Form

LEMBAGA HASIL DALAM NEGERI MALAYSIA

RETURN FORM OF AN INDIVIDUAL (RESIDENT WHO DOES NOT CARRY ON BUSINESS) UNDER SECTION 77 OF THE INCOME TAX ACT 1967
This form is prescribed under section 152 of the Income Tax Act 1967

YEAR OF ASSESSMENT

BE
1
Name
(as per identity card/passport)

2010
CP 4B - Pin. 2010

Income Tax No. Enter SG or OG

New Identity Card No. Police No. Current Passport No.

Old Identity Card No.

Army No. Passport No. Registered with LHDNM

Status of Tax (from page 5) (Indicate X in the relevant box) Tax Repayable
(item E15)

Tax paid in excess

(item F4)

There is balance of tax payable

PART A:
A1
Citizen

A3

Status as at 31-12-2010

A5

Type of Assessment

or

1 = Single 2 = Married 3 = Divorcee / Widow / Widower 4 = Deceased 1= 2= 3= 4= Joint in the name of husband Joint in the name of wife Separate Self whose spouse without source of income/ has tax exempt income 5 = Self (single/divorcee/widow/widower/deceased)

Use Country Code (Enter MY if Malaysian Citizen)

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2 = Not Applicable

PARTICULARS OF INDIVIDUAL
A2
Sex
1 = Male 2 = Female

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A4 A6

(item E14/F3 whichever is relevant)

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Not taxable / Nil balance
(if E14/E15/F3/F4 = 0)

Date of Marriage/ Divorce/Demise

Day

Month 1 = Yes

Year 2 = No

Compliance with Public Rulings Date of Approval (if A7 = 1)

Day

A7

Approved by the Minister as a Knowledge Worker Correspondence Address

1 = Yes

A7a by the Minister

Month

Year

A8

Postcode

Town

State

A9

Telephone No.

A10 No.

Employer's

FOR OFFICE USE

Date received (1)

1

Date received (2)

Date received (3)

Name

Income Tax No.

A11

e-mail

A12

Name of Bank

A13

Bank Account No.

PART B:
B1
Name of Husband/Wife
(as per identity card/passport)

PARTICULARS OF HUSBAND / WIFE

B2

Income Tax No. Enter SG or OG

B3

New Identity Card No.

B4

Old Identity Card No.

B6

Army No.

(Declare amount in Ringgit Malaysia (RM) currency)

PART C :

C1

Employment

C2

Dividends

C3 C4

Interest and discounts

or

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STATUTORY INCOME AND TOTAL INCOME

Amount (RM) C1

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B7 C2

B5

Police No.

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Passport No.

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C3 C4

Rents, royalties and premiums

C5

Pensions, annuities and other periodical payments

C5

C6

Other gains or profits

C6

C7

AGGREGATE INCOME ( C1 to C6 ) LESS : Donations and Gifts

C7

C8 C8A

Gift of money to the Government, State Government or local authorities Gift of money to approved institutions or organisations

C8

,
C9

,
Restricted to 7% of C7

Gift of money or cost of contribution in kind for any approved sports activity or sports body

,
C10

Gift of money or cost of contribution in kind for any project of national interest approved by the Minister of Finance

,
2

Name

Income Tax No.

C11

Gift of artefacts, manuscripts or paintings to the Government/ State Government Gift of money for the provision of library facilities or to libraries Gift of money or contribution in kind for the provision of facilities in public places for the benefit of disabled persons Gift of money or medical equipment to any healthcare facility approved by the Ministry of Health

C11

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C12

C12

C13

C13

C14

C14

C15

Gift of paintings to the National Art Gallery or any state art gallery TOTAL INCOME (SELF) [ C7 - ( C8 to C15 ) ] (Enter "0" if value is negative)

C15

C16

C16

C17

TOTAL INCOME TRANSFERRED FROM HUSBAND / C17 WIFE * FOR JOINT ASSESSMENT 1 = With business income * Type of income transferred from Husband / Wife 2 = Without business income AGGREGATE OF TOTAL INCOME ( C16 + C17 )

C18

PART D:
D1

Individual and dependent relatives

D2

D3

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(i)

Medical expenses for own parents certified by medical practitioner

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C18

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DEDUCTIONS

9, 0 0 0
RESTRICTED TO 5,000

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Basic supporting equipment for disabled self, spouse, child or parent

RESTRICTED TO 5,000

D4

Disabled individual Education fees (self):

6,000

D5

other than a degree at Masters or Doctorate level - for acquiring law, accounting, Islamic financing, technical, vocational, industrial, scientific or technological skills or qualifications (ii) degree at Masters or Doctorate level - for acquiring any skill or qualification

RESTRICTED TO 5,000

D6

Medical expenses on serious diseases for self, spouse or child Complete medical examination for self, spouse or child (restricted to 500)

D7 D8

RESTRICTED TO 5,000

Purchase of books/magazines/journals/similar publications (except newspapers and banned reading materials) for self, spouse or child Purchase of personal computer for individual (deduction allowed once in every 3 years) Net deposit in Skim Simpanan Pendidikan Nasional (total deposit in 2010 minus total withdrawal in 2010) Purchase of sports equipment for any sports activity as defined under the Sports Development Act 1997

RESTRICTED TO 1,000

D9

RESTRICTED TO 3,000

D10

RESTRICTED TO 3,000

D11

RESTRICTED TO

300

D12

Payment of broadband subscription

RESTRICTED TO

500

D13

Interest on housing loan (Conditions for eligibility to claim must be fulfilled)

The Sale and Purchase Agreement has been executed within 10/03/09 - 31/12/10

RESTRICTED TO 10,000

Name

Income Tax No.

D14 Husband/Wife/Payment of alimony to former wife

RESTRICTED TO 3,000

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D15 Disabled husband/wife

No. of children eligible for deduction No. of children claimed by own self No. of children claimed by husband/wife Eligible Rate No.

3,500

D16

100%
No. Child - Under the D16a age of 18 years

50% x 500 = x 500 = x 2,000 =

x 1,000 =

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Child - 18 years D16b & above and studying

x 1,000 = x 4,000 =

x 5,000 =
D16c child
Child - Disabled

x 9,000 =

D17

Life insurance and provident fund (restricted to RM 6,000)

D18 Deferred Annuity

D19 Education and medical insurance

D20

Total relief ( D1 to D19 )

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x 2,500 = x 4,500 =

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D20

RESTRICTED TO 7,000

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RESTRICTED TO 3,000

PART E:
E1 E2 E2a

TAX PAYABLE

CHARGEABLE INCOME [ ( C16 - D20) or ( C18 - D20 ) ] (Enter "0" if value is negative) INCOME TAX COMPUTATION Chargeable Income Subject to Part XIV of Schedule 1 (if A9 = 1) Knowledge Worker Approved By The Minister
Gross income from employment with a designated company Total gross income from all sources

Chargeable income (from E1)

At Rate

15%

Income Tax Computation In Respect of Chargeable Income Subject to Part I of Schedule 1 (Refer to the tax rate schedule provided)

E2b

Tax on the first

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At Rate (%)

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. . .

E2c E3

Tax on the balance

TOTAL INCOME TAX ( E2a + E2b + E2c ) 4

E3

Name

Income Tax No.

LESS : Tax Rebates

E4

Tax rebate for individual (if E1 does not exceed RM35,000)

400

E6

Zakat or fitrah

, ,

. . . . . . . . . .

E5

Tax rebate for husband/ wife (if E1 does not exceed 400 RM35,000 and D14 is claimed) Total rebate ( E4 to E7 ) (Restricted to amount E3)

E7

Fees/Levy paid by a holder of an Employment Pass, Visit Pass (Temporary Employment) or Work Pass

E8

E8

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E9

TOTAL TAX CHARGED ( E3 - E8 ) LESS :

E9

E10 Tax deduction under section 51 of Finance Act 2007 (dividends)

E10

E11

Section 110 tax deduction (others)

E12

Section 132 tax relief

E13

Section 133 tax relief

Restricted to E9

E14

TAX PAYABLE* [ E9 - ( E10 + E11 + E12 + E13 ) ]

E15

OR : TAX REPAYABLE* [ ( E10 + E11 + E12 + E13 ) - E9 ] [For a Tax Repayable case, fill in items A12 and A13 on page 2]

PART F:
F1

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E12 E13 E14 E15

E11

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STATUS OF TAX FOR YEAR OF ASSESSMENT 2010

F1

Tax payable (from E14) LESS :

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. . . .

F2

Instalments/Monthly Tax Deductions Paid for 2010 Income SELF and HUSBAND / WIFE if joint assessment

F2

F3

Balance of tax payable* ( F1 - F2 )

F3

F4

OR : Tax paid in excess* ( F2 - F1 )

F4

Please enter the tax position (E14 / E15 / F3 / F4 whichever is applicable) under the item Status of Tax on page 1 INCOME OF PRECEDING YEARS NOT DECLARED
Type of Income Year for which paid Gross Amount Provident and Pension Fund Contribution

PART G:

G1

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5

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G2

G3

Name

Income Tax No.

PART H:
H1
Executor's Name

PARTICULARS OF EXECUTOR OF THE DECEASED PERSON'S ESTATE

H2

New Identity Card No.

H3

Old Identity Card No.

H4

Police No.

H5

Army No.

H6

No. Pasport

DECLARATION

Identity Card / Police / Army / Passport No. *

* Delete whichever is not relevant

hereby declare that the information regarding the income and claim for deductions and reliefs given by me in this return form and in any document attached is true, correct and complete.

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Date:

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1 = This return form is made on my own behalf 2 = This return form is made on behalf of the individual in item 1

Day Month

Year

Signature

PARTICULARS OF TAX AGENT WHO COMPLETES THIS RETURN FORM

Name of Firm

Telephone No. Tax Agent's Approval No.

Date:
Day

Month

Year

Signature 6

Please read the following reminder before signing this return form

REMINDER
Please ensure that this return form is completed and in order. Carefully check all information given before submitting it to Lembaga Hasil Dalam Negeri Malaysia. Check to ensure that the following have been done (Tick _/ in the relevant box) Tax computation has been done on the appropriate working sheets (according to the Form BE Explanatory Notes and Guidebook) and the amounts accurately transferred to this return form. All working sheets, records and documents are properly kept for reference by LHDNM. All information have been clearly filled in the spaces provided. Name and income tax number are clearly indicated on every page of this return form and relevant working sheets. If there is any balance of tax payable, payment must be made according to the following:Payment can be made as follows: (a) Bank

- Counters of CIMB Bank Berhad (CIMB), Public Bank Berhad (PBB), Malayan Banking Berhad (Maybank) and EON Bank by using the bank payment slip. - CIMB, PBB, Maybank, EON Bank internet banking and Maybank phone banking. - Auto Teller Machine (ATM) of PBB and Maybank.

(b) LHDNM - e-Payment through FPX (Financial Process Exchange) at LHDNM website, http://www.hasil.gov.my - Payment counters of LHDNM or by mail: Cheques, money orders and bank drafts must be crossed and made payable to the Director General of Inland Revenue. Use the Remittance Slip (CP501) when making payment. Write down the name, address, telephone number, income tax number, year of assessment and payment code on the reverse side of the financial instrument. Payment by CHEQUE / MONEY ORDER / POSTAL ORDER / BANK DRAFT must be separately remitted to LHDNM at the following address. Payment by CASH must not be sent by post. (c) Pos Malaysia Berhad - counter and Pos Online An increase in tax of 10% under subsection 103(3) ITA 1967 shall be imposed for failure to pay the tax or balance of tax payable on or before 30 April 2011 Any balance remaining unpaid upon the expiration of 60 days from the date of such increase, shall be further increased by 5% under subsection 103(4) ITA 1967 of the balance unpaid.
Postal Address PENINSULAR MALAYSIA
Lembaga Hasil Dalam Negeri Malaysia Cawangan Pungutan, Tingkat 15, Blok 8A Kompleks Bangunan Kerajaan, Jalan Duta Karung Berkunci 11061 50990 Kuala Lumpur Lembaga Hasil Dalam Negeri Malaysia Cawangan Kota Kinabalu Wisma Hasil Jalan Tunku Abdul Rahman 88600 Kota Kinabalu Lembaga Hasil Dalam Negeri Malaysia Cawangan Kuching Aras 17, Wisma Hasil No. 1, Jalan Padungan 93100 Kuching

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Payment Coun ter

Tingkat Bawah, Blok 8A Kompleks Bangunan Kerajaan Jalan Duta Kuala Lumpur

SABAH & FT LABUAN

Tingkat Bawah Wisma Hasil Jalan Tunku Abdul Rahman Kota Kinabalu

SARAWAK

Aras 1, Wisma Hasil No. 1, Jalan Padungan Kuching

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REMITTANCE SLIP
To: DIRECTOR GENERAL OF INLAND REVENUE

CP501 [Pin. 1/2010]

Enclosed herewith is the cheque/money order/postal order/bank draft for payment of income tax.

INCOME TAX NO.

PAYMENT CODE

INSTALMENT NO.

YEAR OF ASSESSMENT

084
Amount of Payment Name and Postal Address

99 RM

2010

. , , , !!!!!!!!!!!!

Reference No. (Identity Card / Police / Army / Passport No.) Cheque No. and Others Name of Bank Telephone No.

Date :

.........................................................

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MALAYSIAN INCOME TAX Remittance Slip
1.

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Payment can be made as follows: 1.1 Bank - Counters of CIMB Bank Berhad (CIMB), Public Bank Berhad (PBB), Malayan Banking Berhad (Maybank) and EON Bank by using the bank payment slip. - CIMB, PBB, Maybank, EON Bank internet banking and Maybank phone banking. - Auto Teller Machine (ATM) of PBB and Maybank. 1.2 LHDNM - e-Payment through FPX (Financial Process Exchange) at LHDNM website, http://www.hasil.gov.my - Payment counters of LHDNM or by mail: Cheques, money orders and bank drafts must be crossed and made payable to the Director General of Inland Revenue. Use the Remittance Slip (CP501) when making payment. 1.3 Pos Malaysia Berhad - counter and Pos Online

Postal Address PENINSULAR MALAYSIA

Lembaga Hasil Dalam Negeri Malaysia Cawangan Pungutan, Tingkat 15, Blok 8A Kompleks Bangunan Kerajaan, Jalan Duta Karung Berkunci 11061 50990 Kuala Lumpur embaga Hasil Dalam Negeri Malaysia Cawangan Kota Kinabalu Wisma Hasil Jalan Tunku Abdul Rahman 88600 Kota Kinabalu Lembaga Hasil Dalam Negeri Malaysia Cawangan Kuching Aras 17, Wisma Hasil No. 1, Jalan Padungan 93100 Kuching

Payment Coun ter

Tingkat Bawah, Blok 8A Kompleks Bangunan Kerajaan Jalan Duta Kuala Lumpur Tingkat Bawah Wisma Hasil Jalan Tunku Abdul Rahman Kota Kinabalu Aras 1, Wisma Hasil No. 1, Jalan Padungan Kuching

SABAH & FT LABUAN

SARAWAK

2. 3.

Write down the name, address, telephone number, income tax number, year of assessment and payment code on the reverse side of the financial instrument. Check the receipts/bank payment slips before leaving the payment counter.