LEMBAGA HASIL DALAM NEGERI MALAYSIA

RETURN FORM OF A CO-OPERATIVE SOCIETY

UNDER SECTION 77A INCOME TAX ACT 1967

This form is prescribed under section 152 Income Tax Act 1967 C1 Form

CP5(CS) [Pin. 2014]

YEAR OF ASSESSMENT

2014

1

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1

5

3

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[Declare in Ringgit Malaysia (RM) currency]

CS E

Accounting Period

4 Employer’s No.

Income Tax No.

Name of Co-operative Society

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Day Month Year <>>>>>>?

Day Month Year

Record-keeping 7 1 = Yes

2 = No

Business Code Amount (RM)

STATUTORY INCOME, TOTAL INCOME AND TOTAL TAX CHARGEABLE PART A:

Statutory Business Income

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A1 Business 1

Business 2

Income Tax No.

Statutory Partnership Income

Amount (RM)

Business 3

Business 4

Business 5 + 6 and so forth A5

A4 C4

A3

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Partnership 1

Partnership 2

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A7

A6

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Status of Tax ( f rom page 4 ) (Enter ‘X ’ i n the re levant box)

Tax repayable (item B11)

Tax paid in excess (item C4)

There is balance of tax payable (item B10/C3 whichever is relevant)

Not taxable / Nil balance (if B10/B11/C3/C4 = ‘0’)

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2 Reference No. (Registration No.)

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

For Office Use

6 Basis Period

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Day Month Year <>>>>>>?

Day Month Year

To

From

From

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A14

A15

A16

A17

A18

A19

A20

A21

A22

A23

A24

Other Statutory Income

Dividends

Interest and discounts

Rents, royalties and premiums

Other income

Additions pursuant to paragraph 43(1)(c)

Aggregate of other statutory income (A14 to A18)

AGGREGATE INCOME (A13 + A19)

Current year business losses (Restricted to A20)

TOTAL (A20 – A21)

Other Expenditure

Prospecting expenditure – Schedule 4 and paragraph 44(1)(b)

Pre-operation business expenditure – Schedule 4B and paragraph 44(1)(b

A14

A15

A16

A17

A18

A19

A20

A21

A22

A23

A24

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LESS:

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A26

Donations / Gifts / Contributions / Zakat

A26 Gift of money to the Government / Local Authority

LESS:

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Name of Co-operative Society Society

TOTAL (A11 – A12)

A11

A12

A13

Aggregate statutory income from businesses (A1 to A10)

Business losses brought forward (Restricted to A11)

A11

A12

A13

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LESS:

D Partnership 3

Partnership 4

Partnership 5 + 6 and so forth

D

D A10

A9

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3

PART B: TAX PAYABLE

B3b

B3c

B2a

INCOME TAX COMPUTATION (AT FIXED RATE)

Apportionment of Income Tax

B1

5

8

B4

B1

B2

TOTAL INCOME TAX (B2a + B2b + B3a + B3b + B3c)

Tax on the balance

Tax on the first

Chargeable Income (from A36)

INCOME TAX COMPUTATION [AT CO-OPERATIVE SICIETY RATE (Refer to the schedule)]

B3a

B3

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Rate (%)

At Rate (%)

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A35

A34

Deduction under subsection 65A(b)

CHARGEABLE INCOME (A32 + A33 – A34 – A35) A36

A34

A35

A36

Deduction under subsection 65A(a)

LESS:

B2b

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Name of Co-operative

Society

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TAXABLE PIONEER INCOME A33

A32 A32

A33

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TOTAL INCOME [A25 – (A26 to A31)]

A31 A31 Zakat Perniagaan (restricted to 2.5% of aggregate income in A20)

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A30

A28

A27C

A28

A30

A27B

A29 A29

A27A

Gift of money for the provision of library facilities or to libraries

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

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

Gift of money to approved institutions or organisations

Restricted to 7% of A20

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A27

Gift of artefacts, manuscripts or paintings

Gift of paintings to the National Art Gallery or State Art Gallery

Income Tax

Income Tax

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Amount (RM)

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D3

D2

D1

D4

D5

D11

Claim Code Amount (RM)

TOTAL CLAIMED (D1 to D10)

PART D: SPECIAL DEDUCTION, FURTHER DEDUCTION AND DOUBLE DEDUCTION

Claim Code

D11

D8

D7

D6

D9

D10

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B5

B6

B8

B9

B10

B11

Section 133 tax relief

Total Deduction / Relief (B5 hingga B8)

TAX PAYABLE * (B4 – B9)

TAX REPAYABLE * (B9 – B4)

LESS:

B6

B8

B9

B10

B11

OR

Section 132 tax relief

Section 110 tax deduction (others)

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

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PART C: STATUS OF TAX FOR YEAR OF ASSESSMENT 2014

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C1

C2

C3

C4

Tax payable (from B10)

Instalments paid

Balance of tax payable * (C1 – C2)

Tax paid in excess * (C2 – C1)

OR

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LESS:

C1

C2

C3

C4

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. *Please enter the tax posit ion (B10 / B11 / C3 / C4 whichever is applicable) under the item ‘Status of Tax’ on page 1.

Restricted to B4

[For a ‘Tax Repayable’ case, fill in items

M7, M8 and M9 on page 9]

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Baki Hantar Hadapan

Baki Hantar Hadapan

G1 Schedule 4 expenditure

G2 Schedule 4B expenditure

G3 Schedule 7A

allowance

G1

G2

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PART H: INCOME OF PRECEDING YEAR NOT DICLARED

H1 H1 <>_>>_>>_>>?

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PART G: INCENTIVE CLAIM

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G4 Investment tax allowance

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Amount Absorbed

Balance Carried Forward

Chargeable income of preceding year not declared (if any)

PART J: DISPOSAL OF ASSET UNDER THE REAL PROPERTY GAINS TAX ACT 1976

J1 Has disposed of asset?

J2 Has the disposal been declared to LHDNM? (If J1 = 'Yes')

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Name of Co-operative Society

1 = Yes

2 = No

1 = Yes

2 = No

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E1

E2

E3

E4

E5

E6

E7

E8

E9

E10

Business

PART E: CLAIM FOR SCHEDULE 3 ALLOWANCE

Amount Absorbed

1

2

3

4

5

E1a

E5a

E4a

E3a

E2a

1

2

3

4

5

E6a

E10a

E9a

E8a

E7a

Balance Carried Forward

E1b

E5b

E4b

E3b

E2b

Balance Carried Forward

E6b

E10b

E9b

E8b

E7b

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Partnership Amount Absorbed

F1A

F1

PART F: CLAIM FOR LOSSES

Type of Loss

F1 Business/Partnership losses

Pioneer Losses

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K16

K17

K18

K19

K20

K21

K22

K23

Bad debts

Other expenses

TOTAL EXPENSES (K13 to K17)

NET PROFIT / LOSS

Non-allowable expenses

Fixed Assets:

Motor vehicles

Plant and machinery

Land and buildings

!

(Enter “X” if value is negative)

K16

K17

K18

K19

K20

K21

K22

K23

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6

Name of Co-operative Society

PART K: FINANCIAL PARTICULARS OF CO-OPERATIVE SOCIETY

Business Income (Main Business):

K1 Business Code

K2 Sales or turnover

K3 Opening stock

K4 Purchases and cost of production

K5 Closing stock

K6 Cost of sales (K3 + K4 – K5)

K7 GROSS PROFIT / LOSS (K2 – K6)

K8 Other business income

K9 Rental income

K10 Interest income

K11 Dividend income

K12 Other income

(Enter “X” if value is negative) !

K1

K2

K3

K4

K5

K6

K7

K8

K9

K10

K11

K12

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K14

K15

Salaries and wages

Rental

K13

K14

K15

Expenses

Funds K39

TOTAL LIABILITY AND FUNDS (K38 + K39) K40

Amount of Members‘ Funds at the first dayof the basis period

K41

Amount transferred during the basis period to the Statutory Reserve Fund pursuant to subsection 65A(a)

K42

Amount pursuant to subsection 65A(b) K43

K39

K40

K41

K42

K43

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K37

K38

Other liabilities

TOTAL LIABILITY (K35 to K37 )

K37

K38

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K24

K25

K26

K27

K28

K29

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K30

K31

K32

K33

Other fixed assets

TOTAL FIXED ASSET (K21 to K24)

Investments:

Investments

Current Assets:

Stock

Trade debtors

Sundry debtors

Cash at bank

Other current assets

TOTAL ASSET (K25 + K26 + K33)

TOTAL CURRENT ASSET (K27 to K32)

Cash in hand

K34

K24

K25

K26

K27

K28

K29

K30

K31

K32

K33

K34

!

(Enter “X” if value is negative)

K35 Trade creditors

Sundry creditors

Liabilities:

K36

K35

K36

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M4

M5

Date Registered

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Place of Registration

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Day Month Year

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M3 Address of Business Premise

State

Town Postcode

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Name of Co-operative Society

Section

107A

109

109A

109B

L1

L2

L3

L4

M1

M2 Correspondence Address

Total Gross Amount Paid Total Tax Withheld And

Remitted To LHDNM Total Net Amount Paid

PART M: PARTICULARS OF CO-OPERATIVE SOCIETY

Main Business Address

PART L: PARTICULARS OF WITHHOLDING TAX

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

State

Town Postcode

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State

Town Postcode

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109F L5 <>_>>_>>?

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M13a

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Particulars of Co-operative Society’s Principal Officers M13

Name

Chairman

Treasurer

Secretary

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Name of Co-operative Society

M8

M9

M10

M11

<>>>>>>>>>>>>>>>>>>>>>>>>? <>>>>>>>>>>>>>>>>>>>>>>>>? !

Name of Bank

Bank Account Number

Address where co-operative society’s records are maintained

If item “M10” does not apply, state the address where the co-operative society’s records are maintained

Telephone No.

1 = Address as per M1 2 = Address as per M2 3 = Address as per M3

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M7

e-Mail M12

State

Town Postcode

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Address

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Website / Blog address

M6

Notes : Enter the name of the bank and bank account number for the purpose of electronic income tax refund

10

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Name

Identification / Passport No.

Income Tax No.

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Particulars of co-operative society’s five board members M14

M14a

M14b

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Type of file:

SG/OG

Name <>>>>>>>>>>>>>>>>>>>>>>>>>>? <>>>>>>>>>>>>>>>>>>>>>>>>>>? <>>>>>>>>>>?

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SG/OG

Name of Co-operative Society

Identification / Passport No.

Income Tax No. Type of file:

Chairman

M13b Identification No.

Treasurer

Secretary

Chairman

Treasurer

Secretary

Chairman

Treasurer

Secretary

Chairman

Treasurer

Secretary

M13h Amount of Allowance

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Passport No. M13c

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M13f Salary / Commission / Bonus

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M13d Income Tax No.

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Type of file:

SG/OG

Type of file:

SG/OG

Type of file:

SG/OG

Telephone No.

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M13e

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Equity Holding (%) M13g

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DECLARATION

11

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Name of Co-operative Society

M14c

M14d

M15e

Name <>>>>>>>>>>>>>>>>>>>>>>>>>>? <>>>>>>>>>>>>>>>>>>>>>>>>>>? <>>>>>>>>>>?

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SG/OG

Name <>>>>>>>>>>>>>>>>>>>>>>>>>>? <>>>>>>>>>>>>>>>>>>>>>>>>>>? <>>>>>>>>>>?

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SG/OG

Name <>>>>>>>>>>>>>>>>>>>>>>>>>>? <>>>>>>>>>>>>>>>>>>>>>>>>>>? <>>>>>>>>>>?

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SG/OG

Identification / Passport No.

Income Tax No. Type of file:

Identification / Passport No.

Income Tax No. Type of file:

Identification / Passport No.

Income Tax No. Type of file:

DECLARATION

I

Identification / Passport No.* (* Delete whichever is not relevant)

hereby declare that this return form contains information that is true, correct and complete pertaining to the income tax of the above co-

operative as required under the Income Tax Act 1967.

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Signature Date

Designation

Day Month Year

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12

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Name of Co-operative Society

f Tax Agent’s Approval No. <>>>>>>>>>>>>>?

Signature Date

Day Month Year

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Designation <>>>>>>>>>>>>>>>>>>>>>>>>? <>>>>>>>>>>>>>>>>>>>>>>>>?

PARTICULARS OF THE FIRM AND SIGNATURE OF THE PERSON WHO COMPLETE THIS FORM

a

b

c

d

e

Name of Firm

Address of Firm

Telephone No.

e-Mail

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Postcode

State

Town

Handphone No.

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