[Form Form 37] (page1)
Report of Exemption & Deduction from Income/
Report of Exemption & Deduction from Wage & Salary Income
(For the Year-end Settlement of 2004 Income)
Employee
Name
Resident (Alien) Reg. No.
Employer
Name
(Company Name)
Tax Registration No.
Personal
Deduction
Basic Deduction
Additional (If applicable, mark “○”)
Relationship
Name
Resident (Alien)
Reg. No
Address
Aged
handicapped
Woman
under
6 years
old
65-69
over 70
Myself
Spouse
Dependent
Father
Mother
Child
Child
The child should be the one who was born after Jan. 1, 1984 for the child deduction.
Pension
Deduction
Pension
Premium
Place of duty
Premium Paid
Limit
Deduction Amt.
Previous Place
Total Amt.
Current Place
Total Amt.
Total
Special
Deduction
Items
Breakdown of Payment
Class
Amt. Paid
Limit
Deduction Amt.
Insurance
Premium
Health Ins.
Previous
premium
Total Amt.
Current
premium
Total Amt.
Employment Insurance
Previous
premium
Total Amt.
Current
premium
Total Amt.
General Ins. (life, accident, etc.)
premium
1,000,000
Insurance for the Handicapped
premium
1,000,000
Total
Medical
Expenses
For Dependents
expenses
-
Him/herselfthe Aged
the Handicapped
expenses
-
Total medical expenses
Education
Expenses
Him/Herself
(include the graduate student)
Tuition
Total Amt.
For Child before entering an
elementary school (1)
Tuition, etc.
2 mil./person
For Students (1)
(elementary, secondary, high)
Tuition
2 mil./person
For Undergraduates ()
(college or university)
Tuition
7 mil./person
For the handicapped ()
Tuition etc.
Total Amt.
Total education expenses
297㎜×210㎜
(Page2) |
2008.01.31
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