Receipt for Wage & Salary Income Taxes Withholding,Statement on Wage & Salary Income Payment

1. Receipt_for_Wage_&_Salary_Income_Tax.hwp
2. Receipt_for_Wage_&_Salary_Income_Tax.doc
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Receipt for Wage & Salary Income Taxes Withholding,Statement on Wage & Salary Income Payment
[Tax Form 24(1)] [2004.3.5.Amended] (page1)

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
① Company Name

② Representative Name

③ Tax Reg. No.

④ Resident Reg. No.

⑤ Address

Employee
(Taxpayer)
⑥ Name

⑦ Resident(Alien) Reg. No.

⑧ Address

⑨ Period Attributable (mm/dd/yy)
From To
⑩ Period 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 for Class A

Education Expenses

Taxpayer Assn. Credit

Housing Fund

Home Mortgage Interests

Donation

Foreign Tax Credit

Marriage,Funeral,Moving

Political Money Donation

Tax
Credit

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.)