Kuslodian:

a. Fonmulir SKD sebagaimana lerdapal pada Lampiran III harus diisi dengan lengkap dandilandalangani olen WPLN penerima penghasilan serta disahkan oleh pejabal yangberwenang di negara rnt tra P3B;

b. SKD asli diserahkan kepada Kuslodian oleh WPLN penerima penghasilan;

c. Kuslodian wajib menyerahkan SKD asli yang masih berlaku yang dilerima dari WPLN kepadaPemolong/Pemungul Pajak;

d. Dalam hal WPLN penerima penghasilan menerima penghasilan dari beberapa sumber,Kuslodian dapat membual folokopi SKD dan meminla legalisasi kepada Kepala KanlorPelayanan Pajak lempal Kuslodian lerdaftar sebagai Wajib Pajak;

e. Kepala Kanlor Pelayanan Pajak yang melegalisasi folokopi SKD wajib menyimpan SKD asli;

f. Pemotong/Pemungut Pajak wajib melakukan pemotongan atau pemungutan pajak sesuaidengan ketentuan yang diatur dalam P3B dengan mengacu kepada SKD asli yang masihberlaku atau fotokopi SKD yang telah dilegalisasi yang disampaikan oleh Kustodian danmenyimpan fotokopi SKD;

g. Pemotong/Pemungut Pajak wajib membual tanda bukti pemotongan/pemungutan pajak sertawajib menyerahkannya kepada WPLN melalui Kustodian.

11. Untuk pemotongan atau pemungutan pajak atas penghasilan yang diterima atau diperoleh WPLNbank:

a. Formulir SKD sebagaimana terdapat pada Lampiran III harus diisi dengan lengkap danditandatangani oleh WPLN bank serta disahkan oleh pejabat yang berwenang di negara mitraP3B;dan

b. SKD asli diserahkan kepada Pemotong/Pemungut Pajak.

12. SKD wajib disimpan oleh Pemotong/Pemungut Pajak selama 10 (sepuluh) tahun berdasarkanketenluan Pasal 28 ayat (11) Undang-Undang Nomor 6 Tahun 1983 tentang Kelenluan Umumdan Tata Cara Perpajakan sebagaimana telah beberapa kali diubah lerakhir dengan Undang­Undang Nomor 28 Tahun 2007.

B. Pengadministrasian SKD oleh Kantor Pelayanan Pajak

1. Pada saat penerimaan SPT petugas yang menerima SPT wajib meneliti kelengkapan SPT MasaPemotong/Pemungut Pajak , yang sekurang-kurangnya dilampiri dengan buktipemotongan/pemungutan pajak dan fotokopi SKD.

2. Penelitian kebenaran pelaporan atas jumlah pajak yang dipotong atau dipungut denganmencocokkan fotokopi SKD dengan nama WPLN yang tercantum dalam buktipemotongan/pemungutan pajak, dilakukan oleh Kepala Kantor Pelayanan Pajak c.q. Kepala SeksiPengawasan dan Konsultasi.

3. Dalam hal Pemotong/Pemungut Pajak belum melaksanakan kewajibannya sesuai denganketentuan yang diatur dalam Peraturan Direktur Jenderal Pajak ini, Kepala Kantor PelayananPajak mengirimkan Surat Himbauan sesuai dengan ketentuan yang berlaku.

4. Dalam hal inforrnasi yang terdapat dalam SKD mengindikasikan keberadaan bentuk usaha tetapdari WPLN di Indonesia, Kantor Pelayanan Pajak mengirimkan informasi tersebut ke KantorPelayanan Pajak yang berwenang untuk diteliti keberadaannya atau dibuatkan Surat Himbauansesuai dengan ketentuan yang berlaku.

5. Perekaman SKD dan bukti pemotongan/pemungutan yang dilaporkan oleh Pemotong/PemungutPajak dilaksanakan oleh Seksi Pengolahan Data Informasi.

MINISTRY OF FINANCE OF THE REPUBLIC OFINDONESIADIRECTORATE GENERAL OFTAXES

Lampiran IIPerat uran Direktu r Jendera l PajakNomor: PER· 6 1 1PJ/200gTanggal: 5 Nov 2009

CERTIFICATE OF DOMICILE OF NON RESIDENTFOR INDONESIA TAX WITHHOLDING (FORM - DGT 1)

Guidance:

This form is to be compieted by a person (which includesa body of person, corporate or non corporate):

who is a resident of a coun try which has concluded a Double Taxation Convention (OTC) with Indonesia; and

• who claims relief from Indonesia Income Tax in respect of the following income earned in Indonesia (dividend. interest,royalties , income from rendering services, and other income ) subject to withholding tax in Indonesia.

00 not use this form for:

a banki ng institu tion, or

a person who claims relief from Indonesia Income Tax in respect of income arises from the transfer of bonds or stockswhich traded or registered in Indonesia stock exchange and earned the income or settled the transaction through aCustodian in Indonesia, other than interest and dividend .

All particulars in the fonn are to be properly furnished, and the form shall be signed as completed, This form must be certifiedby the Competent Authority or his au thori zed represent ati ve in the cou ntry whe re th e in com e recipient is a taxpayer res identbefore submitted to Indonesia withho lding agent.

Please note that this subm itted form must bear the or ig inal endorsement o f the Co m pe ten t Authority.

INAME OF THE COUNTRY OF INCOME RECIPIENT (I) IINCOME RECIPIENT: INDONESIA WITHHOLDING AGENT:

Tax JD Number _ __________ (2) Tax 10 Number _ _ _ _ _ _ _ _ _ _ (5)

Name , (3) Name _ _ _ _ _ _ _ ___ (6)

Address , (4) Address ___ _ ____ __ {7}

DECLARATION BY THE INCOME RECIPIENT:

I, (full name) (8) hereby declare that I have examined theinfonnation provided in this form and to the best of my knowledge and belief it is true, correct, and complete, 1 furtherdeclare that 0 I am 0 this company is not an Indonesia resident taxpayer. (Please check the box accordingly)

===== = = = = = ,(9)Signatureof the income recipient or individualauthorized tosign for the income recipient

_'_'_(ID}Date(mmldd/yy)

(I I)"ea-pacrty---"'·:-O-in-wh'CC'ich:-a-cti""ng'

(12)- -cCoo;;-:-Iact-:-:CN:-um-cbe:-r

CERTIFICATION BY COMPETENT AUTHORITY OF THE COUNTRY OF RESIDENCE:

For the purpose of tax relief concerning Ihe types of income mentioned in Part V, it is hereby confinned that thetaxpayer mention ed in Part I is a resident in (13) {name of the state] with in the meaning of theDouble Taxation Convention in accordance with Doub le Taxation Convention concluded between Indonesia and_ _ _ _______,(14) [name of the state of residence).

Date (mm'dd'yyyy): -1_'__(17)

Office address:______ _ _ _ _ _ _ _ _ ,(18)

OfficialStamp /(if any) /

.--/

Capacity/designallon ofsignatory__=====..."..,== _ (16)

=====::-::;=====~(l5}Name and Signature of !he Competent Authorityorhis authorized representative

This form is available and rna be downloaded at this website: htt

Part IV TO BE COMPLETED IF THE INCOME RECIPIENT IS AN INDIVIDUAL

1. Name of Income Recipient: (19)

2. Date of birth (mmlddlyyyy) : -1-1__ (20) / 3. Are you acting as an agent or a nominee? 0 Yes 0 No ' (21)

4. Full address: _

_________________________________---'(22)

5. Do you have permanent home in Indonesia? 0 Yes 0 No') (23)

6. In what country do you ordinarily reside? "- (24)

7. Have you ever been resided in Indonesia? 0 Yes 0 No') If so, in what period? -1_'__ to _ '-1__(25)

(26)

Please provide the address _

8. Do you have any office, or other place of business in Indonesia? 0 Yes 0 No '

If so, please provide the address

Part V TO BE COMPLETED IF THE INCOME RECIPIENT IS NON INDIVIDUAL

1. Country of registrationJincorporation: (27)

2. Which country does the place of management or control reside? (28)

3. Address of Head Office: (29)

4. Address of branches, offices, or other place of business in Indonesia (if any): ,(30)

5. Nature of business (i.e. Pension Fund, Insurance, Headquarters, Financing) (31)

o Yes o No'

o Yes o No'

o Yes o No'

o Yes o No'

o Yes o No'

(36)10. The company engages in active conduct of a trade or business.

11 . The earned income is SUbject to lax in your country. (37)

12. No more lhan 50 per cent of the company's income is used to satisfy claims by other persons(i.e. interest, royalties, other fees) (38)

6. The company is listed in stock market and the shares are regularly traded. 0 Yes 0 No ')

If yes, please provide the name of the stock market: (32)

7. The creation of the entity and/or the transaction structure is not motivated by reasons to take 0 Yes 0 No'advantage of benefit of the DTC. (33)

8. The company has its own managemenl to conduct the business and such management has anindependent discretion. (34)

9. The company employs sufficient qualified personnel. (35)

INCOME EARNED FROM INDONESIA IN RESPECT TO WHICH RELIEF IS CLAIM ED

This form is available and may be downloaded at this website: htto:llwNw.paiak.go.ld

*} Please check the appropriate box This form must be endorsed by the Compe tent Authorities:

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/ OffICial '\{ Stamp j\ (il any) j\,»<.:»:/

INSTRUCTIONSFOR CERTIFICATE OF DOMICILE OF NON RESIDENTFOR INDONESIA TAX WITHHOLDING (FORM - DGT 1)

Number 1:Please fill in the name of the country of income recipient.

Part I Information of Income Recipient:

Number 2:Please fill in the income recipient's taxpayer ldentificationnumber in country where the claimant is registered as a residenttaxpayer.

Number 3:Please fill in the income recipient's name.

Number 4:Please fill in the income recipient's address.

Number 5:Please fill in the Indonesia withholding agent's taxpayeridentification number.

Number 6:Please fill in the Indonesia withholding agent's name.

Number 7:Please fill in the Indonesia withholding agent's address.

Part II Declaration by the Income Recipient:

Number 8:In case the income recipient is not an individual this form shallbe filled by the management of the income recipient. Please fillin the name of person authorized to sign on behalf the incomerecipient. If the income recipient is an individual, ptease fill in thename as stated in Number 3.

Number 9:The income recipient or his representative (for non individual)shall sign this fonn.

Number 10:Please fill in the place and date of signing.

Numb er 11:Please fill in the capacity of the claimant or his representativewho signs this form.

Number 12:Please fill in the contact number of person who signs this form.

Part III Certification by Competent Authority of th e Countryof Residence:

Number 13 and 14:Please fill in the name of country where the income recipient isregistered as a resident taxpayer.

Number 15 and 16The Competent Authorities or his authorized representativeshould certify this fonn by signing it. The position of the signorshoutd be filled in Number 16. .

Number 17:Please fill in the date when the fonn is signed by the CompetentAuthorities or his authorized representative.

Number 18:Please fill in the office address of the Competent Authority orauthorized representative.

Part IV to be completed if the Income Recipient is anIndividual:

Number 19:Ptease fill in the income recipient's full name.

Number 20:Please fill in the income recipient's date of birth.

Number 21:Please check the appropriate box. You are acting as an agent ifyou act as an intermediary or act for and on beha lf of other partyin relation with the income source in Indonesia. You are adi ng

as a nominee if you are the legal owner of income or of assetsthat the income is generated and you are not the real owner ofthe income or assets.

Number 22:Please fill in the income recipient's address.

Number 23:Please check the appropriate box. If your pennanent home is inIndonesia, you are considered as Indonesian resident taxpayeraccording to the Income Tax Law and if you receive income fromIndonesia, the Double Tax Conventions shall not be applied.

Number 24:Please fill the name of country where you ordinarily reside.

Numb er 25:Please check the appropriate box. In case you have ever beenresided in Indonesia, please fill the period of your stay andaddress where you are resided .

Numb er 26:Please check the appropriate box. In case you have any offices,or other place of business in Indonesia, please fill in the addressof the offices, or other place of business in Indonesia.

Part V To be Completed if the Income Recipient is nonIndividual:

Number 27:Please fill in the country where the entity is registered orincorporated.

Numb er 28:Please fill in the country where the entity is controlled or whereits management is situated.

Number 29:Please fill in Ihe address of the entity's Head Office.

Number 30:Please fill in the address of any branches, offices, or other placeof business of the entity situated in Indonesia.

Numb er 31:Please fill in the nature of business of the claimant.

Number 32·38:Please check the appropriate box in accordance with theclaimant's facts and circumstances.

Part VI for Income Earned from Indonesia in Respect towhich relief is claimed :

Numb er 39:Please fill in the type of income (e.g. dividend, interest, orroyalties).

Number40:Please fill in the amount of Income liable to withholding taxunder Indonesian Law.

Number41 :Please fill in the type of income from rendering services(including professional).

Number 42:Please fill in the amount of income liable to withholding taxunder Indonesian Law.

Numbcr43:In case your income is arising from rendering service, please fillin the periode when the service is provided.

Number 44:Please fill in the other type of income.

Number 45:Please fill in the amount of Income liable to withholding taxunder Indonesian Law.

MINISTRY OF FINANCE OF THE REPUBLIC OF INDONESIADIRECTORATE GENERAL OF TAXES

Lampiran 111Peraturan Direktur Jenderal PajakNomor: PER· 6 1 /PJ12009Tanggal: 5 Nov 2009

CERTIFICATE OF DOMICILE OF NON RESIDENTFOR INDONESIA TAX WITHHOLDING (FORM - DGT 2)

Guidance :

This form is to be completed by a person (which includes a body of person, corporate or non corporate) who is a resident of acountry which has concluded Double Taxation Convention (DTC) with Indonesia, who:

• is a bank ing institution, or

claims relief from Indonesia Income Tax in respect of income arises from the transfer of bonds or stocks wh ich traded orregistered in Indonesia stock exchange and earn ed the income or sett led the tran saction through a Custodian in Indonesia,other than interest and dividend .

All particulars in the form are to be property furnished and the fonn shall be signed as completed . This fonn must be certifiedby the Competent Autho rity or his authorized representative in the country where the income recipient is a resident beforesubmited the Certificate to a Custodian,

Name of th e Country of In come Rec ipient: ( I)

Name of the Inco me Recipient

Tax 10 number

Address

_ ____ _ _ _ _ _ _ _ _ _ ____ ____ (2)

_ _____ ____ _ _ ___ _ ____ _ ___ _ (3)

___ _________ _ _ _ _______ (4)

DECLARATION BY THE INCOME RECIPIENT:

1. I declare that I am a resident of (:5) [name of the state of residence! fo r income tax purposeswithin the meani ng of Doub le Taxatio n Convention of both countries ;

2 . In relation wi th the earned income, 0 I am 0 th is com pany is not acting as an agent or a nominee; (Please check thebox accordingly)

3 . The beneficial owner is not an Indonesian resident taxpayer and 0 I am 0 th is company is not an Indonesianresident taxpayer; and (Please Check the box accordingly)

4 . I have examined the information stated on this fonn and 10 the best of my knowledge and belief it is tru e, correct,and complete;

______ _ __--,(6)

Signatureofthe incomerecipient orindiVidual authorizedto sign for the income

_'_1__ (7)Date (mmlddlyy)

;;- ~__(8)

Capacity inwhichacting_;;c-:;-~-:;:-~(9)

Contact Number

CERTIFICATION BY COMPETENT AUTHORITY OF THE COUNTRY OF RESIDENCE:

For the purpose of tax relief, it is hereby confinn ed that the taxpayer me ntio ned in Part I is a resident in

-".,--::-...,-,.,--::---,,----=-( IO).[name of the state! within the meaning of the Double Ta xation Co nvention in accordancewi th Double Taxation Co nvention concl uded between Indonesia and (I I) [name of the state of

residence!.

Date (mmldd'yyyy): _,_,_ _ (14)

7.'"'-~c--r--:---.,.,,---,c-__..,..,...,,..,(12)Name and SignatureoftheCompetent Authonty

orhisauthorized representative

Capacity/designalOO ofsignatory

'.

( OffICial Stamp .\

\ (danY

) ,./

\ .,..~ ~.../................... Offi ce address:

_ _ _ _ ________ __ ( 15)

TIlis tam isavailable andmay be downloadedat website: hffo:llwww. oajak.qo.id

This certificate is valid(or 12 (twelve) months commencing from ttle dareof certIfiCation by the Competent Authonty or his authOrized representative .

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INSTRUCTIONSFOR CERTIFICATE OF DOMICILE OF NON RESIDENT

FOR INDONESIA TAX WITHHOLDING (FORM - DGT 2)

Number 1:Please fill in the name of the country of income recipient.

Numb er 2:Please fill in the name of the income recipient.

Number 3:Please fill in the income recipient's taxpayer identificationnumber in country where the income recipient is registered as aresident taxpayer.

Number 4:Please fill in the income recipient's address.

Numb er 5:This form shall be filled by the management of the claimant.Please fill in the name of country where income recipient isregistered as a resident taxpayer.

Number 6:The claimant or his representative (for non individual) shall signthis form.

Numb er 7:Please fill in the place and date of signing.

Number 8:Please fill in the capacity of the claimant or his representativewho signs thisform.

Number 9:Please fill in the contact number of person who signs this form.

Number 10 and 11:Please fill in the name of country where the claimant isregistered as a resident taxpayer.

Number 12 and 13The Competent Authorities or his authorized representativeshould certify this form by signing it. The position of the signorshould be filled in Number 13.

Number 14:Please fill in the date when the form is signed by the CompetentAuthorities or his authorized representative.

Number 15:Please fill in the office address of the Competent Authority orauthorized representative.