Lampiran I
Keputusan Menteri Keuangan
Nomor 1121/KMK.04/1991

DEPARTEMEN KEUANGAN REPUBLIK INDONESIA	Lembar 1
DIREKTORAT JENDERAL PAJAK	Untuk KPKN
-----------------------------------------------------------------------------	melalui BANK Pembayar

SURAT PERINTAH MEMBAYAR KEMBALI PAJAK (SPMKP)

Nomor  :
Tahun Anggaran  : 19.............../19.................1)	No. Urut SKPKPP :................................2)

MEMERINTAHKAN KEPADA

Bank ......................................................3) di........................................................4) untuk membayar kembali memindah bukukan KELEBIHAN PEMBAYARAN PAJAK............................5) Tahun.........................6) kepada :

Nama Wajib Pajak

:.............................................................................................7)

Alamat

:.............................................................................................

:.............................................................................................8)

NPWP

:

9)

Pemegang rekening bank

 : ........................................................................................................10)

Nomor Rekening

: ........................................................................................................11)

Sejumlah

: Rp.....................................................................................................

(: ........................................................................................................

: ........................................................................................................12)

atas beban Rekening Kas Negara A/Bendaharawan Umum KPKN di :...............................................

 : ........................................................................................................13)

pada Mata Anggaran Pengeluaran (MAK) :........................................................................................14)

....................tgl............................15)
A.n. DIREKTUR JENDERAL PAJAK
KEPALA...................................16)

____________________________
NIP.

DIBAYAR/DIPINDAH BUKUKAN	DITERIMA WAJIB PAJAK
............................tgl...........................	..................tgl....................
Bank.................................................	PENERIMA
Nota Debet No.................................	............................................
Tgl.....................................................

DEPARTEMEN KEUANGAN REPUBLIK INDONESIA	Lembar 2
DIREKTORAT JENDERAL PAJAK _____________________________________________	untuk Bank Pembayar (setelah dibayarkan/dipindah bukukan kembali ke KPP)

SURAT PERINTAH MEMBAYAR KEMBALI PAJAK (SPMKP)

Nomor   :
Tahun Anggaran :  19................./19...........	No. Urut SKPKPP :

MEMERINTAHKAN KEPADA

Bank ...................................................... di........................................................ untuk membayar kembali memindah bukukan KELEBIHAN PEMBAYARAN PAJAK............................ Tahun......................... kepada :
Nama Wajib Pajak	:.............................................................................................
Alamat	:.............................................................................................
	:.............................................................................................
NPWP	: