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Receipt for Wage & Salary Income Taxes Withholding,Statement on Wage & Salary Income Payment
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Control
No.
□ Receipt for Wage & Salary Income Taxes Withholding
□ Statement on Wage & Salary Income Payment
(Copy to report by issuer)
Residency
Resident 1/
Non-Resident 2
Nationality
Citizen 1/
Foreigner 9
Application of Flat tax rate
Yes 1/ No 2
State of Residence
State Code
Employer
①Company Name
②Representative Name
③Tax Reg. No.
④Resident Reg. No.
⑤Address
Employee
(Taxpayer)
⑥Name
⑦Resident(Alien) Reg. No.
⑧Address
⑨Period Attributable (mm/dd/yy)
From To
⑩Period of Tax Exemption
From To
Details
of
Income
by
Company
Description
Current Job
Previous Job
Previous Job
Taxpayer Association
Total
⑪ Company Name
⑫ Tax Reg. No.
⑬ Gross Payroll
⑭ Gross Bonus
⑮ Deemed Bonus
Total
Non-taxable
Income
Overseas Allowances
Night time Allowances
Other Allowances
Total (++)
Items
Gross Wage & Salary ()
Special
Deduction
by
Special
Taxation
Per'l Pension Savings Deduction
Deduction for Wage & Salary Income
Pension Savings Deduction
Adjusted Wage & Salary Income
Investment Assn Deduction
Deduc-
tion
Basic
Deduction
Employee
Credit Card Usage Deduction
Spouse
Employee Stock Ownership Deduction
Dependents
Additional
Deduction
The Aged
Sub-Total
The Handicapped
Taxable Income (Tax Base)
Women
Calculated Income Tax
under 6 years old
Tax
Exemption
Income Tax Act
For Small Dependents
RSTA
For Pension Contribution
Special
Deduction
Insurance
Total Exemptions
Medical Expenses
Tax
Credit
Tax Credit for Class A
Education Expenses
Taxpayer Assn. Credit
Housing Fund
Home Mortgage Interests
Donation
Foreign Tax Credit
Marriage,Funeral,Moving
Political Money Donation
Sub-Total
Standard Dedcution
Sub-Total
Income after Deduction
Final Tax Liability (--)
Tax
Classification
Income Tax
Inhabitant Tax
Special Tax for Agriculture
Total
Final Tax Liability
Prepaid
Tax
Previous Job
Current Job
Taxes Due
We acknowledge the withholding (or payment) of above taxes (or payroll income).
January . 2005
Taxes withheld by (Signature or seal)
※1. State of residence and code is applied only to foreigners and it should follow the abbreviation name and code by ISO.
2. Withholding agent shall submit the statement on wage & salary income payment by the end of February next to the year of payment. (In case of closing or suspension of business, by the end of the month next to the month of closing or suspension.) |
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2008.01.31
1페이지
