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REKAM DATA 1721 A2 PEGAWAICETAK FORMULIR 1721 A2 PEGAWAI

REKAM DATA 1721 A2 PENSIUNANCETAK FORMULIR 1721 A2 PENSIUN

KE MENU UTAMA

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NO NAMA NIP GOL PANGKAT JABATAN NPWP

1 2 3 4 5 6 7

1 Hj. Siti Masitah, SKM 19701124199III/c Penata Ka.TU Puskesmas Gam 14.999.49!.0"7#2.000 ani Km.

2 Hj. %us)iana *ah+ani 19&0072719 III/) Penata Tk.I *i)an Pene-ia 14.(99.047.9"7#2.000 ani Km.

# H.I-ham 19&4042019 III/) Penata Tk.I Pe+a'at Pene-ia !9.14!.1#&.!"7#1.000 isti+a I

4 Hj. Guna+ti 19&&0&1019 III/) Penata Tk.I *i)an Pene-ia 14.44#.9!9.0"7#2.000 24,(00

( )+.T3ik +man Hi)aat 197#0#1920 III/c Penata Ke3a-a Puskesmas Ga 14.9&1.0(&.0"7#2.000 KM 14.!

& khma)i 19&!070119!III/c Penata Pe+a'at Pene-ia 14.9&1.0(7.!"7#2.000 Km 14.

7 %akhma'ati 19710!0919 III/c Penata *i)an Pene-ia 14.999.49&.4"7#2.000 Km 14.! )+.S+i Su5iantini 19&11020200III/c Penata 6kte+ Umum 14.919.029.0"7#2.000 4.!00 %

9 Siti Maimunah,MK 19&!100719 III/c Penata Pe+a'at Pene-ia 14.999.49#.1"7#2.000 k

10 %usi)a Si3tiani 1970091&19 III/c Penata *i)an Pene-ia 14.9&1.0(9.4"7#2.000 ani Km

11 Siti Sa-hah 19&(0(0&19 III/ P enata Mu)a Tk.I P+mkes 14.!97.77&.2"7#2.000 i Km 14

12 a+i)ah 19&7011119! III/ Penata Mu)a Tk.I Sta8 14.999.4!9.9"7#2.000 n5 %

1# hma) Mu+si)i 19&70(0&19 III/ Penata Mu)a Tk.I Sta8 14.919.0#0.!"7#2.000 -k * 1

14 - - $anni 19&7110#19!III/ Penata Mu)a Tk.I ut+isinis Pe-.anjutan 14.999.490.7"7#2.000 +i *-k *

1( i man n55+aeni, M) 1972070219 III/ Penata Mu)a Tk.I *i)an Pe-.anjutan !9.4!(.(1&.2"7#1.000 T 02! P

1& I+hamna,SKM 1971072&19 III/ Penata Mu)a Tk.I Sanita+ian Pe- anjutan 14.999.494.9"7#2.000 :- *e-i

17 Iskan)a+ 197#0!1419 III/ Penata Mu)a Tk.I Pe+a'at Pe-.anjutan 14.919.0#2.4"7#2.000 ani KM

1! + it+iana,.M 197(020&19 III/ Penata Mu)a Tk.I P+anata a.anjutan 14.999.497.2"7#2.000 14

19 ut8i a+)ani, MK 197(041919 III/ Penata Mu)a Tk.I Pe+a'at Pe-.anjutan 14.999.4!7.#"7#2.000 Sun5

20 is)aani 19&!122219 III/a Penata Mu)a sisten 3t.Pe- anjutan 14.919.0##.2"7#2.000 "0& %T

21 athu- :annah 19&9101019 III/a Penata Mu)a sisten 3t.Pe- anjutan 14.9&1.0(!.&"7#2.000 ani KM

22 ;n %ahau,.M) 1971071#19 III/a Penata Mu)a *i)an Pe- anjutan 14.999.491.("7#2.000 - $an

2# Ma+iatu- Ki8tiah 1974090719 III/a Penata Mu)a Pe+a'at Gi5i Pe- anjuta 14.999.499.!"7#2.000 70 %T

24 Ma+-iana 1971110#199III/a Penata Mu)a Sta8 1(.44#.1#(.7"7#2.000 $usu8

2( H -3iannu+ 1977120(19 III/a Penata Mu)a Pe+a'at Pe- anjutan 79 112 1"7#1 000 019 %

K H Ke +mu-i+ 1721 2ISILAH DAFTAR PPH 21 DISAMPING

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2,&!!,000 2&(,000 14!,(00 0 0 12 1 12 2!,!00,000 2,!!0,000

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2,&&2,#(& 2&(,000 1&9,200 0 0 12 1 12 2!,024,!00 2,!02,4!0 2,(90,&(0 2&(,000 1&9,200 0 0 12 1 12 27,270,000 2,727,000

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2,((4,2!4 2&(,000 1&9,200 0 0 12 1 12 2&,!!7,200 2,&!!,720

2,(&!,940 2&(,000 !4,&00 0 0 12 1 12 2!,024,!00 2,!02,4!0

2,(#2,!&0 1!(,000 !4,&00 0 0 12 1 12 27,,200 2,7,120

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B,/-(")/ T-B,/- ETO 33%37 NETO12 PTKP PKP PEMBU

32 33 34 35 36 37 38 3 4! 41

0 42,&01,240 1,&11,!29 2,1#0,0&2 #,741,!91 #!,!(9,#49 #!,!(9,#49 17,1&0,000 21,&99,#49 21,&

0 4(,(72,2!0 1,!2#,2(# 2,27!,&14 4,101,!&7 41,470,41# 41,470,41# 17,1&0,000 24,#10,41# 24,#

0 4&,04#,!!0 1,7!9,224 2,#02,194 4,091,41! 41,9(2,4&2 41,9(2,4&2 21,120,000 20,!#2,4&2 20,!

0 4&,04#,!!0 1,7!9,224 2,#02,194 4,091,41! 41,9(2,4&2 41,9(2,4&2 21,120,000 20,!#2,4&2 20,!

0 #!,0(#,20! 1,291,!&7 1,902,&&0 #,194,(27 #4,!(!,&!1 #4,!(!,&!1 21,120,000 1#,7#!,&!1 1#,7

0 4(,0#0,192 1,741,074 2,2(1,(09 #,992,(!# 41,0#7,&09 41,0#7,&09 19,!00,000 21,2#7,&09 21,2

0 4#,(4#,17& 1,&70,441 2,177,1(! #,!47,(99 #9,&9(,(77 #9,&9(,(77 21,120,000 1!,(7(,(77 1!,(

0 42,0(!,!72 1,4(7,4#& 2,102,94# #,(&0,#79 #!,49!,49# #!,49!,49# 19,!00,000 1!,&9!,49# 1!,&

0 42,(9&,(20 1,&2(,47( 2,129,!2& #,7((,#01 #!,!41,219 #!,!41,219 21,120,000 17,721,219 17,7

0 4#,(4#,17& 1,&70,441 2,177,1(! #,!47,(99 #9,&9(,(77 #9,&9(,(77 21,120,000 1!,(7(,(77 1!,(

0 40,20#,#&0 1,702,1!0 2,010,1&! #,712,#4! #&,491,012 #&,491,012 17,1&0,000 19,##1,012 19,#

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0 #7,#!7,!00 1,(&!,441 1,!&9,#90 #,4#7,!#1 ##,949,970 ##,949,970 17,1&0,000 1&,7!9,970 1&,7

0 #7,21!,000 1,(#2,1&0 1,!&0,900 #,#9#,0&0 ##,!24,940 ##,!24,940 1!,4!0,000 1(,#44,940 1(,#

0 #7,1(!,&72 1,(17,(4# 1,!(7,9## #,#7(,47& ##,7!#,19& ##,7!#,19& 21,120,000 12,&,19& 12,&

0 #7,1(!,&72 1,(17,(4# 1,!(7,9## #,#7(,47& ##,7!#,19& ##,7!#,19& 21,120,000 12,&,19& 12,&0 #&,29!,200 1,47&,&71 1,!14,910 #,291,(!1 ##,00&,&20 ##,00&,&20 19,!00,000 1#,20&,&20 1#,2

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0 #(,!&1,!0! 1,4((,942 1,79#,090 #,249,0#2 #2,&12,77& #2,&12,77& 21,120,000 11,492,77& 11,4

0 #(,022,4!0 1,4&4,29& 1,7(1,124 #,21(,420 #1,!07,0&0 #1,!07,0&0 17,1&0,000 14,&47,0&0 14,&

0 ##,&29,(20 1,44#,7#0 1,&!1,47& #,12(,20& #0,(04,#14 #0,(04,#14 17,1&0,000 1#,#44,#14 1#,#

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TAHUN

KALENDER

FORMULIR 1721 - A2

1. ema+ 1 untuk Pe5a

2.

2016P%TM KUG %I6I%KT;%T :6% P:K

;M;% U%UT > 12

M ISTSI / *6 I > DINAS KESEHATAN KAB.BANJAR

PP *6H% > 00.375.107.0.732.000

M *6H% > BENDAHARA DINAS KESEHATANM PGI / PSIU > FaridahIP / %P > 1!701111"!03200#

PP PGI / PSIU > 1#..#".-732.000

MT PGI / PSIU > J$ %&'&() R&*&() RT RT 02! R+ 00" %a,'

PGKT / G;;G > /(a'a Mda T.I III

:*T > S'aSTTUS 6 :IS KMI > 4 KA+IN TIDAK KA+IN LAKI-LAKI /EREM/UAN

:UMH TGGUG KU%G UTUK PTKP > K 0 TK - HB

MS P%;H PGHSI > 1 S.D 12

A. RINIAN /EN%HASILAN DAN /EN%HITUN%AN //h /ASAL 21 SEBA%AI BERIKUT 6 RU/IAH

/EN%HASILAN BRUTO 6

1. G:I P;K;K / PSIU 1 #

BUKTI /EMOTON%AN /AJAK /EN%HASILAN /ASAL 21BA%I /E%A+AI NE%ERI SI/IL8 AN%%OTA TENTARA

NASIONAL INDONESIA/OLISI RE/UBLIK INDONESIA8

/EJABAT NE%ARA DAN /ENSIUNANN9A

ema+ 2 untuk PemPajak

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NO NAMA NIP GOL PANGKAT JABATAN

1 2 3 4 5 61 *u)ia+t 0&00&!& I/ Pemina Tk.I 6I%KTU%

2 6jatnika 0&007&797 I/ Pemina Tk.I KSU*6IT

# Sanitas 0&00777(4 I/a Pemina KSU*6IT4 I+. Samn 0&00!#0!& I/a Pemina KSU*6IT

( *achtia+ 0&0077(0! III/) Penata Tk.I KSU*6IT

& u-an)a+i 0&00!7### III/) Penata Tk.I KSU*6IT

7 k i)) 0&00777&& III/) Penata Tk.I KP SKSI

! +i8 0&007!(## III/) Penata Tk.I KP SKSI

9 %inanin5sih 0&00!709& III/) Penata Tk.I KP SKSI

10 Suhastin 0&00!7179 III/) Penata Tk.I KP SU**GI

11 Muhamma) 0&00!9717 III/) Penata Tk.I KP SKSI12 $us+ie 0&00!999( III/) Penata Tk.I PKS

1# *u)iha+)j K 0&0079#79 III/c Penata KP SKSI

14 Ha+ia)i 0&0079!#7 III/c Penata KP SKSI

1( min 0&00!1 III/c Penata KP SKSI

Ha- See-uKe +mu-i+ 1721 2 PeK,a$i K M( U'a

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NPWP ALAMAT K TK GAJI POKOK

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0 44,712 2,2!0,#12 1,2&0,000 !4,&00 7,000,000

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1!7,(20 7(,00! 2,1#7,72! 1,2&0,000 1&9,200 (,000,000

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0 #!,#!& 1,9(7,&!& (40,000 !4,&00 (,000,000

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PKP PPH

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PPH PERBULAN

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KALENDER

ULIR 1721 - A2

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2.BUKTI /EMOTON%AN /AJAK /EN%HASILAN /ASAL 21

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TA

HUN

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FORMU

26P%TM KUG %I

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STTUS 6 :IS KMI > 4 KA+IN TIDAK KA+IN LAKI-LAKI /EREM/UAN

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MS P%;H PGHSI > 1 S.D 12

A. RINIAN /EN%HASILAN DAN /EN%HITUN%AN //h /ASAL 21 SEBA%AI BERIKUT 6 RU

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JIKA FORMULIR INI TIDAK MENCUKUPI, DAPAT DIBUAT SENDIRI SESUAI DENGAN B

NO NAMA NIP GOL PANGKAT JABATAN NPWP

K H Ke +mu-i+ 1721 2ISILAH DAFTAR PPH 21 DISAMPING

DI ITEM YG BERWARNA PUTIH

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7 %akhma'ati 19710!0919 III/c Penata *i)an Pene-ia 14.999.49&.4"7#2.000 Km 14.

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12 a+i)ah 19&7011119! III/ Penata Mu)a Tk.I Sta8 14.999.4!9.9"7#2.000 n5 %

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21 athu- :annah 19&9101019 III/a Penata Mu)a sisten 3t.Pe- anjutan 14.9&1.0(!.&"7#2.000 ani KM

22 ;n %ahau,.M) 1971071#19 III/a Penata Mu)a *i)an Pe- anjutan 14.999.491.("7#2.000 - $an

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