Report of Exemption & Deduction from Income/Report of Exemption & Deduction from Wage & Salary Income

[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㎜

[hwp/doc/pdf]Report of Exemption & Deduction from Income/Report of Exemption & Deduction from Wage & Salary Income