Lampiran I Keputusan Menteri Keuangan
Nomor	:	120/KMK.04/1995
Tanggal	:	26 Maret 1995

DEPARTEMEN KEUANGAN REPUBLIK INDONESIA DIREKTORAT JENDERAL PAJAK ____________________________________________

Lembar 1 Untuk KPKN melalui Bank Pembayar

SURAT PERINTAH MEMBAYAR KELEBIHAN PAJAK

( S P M K P )

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

MEMERINTAHKAN KEPADA

Bank ..................................................................................... di ...............................................................................		4)
untuk membayar kembali/memindahbukukan KELEBIHAN PEMBAYARAN PAJAK .......................................................		5)
Tahun ......................... 6) kepada :
Nama Wajib Pajak	:  .................................................................................................................................	7)
A l a m a t	:  .................................................................................................................................    .................................................................................................................................	8)
N P W P	:	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. ............................. A.n. DIREKTUR JENDERAL PAJAK KEPALA ....................................................... _________________________________ NIP.

14) 16)

DIBAYAR/DIPINDAHBUKUKAN ..........................................., tgl. .............................. BANK ................................................... Nota Debet No. : ....................................                  Tgl. : ....................................

DITERIMA WAJIB PAJAK ..........................................., tgl. .............................. PENERIMA .............................................................

DEPARTEMEN KEUANGAN REPUBLIK INDONESIA DIREKTORAT JENDERAL PAJAK ____________________________________________

Lembar 2 Untuk BANK Pembayar (setelah dibayarkan/ dipindahbukukan kembali ke PP)

SURAT PERINTAH MEMBAYAR KELEBIHAN PAJAK

( S P M K P )

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

MEMERINTAHKAN KEPADA

Bank ..................................................................................... di ...............................................................................
untuk membayar kembali/memindahbukukan KELEBIHAN PEMBAYARAN PAJAK .......................................................
Tahun ......................... kepada :
Nama Wajib Pajak	:  .................................................................................................................................
A l a m a t	:  .................................................................................................................................    .................................................................................................................................
N P W P	:
Pemegang Rekening Bank	:  .................................................................................................................................
Nomor Rekening	:  .................................................................................................................................
Sejumlah	:  Rp. ...........................................................................................................................    (................................................................................................................................    ................................................................................................................................)
atas beban Rekening Kas Negara A / Bendaharawan Umum KPKN di : .........................................................................
pada Mata Anggaran Pengeluaran (MAK) : ...................................................................................................................

........................................, tgl. .............................

A.n. DIREKTUR JENDERAL PAJAK
KEPALA .......................................................


_________________________________
NIP.                                                   

DIBAYAR/DIPINDAHBUKUKAN ..........................................., tgl. .............................. BANK ................................................... Nota Debet No. : ....................................                  Tgl. : ....................................

DITERIMA WAJIB PAJAK ..........................................., tgl. .............................. PENERIMA .............................................................

DEPARTEMEN KEUANGAN REPUBLIK INDONESIA DIREKTORAT JENDERAL PAJAK ____________________________________________

Lembar 3 Untuk arsip BANK Pembayar

SURAT PERINTAH MEMBAYAR KELEBIHAN PAJAK

( S P M K P )

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

MEMERINTAHKAN KEPADA

Bank .................................................................................... di ................................................................................
untuk membayar kembali/memindahbukukan KELEBIHAN PEMBAYARAN PAJAK .......................................................
Tahun ......................... kepada :
Nama Wajib Pajak	:  .................................................................................................................................
A l a m a t	:  .................................................................................................................................    .................................................................................................................................
N P W P	:
Pemegang Rekening Bank	:  .................................................................................................................................
Nomor Rekening	:  .................................................................................................................................
Sejumlah	:  Rp. ...........................................................................................................................    (................................................................................................................................    ................................................................................................................................)
atas beban Rekening Kas Negara A / Bendaharawan Umum KPKN di : .........................................................................
pada Mata Anggaran Pengeluaran (MAK) : ...................................................................................................................

........................................, tgl. .............................

A.n. DIREKTUR JENDERAL PAJAK
KEPALA .......................................................


_________________________________
NIP.                                                   

DIBAYAR/DIPINDAHBUKUKAN ..........................................., tgl. .............................. BANK ................................................... Nota Debet No. : ....................................                  Tgl. : ....................................

DITERIMA WAJIB PAJAK ..........................................., tgl. .............................. PENERIMA .............................................................

DEPARTEMEN KEUANGAN REPUBLIK INDONESIA DIREKTORAT JENDERAL PAJAK ____________________________________________

Lembar 4 Untuk WAJIB PAJAK

SURAT PERINTAH MEMBAYAR KELEBIHAN PAJAK

( S P M K P )

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

MEMERINTAHKAN KEPADA

Bank .................................................................................... di ................................................................................
untuk membayar kembali/memindahbukukan KELEBIHAN PEMBAYARAN PAJAK .......................................................
Tahun ......................... kepada :
Nama Wajib Pajak	:  .................................................................................................................................
A l a m a t	:  .................................................................................................................................    .................................................................................................................................
N P W P	:
Pemegang Rekening Bank	:  .................................................................................................................................
Nomor Rekening	:  .................................................................................................................................
Sejumlah	:  Rp. ...........................................................................................................................    (................................................................................................................................    ................................................................................................................................)
atas beban Rekening Kas Negara A / Bendaharawan Umum KPKN di : .........................................................................
pada Mata Anggaran Pengeluaran (MAK) : ...................................................................................................................

........................................, tgl. .............................

A.n. DIREKTUR JENDERAL PAJAK
KEPALA .......................................................


_________________________________
NIP.                                                   

DEPARTEMEN KEUANGAN REPUBLIK INDONESIA DIREKTORAT JENDERAL PAJAK ____________________________________________

Lembar 5 Untuk KPKN yang bersangkutan

SURAT PERINTAH MEMBAYAR KELEBIHAN PAJAK

( S P M K P )

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

MEMERINTAHKAN KEPADA

Bank .................................................................................... di ................................................................................
untuk membayar kembali/memindahbukukan KELEBIHAN PEMBAYARAN PAJAK .......................................................
Tahun ......................... kepada :
Nama Wajib Pajak	:  .................................................................................................................................
A l a m a t	:  .................................................................................................................................    .................................................................................................................................
N P W P	:
Pemegang Rekening Bank	:  .................................................................................................................................
Nomor Rekening	:  .................................................................................................................................
Sejumlah	:  Rp. ...........................................................................................................................    (................................................................................................................................    ................................................................................................................................)
atas beban Rekening Kas Negara A / Bendaharawan Umum KPKN di : .........................................................................
pada Mata Anggaran Pengeluaran (MAK) : ...................................................................................................................

........................................, tgl. .............................

A.n. DIREKTUR JENDERAL PAJAK
KEPALA .......................................................


_________________________________
NIP.                                                   

SURAT PERINTAH MEMBAYAR KELEBIHAN PAJAK

( S P M K P )

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

MEMERINTAHKAN KEPADA

Bank .................................................................................... di ................................................................................
untuk membayar kembali/memindahbukukan KELEBIHAN PEMBAYARAN PAJAK .......................................................
Tahun ......................... kepada :
Nama Wajib Pajak	:  .................................................................................................................................
A l a m a t	:  .................................................................................................................................    .................................................................................................................................
N P W P	:
Pemegang Rekening Bank	:  .................................................................................................................................
Nomor Rekening	:  .................................................................................................................................
Sejumlah	:  Rp. ...........................................................................................................................    (................................................................................................................................    ................................................................................................................................)
atas beban Rekening Kas Negara A / Bendaharawan Umum KPKN di : .........................................................................
pada Mata Anggaran Pengeluaran (MAK) : ...................................................................................................................

........................................, tgl. .............................

A.n. DIREKTUR JENDERAL PAJAK
KEPALA .......................................................


_________________________________
NIP.