lembaga hasil dalam negeri malaysia name of company:...

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Name of Company: ..............................................................................................................................................

TaxReference No. –

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CP5-Pin. 2005YEAR OF ASSESSMENT

2005 Form

CLEMBAGA HASIL DALAM NEGERI MALAYSIAINCOME TAX FORM OF A COMPANY UNDERSECTION 77A OF THE INCOME TAX ACT 1967

This form is prescribed under section 152 of the Income Tax Act 1967

II

III

Tax referencenumber

Employer'snumber

IV

B: SUMMARY OF TAX AND PAYMENTS

DECLARATION

B1 Tax payable (from A16) B1

B2 Less: Instalments payments made B2

B3 Balance of tax payable B3Or

B4 Tax paid in excess B4

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I Identity card no./Passport no. herebydeclare that this form contains information that is true, correct and complete pertaining to the income tax of the above company for theYear of Assessment 2005 as required under the Income Tax Act 1967.

Date Signature Designation

A: TAX PAYABLE

A2 5

A3 8

A4 10

A5 15

A5A 20

A6 28

A7

A8 TOTAL INCOME TAX CHARGED A8

A9 LESS: Section 6B rebate A9

A10 TOTAL A10

A11 Section 110 tax deduction (dividends) A11

A12 Section 110 tax deduction (others) A12

A13 Section 132 tax relief A13

A14 Section 133 tax relief A14

A15 Total Deduction/Relief A15

A16 TAX PAYABLE A16

TAX REPAYABLE A17

Apportionment of Chargeable Income

A1 Chargeable income [from ( C32 + C33 )] A1 , , , ,

V Country of residence(Use the country code)

Declare in Ringgit Malaysia currency

C

E VII

VIII

IX

X Compliance withPublic Rulings

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Less:

Name ofcompany

Yes No

Opening dateof accounts

Closing dateof accounts

Yes No

Yes No

Companyregistrationnumber MonthDay Year

VI

Electronic filing

Resident: (Indicate "X")

Income TaxRate (%)

MonthDay Year

A17

I

Or

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Name of Company: ..............................................................................................................................................


C: STATUTORY INCOME, TOTAL INCOME AND CHARGEABLE INCOMEStatutory Business Income

C1 Business 1

C2 Business 2

C3 Business 3

C4 Business 4

C5 Business 5

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Statutory Partnership Income

C6 Partnership 1 D:

C7 Partnership 2 D:

C8 Partnership 3 D:

C9 Partnership 4 D:

C10 Partnership 5 D:

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Less:

Less:

Less:

Business Code Amount

Tax Reference No. Amount

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Aggregate statutory income from businesses

C24

C25

C26

C29

C29A

CHARGEABLE INCOME OF FOREIGN FUND MANAGEMENT(S 60G)

C29A

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Donation (gifts of money/contributions)

Current year business losses

C29

C26

C25

C24

Business losses brought forward

C11 TOTAL (C1 to C10) C11

C12 C12

C13 C13Other Statutory Income

C14 Dividends C14

C15 Interest or discounts C15

C16 Rents, royalties or premiums C16

C17 Other income C17

C18 Additions pursuant to paragraph 43(1)(c) C18

C19 C19

C20 AGGREGATE INCOME (C13 + C19) C20

C21 C21

C22 TOTAL (C20 - C21) C22

C23 Prospecting expenditure-Schedule 4 and paragraph 44(1)(b) C23Qualifying farm expenditure-Schedule 4A andparagraph 44(1)(b)Pre-operational business expenditure-Schedule 4B andparagraph 44(1)(b)Deduction for approved food production projects-Schedule 4Cand paragraph 44(1)(b)

C27 Expenditure allowed under section 60F or 60H C27

C28 TOTAL C28

BUSINESS ZAKAT [restricted to 2.5% of the aggregateincome in C20]

C30 TOTAL INCOME C30

C31 TAXABLE PIONEER INCOME C31

C32 CHARGEABLE INCOME (C30 + C31) C32

C33 C33

Less: Other Expenses

Aggregate statutory income from other sources(add C14 till C18)

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Name of Company: ..............................................................................................................................................


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D: SPECIAL DEDUCTION, DOUBLE DEDUCTION AND FURTHER DEDUCTIONClaim Code

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D1 D6

D2 D7

D3 D8

D4 D9

D5 D10

D11

E: CLAIM FOR CAPITAL ALLOWANCE

Business

E1 1 E1(a) E1(b)

E2 2 E2(a) E2(b)

E3 3 E3(a) E3(b)

E4 4 E4(a) E4(b)

E5 5 E5(a) E5(b)

Partnership

E6 1 E6(a) E6(b)

E7 2 E7(a) E7(b)

E8 3 E8(a) E8(b)

E9 4 E9(a) E9(b)

E10 5 E10(a) E10(b)

F: CLAIM FOR LOSSES/TAX REBATE

Type of Loss/Rebate

F1 Business/Partnership Losses F1

F2 Pioneer Losses F2(a)

F3 Losses from F3(a)Approved ServiceProjects

F4 Business Lossesfrom OperationalHeadquarters/Foreign FundManagement

F5 Shipping Lossesunder Section 54A

F6 Section 6B Rebate F6

AmountAmount Claim Code

Amount Claimed Balance Carried Forward



D11TOTAL CLAIMED

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F3(b)

F4(b)

F5(b)

F4(a)

F5(b)

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Name of Company: ..............................................................................................................................................


G: INCENTIVE CLAIM

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H: INCOME TRANSFERRED TO EXEMPT ACCOUNT

Type of Incentive

Amount

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Amount Claimed Balance Carried ForwardInvestment TaxAllowance

IndustrialAdjustmentAllowance

TOTAL TRANSFERRED TO EXEMPT ACCOUNT [G1(a) to G6D(a)]

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G1(a)

G2(a)

G1(b)

G2(b)

G1

G2

InfrastructureAllowance , , , , , ,G3(a) G3(b)G3

Schedule 7AAllowance , , , , , ,G4(a) G4(b)G4

Schedule 7BAllowance , , , , , ,G5(a) G5(b)G5

Allowance forIncreasedExports

, , , , , ,G6(a) G6(b)G6

Allowance forIncreasedAgricultureExports

, , , , , ,G6A(a) G6A(b)G6A

, , , , , ,G6B(a) G6B(b)G6B IncreasedExportsAllowance forMalaysian InternationalTrading Companies

Value ofIncreasedExport ofServices

, , , , , ,G6C(a) G6C(b)G6C

SpecialIncentive forExports

, , , , , ,G6D(a) G6D(b)G6D

Schedule 4 Expenditure

Schedule 4A Expenditure

Schedule 4B Expenditure

TOTAL CLAIM [C23 to C25 and G1(a) to G6D(a)]

G7

G8

G9

G10

G11

G7

G8

G9

G10

G11

H1

H2

H3

H4

H5

H6

H6A

H7

H7A

H7B

H8

H9

H10

Foreign income remittances

Pioneer income/Portion of pioneer income

Exempt income from approved service projects

Exempt income under subsection 60A(2)

Exempt income under subsection 60B(2)

Income of Venture Capital Company

Income of Venture Capital Management Company

Income of Operational Headquarters Company

Exempt income of International Procurement Centre

Exempt income of Regional Distribution Centre

Income of Foreign Fund Management Company

Income of Closed-end Fund CompanyIncome from Domestic Tour and/orGroup Inclusive Tour Operating Business

G1

G2

G3

G4

G5

G6

G6A

G7

G7A

G7B

G8

G9

G10

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Name of Company: ..............................................................................................................................................


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NLYYYYYI: EXEMPT ACCOUNT

J: PREVIOUS YEAR'S INCOME NOT DECLARED

K: DISPOSAL OF SHARES IN A REAL PROPERTY COMPANY AND DISPOSAL OFREAL PROPERTY SUBJECT TO REAL PROPERTY GAINS TAX PROVISION

L: FINANCIAL PARTICULARS OF COMPANYBusiness Income:

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H11

H12

H13

H7

H7A

H7B

H8

H9

H10

Tax exempt dividend income

Shipping income under section 54A

Exempt income under paragraph 127(3)(b) and otherexemptions

Income of organisers of approved international trade exhibitions

Exempt income from the provision of charteringservices of luxury yachts

Income from approved food production projects

Income of conference promoter in Malaysia

TOTAL TRANSFERRED TO EXEMPT ACCOUNT

G11

G12

G13

G14

G15

G16

G17

G18

G19

Amount

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I1

I2

I3

Credit in account

Tax exempt dividend paid, credited or distributed

Balance carried forward

I1

I2

I3 (Indicate "X" if value is negative)

NoYes

(Indicate "X" in the relevant box)

If K1 = "yes"

NoYesAny disposal of shares and/or real property?

Has the disposal been declared to LHDNM?

K1

K2

, , ,J1Previous year's chargeable income (if any)J1

Business code (Main business)L1 L1

, , ,L2Sales or turnover (Main business)L2

Cost of ProductionL4A L4A

L5Closing StockL5

, , ,Opening StockL3 L3Less:

, , ,PurchasesL4 L4

, , ,L6Cost of salesL6

, , ,L7GROSS PROFIT (L2-L6) / GROSS LOSS (L6-L2)L7

, , ,L8Other business incomeL8

, , ,L9Other incomeL9

, , ,L10Non-taxable profitsL10

(Indicate "X" if value is negative)

, , ,, , ,Contract paymentL13 L13

L14Salaries andwagesL14

, , ,InterestL11 L11

, , ,Professional,technical,managementand legal fees

L12 L12

Expenses:

Income from offshore trading via website in Malaysia

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Name of Company: ..............................................................................................................................................


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L15 Royalties L15

L16 Rental/lease L16

L17 L17

Fixed Assets:

L29 TOTAL FIXED ASSET L29

L30 Investments L30

L25 Motor vehicles L25

L26 Plant and machinery L26

L27 Land and buildings L27

L28 Other fixed assets L28

L20 L20

L21 Other expenses L21

L38 Loans L38

L39 Trade creditors L39

L40 Sundry creditors L40

L41 Loan from directors L41

L42 Other current liabilities L42

L36 TOTAL CURRENT ASSET L36

L37 TOTAL ASSET (L29 + L30 + L36) L37

L22 TOTAL EXPENDITURE L22

L23 NET PROFIT OR LOSS L23

L24 Non-allowable expenses L24

L31 Trade debtors L31

L32 Sundry debtors L32

Stock L32A

L33 Loan to directors L33

L34 Cash in hand/Cash at bank L34

L35 Other current assets L35

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Maintenance and repairs

Research anddevelopmentPromotion andadvertisement

Travelling andaccomodation

L18 L18

L19 L19


L32A

Current Liabilities:LIABILITIES AND OWNERS' EQUITY

Current Assets:

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Name of Company: ..............................................................................................................................................


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L43 TOTAL CURRENT LIABILITY L43

L44 Long-term liabilities L44

L45 TOTAL LIABILITY L45

Shareholders' Equity:

L46 Paid-up capital L46

L47 L47

L48 Reserve account L48

L49 Total Equity L49

L50 TOTAL LIABILITY AND EQUITY L50

M: MAKLUMAT CUKAI PEGANGAN

Gross payments to non-residents subject to withholding tax under sections 107A, 109, 109A and 109B.

M1 107A

M2 109

M3 109A

M4 109B

Total tax withheld andremitted to LHDNMSection Gross amount paid Net amount paid

Amount

M: PARTICULARS OF WITHHOLDING TAXES

N: TRANSACTIONS BETWEEN RELATED COMPANIES

N1 Total sale to related companies in Malaysia N1

N2 Total sale to related companies outside Malaysia N2

N3 Total purchase from related companies in Malaysia N3

N4 Total purchase from related companies outside Malaysia N4

N5 Other payments to related companies in Malaysia N5

N6 Other payments to related companies outside Malaysia N6

N7 Loans to related companies in Malaysia N7

N8 Loans to related companies outside Malaysia N8

N9 Loans from related companies in Malaysia N9

N10 Loans from related companies outside Malaysia N10

N11 Receipts from related companies in Malaysia N11

N12 Receipts from related companies outside Malaysia N12

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Profit and loss appropriationaccount

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Name of Company: ..............................................................................................................................................


O: PARTICULARS OF COMPANY

O1 Status of company: Public Controlled Institution

Real Property Venture Capital

Foreign FundManagement

O4 Correspondenceaddress

O5 Address ofbusiness premise

O2 Registered address

O3 e-mail

O6 Name of bank

O7 Bank account number

O9 O2 O4 O5

O9A

O8 Address of bank

Postcode Town

State

Postcode Town

State

Postcode Town

State

Postcode Town

State

Postcode Town

State

(Indicate “X” in therelevant box)

MalaysianInternationalTrade

OperationalHeadquarters

RegionalDistributionCentre

InternationalProcurementCentre

Others

CharitableOrganisationC losed -endFund

InvestmentHolding

Indicate “X” in the box pertaining to theaddress where company records are kept

Other address if O9does not apply

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Name of Company: ..............................................................................................................................................


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O10 Name

O11 Identitycard /passport no.

O12

Equityshareholding (%)

Salaries/fees/commissionsbonus

P: PARTICULARS OF FIVE MAJOR SHAREHOLDERS OF CONTROLLED COMPANY

Director I Director II Director III

Q: FOREIGN EQUITY COMPARED TO PAID-UP CAPITAL

Identity card/ Name % Country of Relationshippassport no./ residence betweenregistration no. (use country companiesof company code) (use code)

Indicate “X” in the relevant box

Q1 70% - 100% 51% - 69% 20% - 50% 19% NIL<

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O16 Telephoneno.

.

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P1

P2

P3

P4

P5

O13

O14

O15

–

–

( )

( )

–

–

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–

–

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Taxreferenceno.

Allowances

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R:PARTICULARS OF THE FIRM AND SIGNATURE OF THE PERSON WHO COMPLETES THIS FORM

R1 Name of firm

R2

R3 Telephone no.

R4 Tax agent's approval /audit licence no.

R5 Business registration no.

R6 e-mail

Please read the following reminder before signing this form.

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R2 Address of firm

Date received Date processed Status of assessment

For Office Use

Date Signature Designation............................................... ...............................................

Website: http://www.hasilnet.org.myDay Month Year

Postcode Town

State

Name of Company: ..............................................................................................................................................


REMINDERPlease ensure that this form is completed and in order. Carefully check all information beforesubmitting it to Lembaga Hasil Dalam Negeri Malaysia.Check to ensure that the following have been done:√ Tax computation has been done on the appendices/working sheets provided and the amounts

accurately transferred to this Form C.√ All appendices/working sheets are kept in order for reference by Lembaga Hasil Dalam Negeri

Malaysia.√ All information has been clearly filled in the spaces provided.√ Name and tax reference number are indicated on the top of every page in this form and

relevant appendices/working sheets.√ Use the remittance slip provided for paying the balance of tax (if any).

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RegistrationNo.

Name ofBankTelephoneNo.

Cheque No.and Others

TAX REFERENCE NO.

Name and Postal Address

CODE

CP207-Pin.1/2005

RM

Date : .........................................................

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99 086

✁

YEAR OF ASSESSMENT

2005

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Amount of Payment

INSTALMENT NO.

REMITTANCE SLIPTo: DIRECTOR GENERAL OF INLAND REVENUEEnclosed herewith is the cheque/money order/postal order/bank draft for the payment of income tax.

-12-JD113870—PNMB., K.L.

MALAYSIAN INCOME TAXRemittance Slip

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NLYYYYY1. Use the Remittance Slip (CP207) when making payment.2. Cheques, money orders, postal orders and bank drafts must be crossed and made payable to the Director General Of Inland Revenue. Payment

can be sent to the IRB postal address or made at the IRB payment counter as follows:

Postal Address Payment CounterPENINSULAR MALAYSIA : Lembaga Hasil Dalam Negeri Malaysia Tingkat Bawah, Blok 8A,

Cawangan Pungutan, Tingkat 15, Blok 8A, Kompleks Bangunan Kerajaan,Kompleks Bangunan Kerajaan, Jalan Duta, Jalan Duta,Karung Berkunci 11061, Kuala Lumpur.50990 Kuala Lumpur.

SABAH & FT LABUAN : Lembaga Hasil Dalam Negeri Malaysia Tingkat Bawah,Unit Pungutan, Wisma Bandaraya,Tingkat Bawah, Wisma Bandaraya, Jalan Masjid Lama,Jalan Masjid Lama, Kota Kinabalu.88600 Kota Kinabalu.

SARAWAK : Lembaga Hasil Dalam Negeri Malaysia Aras 1,Unit Pungutan, Wisma Ting Pek Khiing,Aras 3, 6, 7, 8 & 15, No. 1, Jalan Padungan,Wisma Ting Pek Khiing, Kuching.No. 1, Jalan Padungan,93600 Kuching.

3. Alternatively, payment can be made at the counter of Bumiputra-Commerce Bank Berhad (BCB) and Public Bank Berhad (PBB) by using thepayment slip provided by the bank.

4. Write down the name, tax reference number, year of assessment, address, payment code and telephone number behind the payment instrument.5. Check the receipts/bank slips before leaving the payment counter.

lembaga hasil dalam negeri malaysia name of company:...

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