CERTIFICADO DE INGRESOS Y RETENCIONES PARA PERSONAS

NATURALES EMPLEADOS (Año gravable 2017)

Instrucciones:
1- Esta plantilla está diseñada para emitir certificados de ingresos y retenciones por el año gravable 2017
2- Este certificado lo diligenciar el empleador.
3- Inicialmente debe diligenciar los "datos del empleado" de acuerdo al boton que aparece en este menú.
Esta relación tentrá un numero consecutivo el cual debe tener presente a la hora de imprimir el certificado respectivo.
4- Ingrese al botón "Certificado" de este menú en donde deberá diligeniar los datos del empleador Diligencie las casillas 5 a la 11, 32, 33, 34, y 35
Luego cuando quiera imprimir los certificados simplemente digite en la casilla 4. Número del fomulario el respectivo
numero consecutivo al cual corresponda el certificado del empleado que quiera imprimir. Ver imagen 4. Número de formulario

Datos del empleado Certificado

Derechos reservados www.consultorcontable.com año 2018 Actualizado año 2017. Wiliam Dussán Salazar
 F -220

32, 33, 34, y 35

2017. Wiliam Dussán Salazar

 DATOS DE LOS E
Diligencie la información de los terceros a los c

N. Formulario Identificación Primer apellido Segundo apellido Primer nombre Segundo nombre

Totales
1 2125421 GOMEZ GIRALDO MARIA ANGELICA
2 89652458 VARON ALBERTO
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934
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999
1,000
1,001
1,002
1,003
1,004
1,005
1,006
1,007
1,008
1,009
1,010
1,011
1,012
1,013
1,014
1,015
1,016
1,017
1,018
1,019
1,020
1,021
1,022
1,023
1,024
1,025
1,026
1,027
1,028
1,029
1,030
1,031
1,032
1,033
1,034
1,035
1,036
1,037
1,038
1,039
1,040
1,041
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1,044
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1,065
1,066
1,067
1,068
1,069
1,070
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1,072
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1,076
1,077
1,078
1,079
1,080
1,081
1,082
1,083
1,084
1,085
1,086
1,087
1,088
1,089
1,090
1,091
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1,114
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1,159
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1,204
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1,249
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1,294
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1,339
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1,384
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1,429
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1,609
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1,654
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1,789
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1,879
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1,899
1,900
1,901
1,902
1,903
1,904
1,905
1,906
1,907
1,908
1,909
1,910
1,911
1,912
1,913
1,914
1,915
1,916
1,917
1,918
1,919
1,920
1,921
1,922
1,923
1,924
1,925
1,926
1,927
1,928
1,929
1,930
1,931
1,932
1,933
1,934
1,935
1,936
1,937
1,938
1,939
1,940
1,941
1,942
1,943
1,944
1,945
1,946
1,947
1,948
1,949
1,950
1,951
1,952
1,953
1,954
1,955
1,956
1,957
1,958
1,959
1,960
1,961
1,962
1,963
1,964
1,965
1,966
1,967
1,968
1,969
1,970
1,971
1,972
1,973
1,974
1,975
1,976
1,977
1,978
1,979
1,980
1,981
1,982
1,983
1,984
1,985
1,986
1,987
1,988
1,989
1,990
1,991
1,992
1,993
1,994
1,995
1,996
1,997
1,998
1,999
2,000
2,001
2,002
2,003
2,004
2,005
2,006
2,007
2,008
2,009
2,010
2,011
2,012
2,013
2,014
2,015
2,016
2,017
2,018
2,019
2,020
2,021
2,022
2,023
2,024
2,025
2,026
2,027
2,028
2,029
2,030
2,031
2,032
2,033
2,034
2,035
2,036
2,037
2,038
2,039
2,040
2,041
2,042
2,043
2,044
2,045
2,046
2,047
2,048
2,049
2,050
2,051
2,052
2,053
2,054
2,055
2,056
2,057
2,058
2,059
2,060
2,061
2,062
2,063
2,064
2,065
2,066
2,067
2,068
2,069
2,070
2,071
2,072
2,073
2,074
2,075
2,076
2,077
2,078
2,079
2,080
2,081
2,082
2,083
2,084
2,085
2,086
2,087
2,088
2,089
2,090
2,091
2,092
2,093
2,094
2,095
2,096
2,097
2,098
2,099
2,100
2,101
2,102
2,103
2,104
2,105
2,106
2,107
2,108
2,109
2,110
2,111
2,112
2,113
2,114
2,115
2,116
2,117
2,118
2,119
2,120
2,121
2,122
2,123
2,124
2,125
2,126
2,127
2,128
2,129
2,130
2,131
2,132
2,133
2,134
2,135
2,136
2,137
2,138
2,139
2,140
2,141
2,142
2,143
2,144
2,145
2,146
2,147
2,148
2,149
2,150
2,151
2,152
2,153
2,154
2,155
2,156
2,157
2,158
2,159
2,160
2,161
2,162
2,163
2,164
2,165
2,166
2,167
2,168
2,169
2,170
2,171
2,172
2,173
2,174
2,175
2,176
2,177
2,178
2,179
2,180
2,181
2,182
2,183
2,184
2,185
2,186
2,187
2,188
2,189
2,190
2,191
2,192
2,193
2,194
2,195
2,196
2,197
2,198
2,199
2,200
2,201
2,202
2,203
2,204
2,205
2,206
2,207
2,208
2,209
2,210
2,211
2,212
2,213
2,214
2,215
2,216
2,217
2,218
2,219
2,220
2,221
2,222
2,223
2,224
2,225
2,226
2,227
2,228
2,229
2,230
2,231
2,232
2,233
2,234
2,235
2,236
2,237
2,238
2,239
2,240
2,241
2,242
2,243
2,244
2,245
2,246
2,247
2,248
2,249
2,250
2,251
2,252
2,253
2,254
2,255
2,256
2,257
2,258
2,259
2,260
2,261
2,262
2,263
2,264
2,265
2,266
2,267
2,268
2,269
2,270
2,271
2,272
2,273
2,274
2,275
2,276
2,277
2,278
2,279
2,280
2,281
2,282
2,283
2,284
2,285
2,286
2,287
2,288
2,289
2,290
2,291
2,292
2,293
2,294
2,295
2,296
2,297
2,298
2,299
2,300
2,301
2,302
2,303
2,304
2,305
2,306
2,307
2,308
2,309
2,310
2,311
2,312
2,313
2,314
2,315
2,316
2,317
2,318
2,319
2,320
2,321
2,322
2,323
2,324
2,325
2,326
2,327
2,328
2,329
2,330
2,331
2,332
2,333
2,334
2,335
2,336
2,337
2,338
2,339
2,340
2,341
2,342
2,343
2,344
2,345
2,346
2,347
2,348
2,349
2,350
2,351
2,352
2,353
2,354
2,355
2,356
2,357
2,358
2,359
2,360
2,361
2,362
2,363
2,364
2,365
2,366
2,367
2,368
2,369
2,370
2,371
2,372
2,373
2,374
2,375
2,376
2,377
2,378
2,379
2,380
2,381
2,382
2,383
2,384
2,385
2,386
2,387
2,388
2,389
2,390
2,391
2,392
2,393
2,394
2,395
2,396
2,397
2,398
2,399
2,400
2,401
2,402
2,403
2,404
2,405
2,406
2,407
2,408
2,409
2,410
2,411
2,412
2,413
2,414
2,415
2,416
2,417
2,418
2,419
2,420
2,421
2,422
2,423
2,424
2,425
2,426
2,427
2,428
2,429
2,430
2,431
2,432
2,433
2,434
2,435
2,436
2,437
2,438
2,439
2,440
2,441
2,442
2,443
2,444
2,445
2,446
2,447
2,448
2,449
2,450
2,451
2,452
2,453
2,454
2,455
2,456
2,457
2,458
2,459
2,460
2,461
2,462
2,463
2,464
2,465
2,466
2,467
2,468
2,469
2,470
2,471
2,472
2,473
2,474
2,475
2,476
2,477
2,478
2,479
2,480
2,481
2,482
2,483
2,484
2,485
2,486
2,487
2,488
2,489
2,490
2,491
2,492
2,493
2,494
2,495
2,496
2,497
2,498
2,499
2,500
2,501
2,502
2,503
2,504
2,505
2,506
2,507
2,508
2,509
2,510
2,511
2,512
2,513
2,514
2,515
2,516
2,517
2,518
2,519
2,520
2,521
2,522
2,523
2,524
2,525
2,526
2,527
2,528
2,529
2,530
2,531
2,532
2,533
2,534
2,535
2,536
2,537
2,538
2,539
2,540
2,541
2,542
2,543
2,544
2,545
2,546
2,547
2,548
2,549
2,550
2,551
2,552
2,553
2,554
2,555
2,556
2,557
2,558
2,559
2,560
2,561
2,562
2,563
2,564
2,565
2,566
2,567
2,568
2,569
2,570
2,571
2,572
2,573
2,574
2,575
2,576
2,577
2,578
2,579
2,580
2,581
2,582
2,583
2,584
2,585
2,586
2,587
2,588
2,589
2,590
2,591
2,592
2,593
2,594
2,595
2,596
2,597
2,598
2,599
2,600
2,601
2,602
2,603
2,604
2,605
2,606
2,607
2,608
2,609
2,610
2,611
2,612
2,613
2,614
2,615
2,616
2,617
2,618
2,619
2,620
2,621
2,622
2,623
2,624
2,625
2,626
2,627
2,628
2,629
2,630
2,631
2,632
2,633
2,634
2,635
2,636
2,637
2,638
2,639
2,640
2,641
2,642
2,643
2,644
2,645
2,646
2,647
2,648
2,649
2,650
2,651
2,652
2,653
2,654
2,655
2,656
2,657
2,658
2,659
2,660
2,661
2,662
2,663
2,664
2,665
2,666
2,667
2,668
2,669
2,670
2,671
2,672
2,673
2,674
2,675
2,676
2,677
2,678
2,679
2,680
2,681
2,682
2,683
2,684
2,685
2,686
2,687
2,688
2,689
2,690
2,691
2,692
2,693
2,694
2,695
2,696
2,697
2,698
2,699
2,700
2,701
2,702
2,703
2,704
2,705
2,706
2,707
2,708
2,709
2,710
2,711
2,712
2,713
2,714
2,715
2,716
2,717
2,718
2,719
2,720
2,721
2,722
2,723
2,724
2,725
2,726
2,727
2,728
2,729
2,730
2,731
2,732
2,733
2,734
2,735
2,736
2,737
2,738
2,739
2,740
2,741
2,742
2,743
2,744
2,745
2,746
2,747
2,748
2,749
2,750
2,751
2,752
2,753
2,754
2,755
2,756
2,757
2,758
2,759
2,760
2,761
2,762
2,763
2,764
2,765
2,766
2,767
2,768
2,769
2,770
2,771
2,772
2,773
2,774
2,775
2,776
2,777
2,778
2,779
2,780
2,781
2,782
2,783
2,784
2,785
2,786
2,787
2,788
2,789
2,790
2,791
2,792
2,793
2,794
2,795
2,796
2,797
2,798
2,799
2,800
2,801
2,802
2,803
2,804
2,805
2,806
2,807
2,808
2,809
2,810
2,811
2,812
2,813
2,814
2,815
2,816
2,817
2,818
2,819
2,820
2,821
2,822
2,823
2,824
2,825
2,826
2,827
2,828
2,829
2,830
2,831
2,832
2,833
2,834
2,835
2,836
2,837
2,838
2,839
2,840
2,841
2,842
2,843
2,844
2,845
2,846
2,847
2,848
2,849
2,850
2,851
2,852
2,853
2,854
2,855
2,856
2,857
2,858
2,859
2,860
2,861
2,862
2,863
2,864
2,865
2,866
2,867
2,868
2,869
2,870
2,871
2,872
2,873
2,874
2,875
2,876
2,877
2,878
2,879
2,880
2,881
2,882
2,883
2,884
2,885
2,886
2,887
2,888
2,889
2,890
2,891
2,892
2,893
2,894
2,895
2,896
2,897
2,898
2,899
2,900
2,901
2,902
2,903
2,904
2,905
2,906
2,907
2,908
2,909
2,910
2,911
2,912
2,913
2,914
2,915
2,916
2,917
2,918
2,919
2,920
2,921
2,922
2,923
2,924
2,925
2,926
2,927
2,928
2,929
2,930
2,931
2,932
2,933
2,934
2,935
2,936
2,937
2,938
2,939
2,940
2,941
2,942
2,943
2,944
2,945
2,946
2,947
2,948
2,949
2,950
2,951
2,952
2,953
2,954
2,955
2,956
2,957
2,958
2,959
2,960
2,961
2,962
2,963
2,964
2,965
2,966
2,967
2,968
2,969
2,970
2,971
2,972
2,973
2,974
2,975
2,976
2,977
2,978
2,979
2,980
2,981
2,982
2,983
2,984
2,985
2,986
2,987
2,988
2,989
2,990
2,991
2,992
2,993
2,994
2,995
2,996
2,997
2,998
2,999
3,000
3,001
3,002
3,003
3,004
3,005
3,006
3,007
3,008
3,009
3,010
3,011
3,012
3,013
3,014
3,015
3,016
3,017
3,018
3,019
3,020
3,021
3,022
3,023
3,024
3,025
3,026
3,027
3,028
3,029
3,030
3,031
3,032
3,033
3,034
3,035
3,036
3,037
3,038
3,039
3,040
3,041
3,042
3,043
3,044
3,045
3,046
3,047
3,048
3,049
3,050
3,051
3,052
3,053
3,054
3,055
3,056
3,057
3,058
3,059
3,060
3,061
3,062
3,063
3,064
3,065
3,066
3,067
3,068
3,069
3,070
3,071
3,072
3,073
3,074
3,075
3,076
3,077
3,078
3,079
3,080
3,081
3,082
3,083
3,084
3,085
3,086
3,087
3,088
3,089
3,090
3,091
3,092
3,093
3,094
3,095
3,096
3,097
3,098
3,099
3,100
3,101
3,102
3,103
3,104
3,105
3,106
3,107
3,108
3,109
3,110
3,111
3,112
3,113
3,114
3,115
3,116
3,117
3,118
3,119
3,120
3,121
3,122
3,123
3,124
3,125
3,126
3,127
3,128
3,129
3,130
3,131
3,132
3,133
3,134
3,135
3,136
3,137
3,138
3,139
3,140
3,141
3,142
3,143
3,144
3,145
3,146
3,147
3,148
3,149
3,150
3,151
3,152
3,153
3,154
3,155
3,156
3,157
3,158
3,159
3,160
3,161
3,162
3,163
3,164
3,165
3,166
3,167
3,168
3,169
3,170
3,171
3,172
3,173
3,174
3,175
3,176
3,177
3,178
3,179
3,180
3,181
3,182
3,183
3,184
3,185
3,186
3,187
3,188
3,189
3,190
3,191
3,192
3,193
3,194
3,195
3,196
3,197
3,198
3,199
3,200
3,201
3,202
3,203
3,204
3,205
3,206
3,207
3,208
3,209
3,210
3,211
3,212
3,213
3,214
3,215
3,216
3,217
3,218
3,219
3,220
3,221
3,222
3,223
3,224
3,225
3,226
3,227
3,228
3,229
3,230
3,231
3,232
3,233
3,234
3,235
3,236
3,237
3,238
3,239
3,240
3,241
3,242
3,243
3,244
3,245
3,246
3,247
3,248
3,249
3,250
3,251
3,252
3,253
3,254
3,255
3,256
3,257
3,258
3,259
3,260
3,261
3,262
3,263
3,264
3,265
3,266
3,267
3,268
3,269
3,270
3,271
3,272
3,273
3,274
3,275
3,276
3,277
3,278
3,279
3,280
3,281
3,282
3,283
3,284
3,285
3,286
3,287
3,288
3,289
3,290
3,291
3,292
3,293
3,294
3,295
3,296
3,297
3,298
3,299
3,300
3,301
3,302
3,303
3,304
3,305
3,306
3,307
3,308
3,309
3,310
3,311
3,312
3,313
3,314
3,315
3,316
3,317
3,318
3,319
3,320
3,321
3,322
3,323
3,324
3,325
3,326
3,327
3,328
3,329
3,330
3,331
3,332
3,333
3,334
3,335
3,336
3,337
3,338
3,339
3,340
3,341
3,342
3,343
3,344
3,345
3,346
3,347
3,348
3,349
3,350
3,351
3,352
3,353
3,354
3,355
3,356
3,357
3,358
3,359
3,360
3,361
3,362
3,363
3,364
3,365
3,366
3,367
3,368
3,369
3,370
3,371
3,372
3,373
3,374
3,375
3,376
3,377
3,378
3,379
3,380
3,381
3,382
3,383
3,384
3,385
3,386
3,387
3,388
3,389
3,390
3,391
3,392
3,393
3,394
3,395
3,396
3,397
3,398
3,399
3,400
3,401
3,402
3,403
3,404
3,405
3,406
3,407
3,408
3,409
3,410
3,411
3,412
3,413
3,414
3,415
3,416
3,417
3,418
3,419
3,420
3,421
3,422
3,423
3,424
3,425
3,426
3,427
3,428
3,429
3,430
3,431
3,432
3,433
3,434
3,435
3,436
3,437
3,438
3,439
3,440
3,441
3,442
3,443
3,444
3,445
3,446
3,447
3,448
3,449
3,450
3,451
3,452
3,453
3,454
3,455
3,456
3,457
3,458
3,459
3,460
3,461
3,462
3,463
3,464
3,465
3,466
3,467
3,468
3,469
3,470
3,471
3,472
3,473
3,474
3,475
3,476
3,477
3,478
3,479
3,480
3,481
3,482
3,483
3,484
3,485
3,486
3,487
3,488
3,489
3,490
3,491
3,492
3,493
3,494
3,495
3,496
3,497
3,498
3,499
3,500
3,501
3,502
3,503
3,504
3,505
3,506
3,507
3,508
3,509
3,510
3,511
3,512
3,513
3,514
3,515
3,516
3,517
3,518
3,519
3,520
3,521
3,522
3,523
3,524
3,525
3,526
3,527
3,528
3,529
3,530
3,531
3,532
3,533
3,534
3,535
3,536
3,537
3,538
3,539
3,540
3,541
3,542
3,543
3,544
3,545
3,546
3,547
3,548
3,549
3,550
3,551
3,552
3,553
3,554
3,555
3,556
3,557
3,558
3,559
3,560
3,561
3,562
3,563
3,564
3,565
3,566
3,567
3,568
3,569
3,570
3,571
3,572
3,573
3,574
3,575
3,576
3,577
3,578
3,579
3,580
3,581
3,582
3,583
3,584
3,585
3,586
3,587
3,588
3,589
3,590
3,591
3,592
3,593
3,594
3,595
3,596
3,597
3,598
3,599
3,600
3,601
3,602
3,603
3,604
3,605
3,606
3,607
3,608
3,609
3,610
3,611
3,612
3,613
3,614
3,615
3,616
3,617
3,618
3,619
3,620
3,621
3,622
3,623
3,624
3,625
3,626
3,627
3,628
3,629
3,630
3,631
3,632
3,633
3,634
3,635
3,636
3,637
3,638
3,639
3,640
3,641
3,642
3,643
3,644
3,645
3,646
3,647
3,648
3,649
3,650
3,651
3,652
3,653
3,654
3,655
3,656
3,657
3,658
3,659
3,660
3,661
3,662
3,663
3,664
3,665
3,666
3,667
3,668
3,669
3,670
3,671
3,672
3,673
3,674
3,675
3,676
3,677
3,678
3,679
3,680
3,681
3,682
3,683
3,684
3,685
3,686
3,687
3,688
3,689
3,690
3,691
3,692
3,693
3,694
3,695
3,696
3,697
3,698
3,699
3,700
3,701
3,702
3,703
3,704
3,705
3,706
3,707
3,708
3,709
3,710
3,711
3,712
3,713
3,714
3,715
3,716
3,717
3,718
3,719
3,720
3,721
3,722
3,723
3,724
3,725
3,726
3,727
3,728
3,729
3,730
3,731
3,732
3,733
3,734
3,735
3,736
3,737
3,738
3,739
3,740
3,741
3,742
3,743
3,744
3,745
3,746
3,747
3,748
3,749
3,750
3,751
3,752
3,753
3,754
3,755
3,756
3,757
3,758
3,759
3,760
3,761
3,762
3,763
3,764
3,765
3,766
3,767
3,768
3,769
3,770
3,771
3,772
3,773
3,774
3,775
3,776
3,777
3,778
3,779
3,780
3,781
3,782
3,783
3,784
3,785
3,786
3,787
3,788
3,789
3,790
3,791
3,792
3,793
3,794
3,795
3,796
3,797
3,798
3,799
3,800
3,801
3,802
3,803
3,804
3,805
3,806
3,807
3,808
3,809
3,810
3,811
3,812
3,813
3,814
3,815
3,816
3,817
3,818
3,819
3,820
3,821
3,822
3,823
3,824
3,825
3,826
3,827
3,828
3,829
3,830
3,831
3,832
3,833
3,834
3,835
3,836
3,837
3,838
3,839
3,840
3,841
3,842
3,843
3,844
3,845
3,846
3,847
3,848
3,849
3,850
3,851
3,852
3,853
3,854
3,855
3,856
3,857
3,858
3,859
3,860
3,861
3,862
3,863
3,864
3,865
3,866
3,867
3,868
3,869
3,870
3,871
3,872
3,873
3,874
3,875
3,876
3,877
3,878
3,879
3,880
3,881
3,882
3,883
3,884
3,885
3,886
3,887
3,888
3,889
3,890
3,891
3,892
3,893
3,894
3,895
3,896
3,897
3,898
3,899
3,900
3,901
3,902
3,903
3,904
3,905
3,906
3,907
3,908
3,909
3,910
3,911
3,912
3,913
3,914
3,915
3,916
3,917
3,918
3,919
3,920
3,921
3,922
3,923
3,924
3,925
3,926
3,927
3,928
3,929
3,930
3,931
3,932
3,933
3,934
3,935
3,936
3,937
3,938
3,939
3,940
3,941
3,942
3,943
3,944
3,945
3,946
3,947
3,948
3,949
3,950
3,951
3,952
3,953
3,954
3,955
3,956
3,957
3,958
3,959
3,960
3,961
3,962
3,963
3,964
3,965
3,966
3,967
3,968
3,969
3,970
3,971
3,972
3,973
3,974
3,975
3,976
3,977
3,978
3,979
3,980
3,981
3,982
3,983
3,984
3,985
3,986
3,987
3,988
3,989
3,990
3,991
3,992
3,993
3,994
3,995
3,996
3,997
3,998
3,999
4,000
4,001
4,002
4,003
4,004
4,005
4,006
4,007
4,008
4,009
4,010
4,011
4,012
4,013
4,014
4,015
4,016
4,017
4,018
4,019
4,020
4,021
4,022
4,023
4,024
4,025
4,026
4,027
4,028
4,029
4,030
4,031
4,032
4,033
4,034
4,035
4,036
4,037
4,038
4,039
4,040
4,041
4,042
4,043
4,044
4,045
4,046
4,047
4,048
4,049
4,050
4,051
4,052
4,053
4,054
4,055
4,056
4,057
4,058
4,059
4,060
4,061
4,062
4,063
4,064
4,065
4,066
4,067
4,068
4,069
4,070
4,071
4,072
4,073
4,074
4,075
4,076
4,077
4,078
4,079
4,080
4,081
4,082
4,083
4,084
4,085
4,086
4,087
4,088
4,089
4,090
4,091
4,092
4,093
4,094
4,095
4,096
4,097
4,098
4,099
4,100
4,101
4,102
4,103
4,104
4,105
4,106
4,107
4,108
4,109
4,110
4,111
4,112
4,113
4,114
4,115
4,116
4,117
4,118
4,119
4,120
4,121
4,122
4,123
4,124
4,125
4,126
4,127
4,128
4,129
4,130
4,131
4,132
4,133
4,134
4,135
4,136
4,137
4,138
4,139
4,140
4,141
4,142
4,143
4,144
4,145
4,146
4,147
4,148
4,149
4,150
4,151
4,152
4,153
4,154
4,155
4,156
4,157
4,158
4,159
4,160
4,161
4,162
4,163
4,164
4,165
4,166
4,167
4,168
4,169
4,170
4,171
4,172
4,173
4,174
4,175
4,176
4,177
4,178
4,179
4,180
4,181
4,182
4,183
4,184
4,185
4,186
4,187
4,188
4,189
4,190
4,191
4,192
4,193
4,194
4,195
4,196
4,197
4,198
4,199
4,200
4,201
4,202
4,203
4,204
4,205
4,206
4,207
4,208
4,209
4,210
4,211
4,212
4,213
4,214
4,215
4,216
4,217
4,218
4,219
4,220
4,221
4,222
4,223
4,224
4,225
4,226
4,227
4,228
4,229
4,230
4,231
4,232
4,233
4,234
4,235
4,236
4,237
4,238
4,239
4,240
4,241
4,242
4,243
4,244
4,245
4,246
4,247
4,248
4,249
4,250
4,251
4,252
4,253
4,254
4,255
4,256
4,257
4,258
4,259
4,260
4,261
4,262
4,263
4,264
4,265
4,266
4,267
4,268
4,269
4,270
4,271
4,272
4,273
4,274
4,275
4,276
4,277
4,278
4,279
4,280
4,281
4,282
4,283
4,284
4,285
4,286
4,287
4,288
4,289
4,290
4,291
4,292
4,293
4,294
4,295
4,296
4,297
4,298
4,299
4,300
4,301
4,302
4,303
4,304
4,305
4,306
4,307
4,308
4,309
4,310
4,311
4,312
4,313
4,314
4,315
4,316
4,317
4,318
4,319
4,320
4,321
4,322
4,323
4,324
4,325
4,326
4,327
4,328
4,329
4,330
4,331
4,332
4,333
4,334
4,335
4,336
4,337
4,338
4,339
4,340
4,341
4,342
4,343
4,344
4,345
4,346
4,347
4,348
4,349
4,350
4,351
4,352
4,353
4,354
4,355
4,356
4,357
4,358
4,359
4,360
4,361
4,362
4,363
4,364
4,365
4,366
4,367
4,368
4,369
4,370
4,371
4,372
4,373
4,374
4,375
4,376
4,377
4,378
4,379
4,380
4,381
4,382
4,383
4,384
4,385
4,386
4,387
4,388
4,389
4,390
4,391
4,392
4,393
4,394
4,395
4,396
4,397
4,398
4,399
4,400
4,401
4,402
4,403
4,404
4,405
4,406
4,407
4,408
4,409
4,410
4,411
4,412
4,413
4,414
4,415
4,416
4,417
4,418
4,419
4,420
4,421
4,422
4,423
4,424
4,425
4,426
4,427
4,428
4,429
4,430
4,431
4,432
4,433
4,434
4,435
4,436
4,437
4,438
4,439
4,440
4,441
4,442
4,443
4,444
4,445
4,446
4,447
4,448
4,449
4,450
4,451
4,452
4,453
4,454
4,455
4,456
4,457
4,458
4,459
4,460
4,461
4,462
4,463
4,464
4,465
4,466
4,467
4,468
4,469
4,470
4,471
4,472
4,473
4,474
4,475
4,476
4,477
4,478
4,479
4,480
4,481
4,482
4,483
4,484
4,485
4,486
4,487
4,488
4,489
4,490
4,491
4,492
4,493
4,494
4,495
4,496
4,497
4,498
4,499
4,500
4,501
4,502
4,503
4,504
4,505
4,506
4,507
4,508
4,509
4,510
4,511
4,512
4,513
4,514
4,515
4,516
4,517
4,518
4,519
4,520
4,521
4,522
4,523
4,524
4,525
4,526
4,527
4,528
4,529
4,530
4,531
4,532
4,533
4,534
4,535
4,536
4,537
4,538
4,539
4,540
4,541
4,542
4,543
4,544
4,545
4,546
4,547
4,548
4,549
4,550
4,551
4,552
4,553
4,554
4,555
4,556
4,557
4,558
4,559
4,560
4,561
4,562
4,563
4,564
4,565
4,566
4,567
4,568
4,569
4,570
4,571
4,572
4,573
4,574
4,575
4,576
4,577
4,578
4,579
4,580
4,581
4,582
4,583
4,584
4,585
4,586
4,587
4,588
4,589
4,590
4,591
4,592
4,593
4,594
4,595
4,596
4,597
4,598
4,599
4,600
4,601
4,602
4,603
4,604
4,605
4,606
4,607
4,608
4,609
4,610
4,611
4,612
4,613
4,614
4,615
4,616
4,617
4,618
4,619
4,620
4,621
4,622
4,623
4,624
4,625
4,626
4,627
4,628
4,629
4,630
4,631
4,632
4,633
4,634
4,635
4,636
4,637
4,638
4,639
4,640
4,641
4,642
4,643
4,644
4,645
4,646
4,647
4,648
4,649
4,650
4,651
4,652
4,653
4,654
4,655
4,656
4,657
4,658
4,659
4,660
4,661
4,662
4,663
4,664
4,665
4,666
4,667
4,668
4,669
4,670
4,671
4,672
4,673
4,674
4,675
4,676
4,677
4,678
4,679
4,680
4,681
4,682
4,683
4,684
4,685
4,686
4,687
4,688
4,689
4,690
4,691
4,692
4,693
4,694
4,695
4,696
4,697
4,698
4,699
4,700
4,701
4,702
4,703
4,704
4,705
4,706
4,707
4,708
4,709
4,710
4,711
4,712
4,713
4,714
4,715
4,716
4,717
4,718
4,719
4,720
4,721
4,722
4,723
4,724
4,725
4,726
4,727
4,728
4,729
4,730
4,731
4,732
4,733
4,734
4,735
4,736
4,737
4,738
4,739
4,740
4,741
4,742
4,743
4,744
4,745
4,746
4,747
4,748
4,749
4,750
4,751
4,752
4,753
4,754
4,755
4,756
4,757
4,758
4,759
4,760
4,761
4,762
4,763
4,764
4,765
4,766
4,767
4,768
4,769
4,770
4,771
4,772
4,773
4,774
4,775
4,776
4,777
4,778
4,779
4,780
4,781
4,782
4,783
4,784
4,785
4,786
4,787
4,788
4,789
4,790
4,791
4,792
4,793
4,794
4,795
4,796
4,797
4,798
4,799
4,800
4,801
4,802
4,803
4,804
4,805
4,806
4,807
4,808
4,809
4,810
4,811
4,812
4,813
4,814
4,815
4,816
4,817
4,818
4,819
4,820
4,821
4,822
4,823
4,824
4,825
4,826
4,827
4,828
4,829
4,830
4,831
4,832
4,833
4,834
4,835
4,836
4,837
4,838
4,839
4,840
4,841
4,842
4,843
4,844
4,845
4,846
4,847
4,848
4,849
4,850
4,851
4,852
4,853
4,854
4,855
4,856
4,857
4,858
4,859
4,860
4,861
4,862
4,863
4,864
4,865
4,866
4,867
4,868
4,869
4,870
4,871
4,872
4,873
4,874
4,875
4,876
4,877
4,878
4,879
4,880
4,881
4,882
4,883
4,884
4,885
4,886
4,887
4,888
4,889
4,890
4,891
4,892
4,893
4,894
4,895
4,896
4,897
4,898
4,899
4,900
4,901
4,902
4,903
4,904
4,905
4,906
4,907
4,908
4,909
4,910
4,911
4,912
4,913
4,914
4,915
4,916
4,917
4,918
4,919
4,920
4,921
4,922
4,923
4,924
4,925
4,926
4,927
4,928
4,929
4,930
4,931
4,932
4,933
4,934
4,935
4,936
4,937
4,938
4,939
4,940
4,941
4,942
4,943
4,944
4,945
4,946
4,947
4,948
4,949
4,950
4,951
4,952
4,953
4,954
4,955
4,956
4,957
4,958
4,959
4,960
4,961
4,962
4,963
4,964
4,965
4,966
4,967
4,968
4,969
4,970
4,971
4,972
4,973
4,974
4,975
4,976
4,977
4,978
4,979
4,980
4,981
4,982
4,983
4,984
4,985
4,986
4,987
4,988
4,989
4,990
4,991
4,992
4,993
4,994
4,995
4,996
4,997
4,998
4,999
5,000
OS DE LOS EMPLEADOS
ción de los terceros a los cuales le va a emitir el certificado

Salarios o
Fecha inicial Fecha final emolumentos Honorarios Servicios
eclesiasticos

20,000,000.00 0.00 0.00

2017-01-01 2017-12-01 10,000,000.00
2017-01-01 2017-06-01 10,000,000.00
 Gastos de
Comisiones Prestaciones sociales Víaticos representación

0.00 2,000,000.00 0.00 0.00

2,000,000.00
 Cesantías e intereses
de cesantías
Compensación por el Pensiones de
efectivamente
trabajo asociado Otros pagos jubilación, vejez o
pagadas, consignadas
cooperativo invalidez
o reconocidas en el
periodo casilla 64

0.00 0.00 2,500,000.00 0.00

2,500,000.00
 14

Descuentos aportes
a fondo de
Descuentos Aportes Descuentos Aportes
pensiones y a fondos de AportesAFC
a cuentas
obligatorios por voluntarios
solidaridad P. Y
salud aportes voluntarios pensiones voluntarias
al RAIS

250,000.00 300,000.00 0.00 0.00

250,000.00 300,000.00
Retefuente descontada
por rentas de trabajo o
pensiones

500,000.00
500,000.00 1
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 Certificado de Ingresos y Retenciones por En esta casilla digi
Rentas de Trabajo y de Pensiones certificado que des
información digitad
Año gravable 2017 EMPLEADOS" dado
los datos del respe
Revise que todo es
Antes de diligenciar este formulario lea cuidadosamente las instrucciones 4. Número de formulario 1 procedimiento por

5. Número de Identificación Tributaria (NIT): 6. DV. 7. Primer Apellido 8. Segundo Apellido 9. Primer Nombre 10. Otros Nombres
Retenedor

900526587 - 3
11. Razón Social
EMPRESA DE EJEMPLO
24. Cód. Tipo 25. Número de documento de identificación Apellidos y nombres
Empleado

de documento
13. 2,125,421 GOMEZ GIRALDO MARIA ANGELICA
26. Primer apellido 27 Segundo apellido 28. Primer Nombre 29 Otros Nombres
34
35. Cód. Ciudad/
Periodo de la Certificación 32. Fecha de Expedición 33. Lugar donde se practicó la retención Cód.
Municipio
Dpto.
30. de: 2017-01-01 31. A: 2017-12-01 2018-04-27 BOGOTA 1 41 0 1 3
36. Número de agencias, sucursales, filiales o subsidiarias de la empresa retenedora cuyos montos de retención se consolidan:
1
Concepto de los Ingresos Valor
Pagos por salarios o emolumentos eclesiásticos 37 10,000,000.00
Pagos por honorarios 38
Pagos por servicios 39
Pagos por comisiones 40
Pagos por prestaciones sociales 41 2,000,000.00
Pagos por viáticos 42
Pagos por gastos de representación 43
Pagos por compensaciones por el trabajo asociado cooperativo 44
Otros pagos 45
Cesantías e intereses de cesantías efectivamente pagadas, consignadas o reconocidas en el periodo 46 2,500,000
Pensiones de jubilación, vejez o invalidez 47
Total de ingresos brutos (Sume casillas 37 a 47) 48 14,500,000
Concepto de los aportes Valor
Aportes obligatorios por salud 49 250,000
Aportes obligatorios a fondos de pensiones y solidaridad pensional y Aportes voluntarios al - RAIS 50 300,000
Aportes voluntarios a fondos de pensiones voluntarias 51
Aportes a cuentas AFC. 52
Valor de la retención en la fuente por rentas de trabajo y pensiones 53 500,000
Nombre del pagador o agente retenedor

Datos a cargo del trabajador o pensionado

Concepto de otros ingresos Valor recibido Valor retenido
Arrendamientos 54 0.00 61 0.00
Honorarios, comisiones y servicios 55 0.00 62 0.00
Intereses y rendimientos financieros 56 0.00 63 0.00
Enajenación de activos fijos 57 0.00 64 0.00
Loterías, rifas, apuestas y similares 58 0.00 65 0.00
Otros 59 0.00 66 0.00
Totales: (Valor recibido: Sume casillas 54 a 59), (Valor retenido: Sume 61 a 66) 60 0.00 67 0.00
Total retenciones año gravable 2017 (Sume casillas 53 + 67) 68 500,000.00
Ítem 69. Identificación de los bienes poseídos 70. Valor Patrimonial
1
2
3
4
5
6
7
8
Deudas vigentes a 31 de Diciembre de 2017 71
Identificación de la persona dependiente de acuerdo al parágrafo dos del artículo 387 del Estatuto Tributario
72. C.C. o NIT 73. Apellidos y Nombres 74. Parentesco

Firma del trabajador o pensionado

Certifico que durante el año gravable de 2017:

1. Mi patrimonio bruto era igual o inferior a 4.500 UVT ($143.366.000).

2. No fui responsable del impuesto sobre las ventas ni del impuesto nacional al consumo.
3. Mis ingresos brutos fueron inferiores a 1.400 UVT ($44.603.000).
4. Mis consumos mediante tarjeta de crédito no excedieron la suma de 1.400 UVT ($44.603.000).
5. Que el total de mis compras y consumos no superaron la suma de 1.400 UVT ($44.603.000)
6. Que el valor total de mis consignaciones bancarias, depósitos o inversiones financieras no excedieron los 1.400 UVT ($44.603.000).
Por lo tanto, manifiesto que no estoy obligado a presentar declaración de renta y complementario por el año gravable 2017.

Original: asalariado NOTA: Este certificado sustituye para todos los efectos legales la declaración de Renta y Complementarios para el empleado que lo firme.

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