The image shows a person filling out a form with various sections and numbers. The form appears to be related to financial or tax-related information, as indicated by the presence of a bank account number and other financial details. The person is using a pen to write on the form, and there are several sections with different amounts listed, such as 700, 100, 200, 300, 400, and 500. The form also includes a section for writing a note or comment. The background suggests an office or study setting.