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Name1

CP 4B - Pin. 2007

A7

Postcode Town

State

A10

A12

A8 A9 E

A11

-

1

Date received (1) Date received (2) Date received (3)

CitizenA1 A2

Status as at31-12-2007A3 A4

A5 A6

2 3

5

76

4

Enter SG or OG

YEAR OF ASSESSMENT Form RETURN FORM OF AN INDIVIDUAL(RESIDENT WHO DOES NOT CARRY ON BUSINESS)UNDER SECTION 77 OF THE INCOME TAX ACT 1967

LEMBAGA HASIL DALAM NEGERI MALAYSIA

This form is prescribed under section 152 of the Income Tax Act 19672007

TaxReferenceNo.

PassportNo.

PoliceNo.

NewIdentityCard No.

Army No.

Old IdentityCard No.

PART A: PARTICULARS OF INDIVIDUAL

Date of Marriage/Divorce/Demise

SexUse Country Code

(Enter ‘MY’ if Malaysian Citizen)

Type ofAssessment

1 = Single 2 = Married3 = Divorcee / Widow / Widower4 = Deceased

Compliance withPublic Rulings

1 = Male 2 = Female

1 = Yes 2 = No

CorrespondenceAddress

Bank Account No.

Name of Bank

e-mail

TelephoneNo.

Employer 'sNo.

Day Month Year

- -

FOR OFFICE USE

BE

B1

B2 B3

B5

B7B6

B4

PART B: PARTICULARS OF HUSBAND / WIFE

Name ofHusband/Wife

TaxReferenceNo. Enter SG or OG

PassportNo.

PoliceNo.

NewIdentityCard No.

Army No.

Old IdentityCard No.

(as per identitycard/passport)

(as per identitycard/passport)

1 = Joint in the name of husband2 = Joint in the name of wife3 = Separate4 = Single; Spouse without source of income/

with tax exempt income

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PART C : STATUTORY INCOME AND TOTAL INCOME

Name Tax Reference No.

C1

C2

C3

C5

C4

C7

C6

C3

C4

C5

C6

C2

C7

C1 ,,,

,,,

,,,

,,,

,,,

,,,

,,,

Employment

Other gains or profits

Pensions, annuities and other periodical payments

Rents, royalties and premiums

Interest and discounts

Dividends

AGGREGATE INCOME ( C1 to C6 )

TOTAL INCOME (SELF) [ C7 - ( C8 to C15 ) ](Enter "0" if value is negative)

C16C16 ,,,

C17

AGGREGATE OF TOTAL INCOME ( C16 + C17 ) C18C18 ,,,

C17 ,,,* Type of income transferred from Husband / Wife

1 = With business income

2 = Without business income

C8

C9

C10

C11

C12

C13

C10

C11

C12

C8

C9

C13

,,,

,,,

,,,

,,,

,,,

,,,

LESS : Donations and Gifts

Gift of paintings to the National Art Gallery or any state artgallery

Gift of money or medical equipment to any healthcare facilityapproved by the Ministry of Health

Gift of money or contribution in kind for the provision offacilities in public places for the benefit of disabled persons

Gift of money for the provision of library facilities or tolibraries

Gift of artefacts, manuscripts or paintings to the Government/State Government

Gift of money to the Government, State Government, localauthorities or approved institutions and organisations

TOTAL INCOME TRANSFERRED FROM HUSBAND /WIFE * FOR JOINT ASSESSMENT

D4 ,

,

D8A

D8

}D7

D5

D6

,

,,

D1

D2

D3

8 0 0,

,

,

0

,

Individual and dependent relatives

Disabled individual

PART D: DEDUCTIONS

RESTRICTED TO 5,000

6,000

RESTRICTED TO 5,000

RESTRICTED TO 5,000

RESTRICTED TO 1,000

RESTRICTED TO 3,000

C14

C15

C14

C15

,,,

,,,Gift of money or contribution in kind for any project of nationalinterest approved by the Minister of Finance(C14 + C15 restricted to 7% of amount in C7)

Gift of money or contribution in kind for any approved sportsactivity (C14 + C15 restricted to 7% of amount in C7)

Medical expenses for own parents certified by medical practitioner

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

Education fees (self) for acquiring law, accounting, Islamic financing,technical, vocational, industrial, scientific or technological skills orqualifications

Medical expenses on serious diseases for self,spouse or child

Complete medical examination for self, spouse or child(restricted to 500)

Purchase of books/magazines/journals/similar publications (exceptnewspapers and banned reading materials) for self, spouse or child

Purchase of personal computer for individual (deductionallowed once in every 3 years)

D8B ,Net deposit in Skim Simpanan Pendidikan Nasional(total deposit in 2007 minus total withdrawal in 2007) RESTRICTED TO 3,000

RESTRICTED TO 5,000

2

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3

D11b

D11

D11a

D11c

D12

x 500 = ,

x 2,000 =x 4,000 = ,

x 2,500 =x 5,000 =

x 4,500 =x 9,000 =

D14

D13

D14

x 1,000 =

E3

CHARGEABLE INCOME [ ( C16 - D14 ) or ( C18 - D14 ) ](Enter "0" if value is negative)

E1

E2

E2a

E2b

E3

,,,

Total rebate ( E4 to E7 )(Restricted to amount E3)E8

,

E8 ,,, .

,,, .

,,, .

,,, .,,,

,,,

TOTAL TAX CHARGED ( E3 - E8 ) E9E9 ,,, .

50%100%

x 1,000 =

Eligible Rate

x 500 = ,

,,, .

LESS :

E10

E11

E10

E11 ,,, .

,,, .

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

OR : TAX REPAYABLE [ ( E10 + E11 + E12 + E13 ) - E9 ]

E14

E15

E14

E15

E12E12 ,,, .

,,, .

,

,

,,

,

,

,

,

,

,

E13E13 ,,, .

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

E4 E6

E7

350

, .E5 350

,, .

,

,

,

Name Tax Reference No.

Child - Under theage of 18 years

Child :

Child - 18 years& above andstudying

Child - Disabledchild

No. No.

Total relief ( D1 to D13 )

Life insurance and provident fund

Education and medical insurance

RESTRICTED TO 6,000

RESTRICTED TO 3,000

PART E: TAX PAYABLE

Tax on the balance

TOTAL INCOME TAX ( E2a + E2b )

Tax on the first

INCOME TAX COMPUTATION (Refer to the tax rate schedule provided)

At Rate (%)

LESS : Tax Rebates

Zakat or fitrah

Section 110 tax deduction (dividends)

Section 110 tax deduction (others)

Section 132 tax relief

Section 133 tax relief

D9 ,Husband/Wife/Payment of alimony to former wife

3,500D10 Disabled husband/wife ,

Tax rebate for individual(if E1 does not exceedRM35,000)

Tax rebate for husband/wife(if E1 does not exceedRM35,000 and D9 is claimed)

RESTRICTED TO 3,000

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Balance of tax payable ( F1 - F2 )

F1

LESS :

F3

OR : Tax paid in excess ( F2 - F1 ) F4

F1

F2

F3

F4

F2

,,, .

,,, .

,,, .

,,, .

No. Pasport

H3

H5

H1

H2

H6

H4

4

Name Tax Reference No.

PART F: STATUS OF TAX FOR YEAR OF ASSESSMENT 2007

Tax payable (from E14)

Instalments/Schedular Tax Deductions Paid for 2007 Income -SELF and HUSBAND / WIFE if joint assessment

PART G: INCOME OF PRECEDING YEARS NOT DECLARED

Type of Income Year forwhich paid

Provident and PensionFund ContributionGross Amount

G1

G2

G3

G4

G5

,,

,,

,,

,,

,,

,,

,,

,,

,,

,, PART H: PARTICULARS OF EXECUTOR OF THE DECEASED PERSON'S ESTATE

Executor'sName

New IdentityCard No.

Old IdentityCard No.

Army No.Police No.

I

a

b - c

DECLARATION

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

Identity Card No. / Passport No. /Police No. / Army No. ** Delete whichever is not relevant

2 = This return form is made on behalf of the above1 = This return form is made on my own behalf

Day Month Year

- -Date:

Date:

Signature

Signature

Nameof Firm

TelephoneNo.

Tax Agent'sApproval No./Audit Licence No.

PARTICULARS OF TAX AGENT WHO COMPLETES THIS RETURN FORM

- -Day Month Year

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IdentityCard No

Name ofBankTelephoneNo.

Cheque No.and Others

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

Name and Postal Address

CP501 [Pin. 1/2007]

Amount of Payment

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

RM !!!!!!!!!!!!, ,, .

TAX REFERENCE NO. PAYMENT CODE INSTALMENT NO.

99 084

YEAR OF ASSESSMENT

2007

Please read the following reminder before signing this return form

REMINDERPlease ensure that this return form is completed and in order. Carefully check all information givenbefore 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 FormBE Explanatory Notes and Guidebook) and the amounts accurately transferred to this returnform.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 tax reference number are clearly indicated on every page of this return form andrelevant 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) and Public Bank Berhad (PBB)

by using the bank payment slip.- CIMB and PBB internet banking.

(b) LHDNM - e-Payment at LHDNM website.- Payment counters of LHDNM or by mail:

Cheques, money orders and bank drafts must be crossed and made payableto the Director General of Inland Revenue. Use the Remittance Slip(CP501) when making payment.

Website: http://www.hasil.org.my

Write down the name, address, telephone number, tax reference number, year ofassessment and payment code on the reverse side of the financial instrument.Payment by CASH / CHEQUE / MONEY ORDER / POSTAL ORDER must be separatelyremitted to LHDNM at the above address.

Postal Address Payment CounterLembaga Hasil Dalam Negeri MalaysiaCawangan Pungutan, Tingkat 15, Blok 8AKompleks Bangunan Kerajaan, Jalan DutaKarung Berkunci 1106150990 Kuala Lumpur

Tingkat Bawah, Blok 8AKompleks Bangunan KerajaanJalan DutaKuala Lumpur

Lembaga Hasil Dalam Negeri MalaysiaUnit PungutanTingkat Bawah, 3 & 4, Wisma HasilJalan Tunku Abdul Rahman88600 Kota Kinabalu

Tingkat BawahWisma HasilJalan Tunku Abdul RahmanKota Kinabalu

Lembaga Hasil Dalam Negeri MalaysiaUnit PungutanAras 1, Wisma HasilNo. 1, Jalan Padungan93100 Kuching

Aras 1, Wisma HasilNo. 1, Jalan PadunganKuching

SABAH & FT LABUAN

SARAWAK

PENINSULAR MALAYSIA

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MALAYSIAN INCOME TAXRemittance Slip

1. Payment can be made as follows:1.1 Bank - Counters of CIMB Bank Berhad (BCB) and Public Bank Berhad (PBB) by using the bank payment slip.

- CIMB and PBB internet banking.1.2 LHDNM - e-Payment at LHDNM website.

- 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. Usethe Remittance Slip (CP501) when making payment.

2. Write down the name, address, telephone number, tax reference number, year of assessment and payment code on the reverse side of thefinancial instrument.

3. Check the receipts/bank payment slips before leaving the payment counter.

Postal Address Payment CounterLembaga Hasil Dalam Negeri MalaysiaCawangan Pungutan, Tingkat 15, Blok 8AKompleks Bangunan Kerajaan, Jalan DutaKarung Berkunci 1106150990 Kuala Lumpur

Tingkat Bawah, Blok 8AKompleks Bangunan KerajaanJalan DutaKuala Lumpur

Lembaga Hasil Dalam Negeri MalaysiaUnit PungutanTingkat Bawah, 3 & 4, Wisma HasilJalan Tunku Abdul Rahman88600 Kota Kinabalu

Tingkat BawahWisma HasilJalan Tunku Abdul RahmanKota Kinabalu

Lembaga Hasil Dalam Negeri MalaysiaUnit PungutanAras 1, Wisma HasilNo. 1, Jalan Padungan93100 Kuching

Aras 1, Wisma HasilNo. 1, Jalan PadunganKuching

SABAH & FT LABUAN

SARAWAK

PENINSULAR MALAYSIA