AMPLE COMPANY RETURN FORM FOR YEAR OF A … REMINDER b) orders and bank drafts must be Tol Free Line SAMPLE COMPANY RETURN FORM FOR YEAR OF ASSESSMENT 2017 1) Due date to furnish Form

SAMPLE COMPANY RETURN FORM FOR

YEAR OF ASSESSMENT 2017

IMPORTANT REMINDER

1) Due date to furnish Form e-C and pay the balance of tax payable: Within 7 months from the close of the accounting period

2) This sample form is provided for reference and learning purpose.

3) This sample form CANNOT be used for the purpose of submission to Lembaga Hasil Dalam Negeri Malaysia.

4) In accordance with the provision of the Income Tax Act 1967 (ITA 1967), a company shall:

a) furnish a return on an electronic medium or by way of electronic transmission [subsection 77A(1A)] with effect

from the Year of Assessment 2014;

b) declare its income in the return form based on audited accounts [subsection 77A(4)]; and

c) furnish correct particulars in the return form [paragraph 77A(3)(b) and paragraph 120(1)(h)].

5) A company may be liable to an action under section 112 of ITA 1967 for failure to furnish a return before or on the due date

for submission.

6) An increase in tax of 10% under subsection 103(3) of ITA 1967 shall be imposed for failure to pay the tax or balance of tax

payable before or on the due date for submission. Any balance remaining unpaid upon the expiration of 60 days from the

date of such increase, shall be further increased by 5% of the balance unpaid under subsection 103(4) ITA 1967.

7) METHOD OF PAYMENT

a) Payment can be made at:

i) Bank - Information regarding payment via bank is available at the LHDNM Official Portal, http://www.hasil.gov.my .

ii) LHDNM - ByrHASiL via FPX (Financial Process Exchange) at the LHDNM Official Portal, http://www.hasil.gov.my .

- ByrHASiL via Visa, Mastercard & American Express credit cards at https://byrhasil.hasil.gov.my/creditcard/

- LHDNM payment counters in Peninsular Malaysia (Kuala Lumpur Payment Centre), Sabah dan FT Labuan

(LHDNM Kota Kinabalu Branch) dan Sarawak (LHDNM Kuching Branch) or by mail. Cheques, money

orders and bank drafts must be crossed and made payable to the Director General of Inland Revenue.

When making payment, use the Remittance Slip (CP207) which is available at the LHDNM Official Portal,

http://www.hasil.gov.my . If sent by post, payment must be sent separately from the form. Payment by

CASH must not be sent by post.

iii) Pos Malaysia Berhad - counter and Pos Online

b) Write down the name, address, telephone number, income tax number, year of assessment, payment code ‘086’ and

instalment no. ‘99’ on the reverse side of the financial instrument. e-Filing (e-C) can be accessed via https://ez.hasil.gov.my .

8) For further information, please contact Hasil Care Line:-

Tol Free Line : 1-800-88-5436 (LHDN) Calls From Overseas : 603-77136666

http://www.hasil.gov.my/


https://byrhasil.hasil.gov.my/creditcard/


https://ez.hasil.gov.my/

LEMBAGA HASIL DALAM NEGERI MALAYSIA

SAMPLE OF COMPANY RETURN FORM CP5 [Pin. 2017]

YEAR OF ASSESSMENT

2017

1

PART A: STATUTORY INCOME, TOTAL INCOME AND CHARGEABLE INCOME

[Declare in Ringgit Malaysia(RM) currency]

<>>>?

A1

Business Code Amount (RM)

Business 1

Business 2

Statutory Business Income

Business 3

Business 4

Business 5 + 6 and so forth A5

A4

A3

A2 <>>>?

<>>>?

<>>>?

<>>>?

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

, , ,

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

, , ,

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

, , ,

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

, , ,

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

, , ,

<>>>>>>>>>>>>>>>>>>>>>>>>>>?

I Name of company

<>>>>>>>>>>>>>>>>>>>>>>>>>>?

V

II

[If there is a change in name, submit the Notice of Registration of New Name)

Reference no. (registration no.)

<?

Country of residence (Use the Country Code)

<>>>>>>>>>>?

IV Resident in Malaysia

<>>>>>>>>?

C VI Income tax no.

IX Basis period <>>>>>>?

Day Month Year

From

III Employer’s no. <>>>>>>>>?

E

VIII Accounting period <>>>>>>?

Day Month Year

Substantial change in shareholding and subsection 44(5A) applies

!

XIII 1 = Yes 2 = No 3 = Not relevant

To <>>>>>>?

Day Month Year

To <>>>>>>?

Day Month Year

XI Record-keeping !

1 = Yes 2 = No

From

Small and medium enterprise

!

XII 1 = Yes 2 = No

!

1 = Claim 2 = Surrender 3 = Not relevant

Claim / Surrender loss under the Group Relief provision

[If claiming, submit C (RK-T); If surrendering, submit Form C (RK-S)]

XIV

VII Date of commencement of operations <>>>>>>?

Day Month Year

XV Claim industrial building allowance under subparagraph 42(1) Schedule 3 (Indicate ‘X’)

!

1 = Yes 2 = No

<>>>>>>>>?

Income Tax No. Statutory Partnership Income

Amount (RM)

Partnership 1

Partnership 2

D

D

D Partnership 3 + 4 and so forth

Aggregate statutory income from businesses ( A1 to A8 )

A9

A8

A7

A6

<>>>>>>>>? <>>>>>>>>?

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

, , ,

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

, , ,

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

, , ,

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

, , A9

X Status of business !

1 = In operation 2 = Dormant 3 = In the process of winding up

XVI Claim incentive under section 127 (Indicate ‘X’)

!

Paragraph 127(3)(b) !

Subsection 127(3A) !

Not Relevant

XVII Carry on e-Commerce (If ‘Yes’, complete item P6 on page 11)

!

1 = Yes 2 = No

XVIII Entitled to claim Input Tax from the Royal Malaysian Customs Department

!

1 = Yes 2 = No

XIX Goods & Services Tax registration no.

<>>>>>>>>>>?

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

1 = Yes 2 = No

2

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

……………………………..……………………………………………………………... C <>>>>>>>>? A10

A11 TOTAL ( A9 - A10 )

Business losses brought forward (Restricted to A9)

A10

A11

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

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

, , ,

, , ,

Less:

A12

A13

A18

A19

A20

A21

Other Statutory Income

Dividends

Interest

Other income

Additions pursuant to paragraph 43(1)(c)

Aggregate statutory income from other sources ( A12 to A19 )

AGGREGATE INCOME ( A11 + A20 )

A12

A13

A18

A19

A20

A21

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

, , ,

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

, , ,

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

, , ,

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

, , ,

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

, , ,

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

, , ,

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

A22

A23

Current year business losses (Restricted to A21)

TOTAL ( A21 - A22 )

A22

A23

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

, , ,

Less:

, , ,

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

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

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

A24

A25

A26

A27

Other expenses

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

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

Permitted expenses under section 60H

TOTAL [ A23 – ( A24 to A27 ) ] (Enter ‘0’ if value is negative)

A24

A25

A26

A27

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

, , ,

, , ,

, , ,

, , ,

Less:

Less:

A28

A28

A <>_>>_>>_>>?

, , ,

Gift of money to the Government/ local authority

Donations / Gifts / Contributions / Zakat

A14

A15

A16

A17

Discounts

Rents

Royalties

Premiums

A14

A15

A16

A17

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

, , ,

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

, , ,

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

, , ,

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

, , ,

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

A29 A29 , , ,

Permitted expenses under section 60F

A30AA

Gift of money to approved institutions / organisations / funds

A30B

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

, , ,

Gift of money for any sports activity approved by the Minister of Finance

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

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

, , ,

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

, , ,

Restricted to 10% of A21

A30

A30C

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

, , ,

3

C <>>>>>>>>?

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

……………………………..……………………………………………………………...

Gift of artefacts, manuscripts or paintings

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

A31

A32

A31

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

, , ,

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

, , , Gift of paintings to the National Art Gallery or any state art gallery

A33 A33

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

, , ,

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

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

A36

A34 Zakat perniagaan (restricted to 2.5% of aggregate income in A21)

TOTAL INCOME [ A28 – ( A29 to A35 ) ] (Enter ‘0’ if value is negative)

A34

A36

, , ,

, , ,

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

A35 Claim for loss under Group Relief provision

A35 , , ,

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

CHARGEABLE INCOME ( A36 + A37 )

A39

A38

CHARGEABLE INCOME OF FOREIGN FUND MANAGEMENT (section 60G)

A38

A39

, , ,

, , ,

Apportionment of Chargeable Income

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

B1 CHARGEABLE INCOME [ from ( A38B + A39 ) ] , , , B1 , Rate (%)

Income Tax

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

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

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

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

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

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

B2

B3

B4

B7

B8 TOTAL INCOME TAX CHARGED (B2 to B7 )

5

8

10

15

24

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

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

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

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

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

B8

B5

B6

, , ,

, , ,

, , ,

, , ,

, , ,

, , ,

, , ,

, , ,

, , ,

, , ,

, , ,

, , ,

, , ,

.

.

.

.

.

.

.

TAX PAYABLE

PART B:

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

18 <>_>>_>>_>>?

B5A , , , , , , .

<_?

.

A32

Less:

B11

B10 Section 110B tax deduction <>_>>_>>_>>_>?

B10 , , , .

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

B11 , , , .

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

B13

Section 132 tax relief

B13 , , , .

B9 Tax reduction on income derived from exploration and exploitation of petroleum in a Joint Development Area <>_>>_>>_>>_>?

B9 , , , .

B12 <>_>>_>>_>>_>?

B12

Section 110 tax deduction (others)

, , , . Section 133 tax relief

Restricted to B8

Less: <>_>>_>>_>>?

Exemption in respect of the increase in chargeable income from business

A38A A38A , , ,

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

A38B A38B , , , CHARGEABLE INCOME after exemption ( A38 – A38A )

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

TAXABLE PIONEER INCOME A37 A37 , , ,

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

……………………………..……………………………………………………………... C <>>>>>>>>?

B16 TAX REPAYABLE * ( B14 – B8 ) [For a ‘Tax Repayable’ case, fill in items P7 and P8 on page 11]

Or

B14 Total Tax Reduction / Deduction / Relief ( B9 to B13 )

B14 <>_>>_>>_>>_>?

, , , .

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

B15 TAX PAYABLE * ( B8 – B14 ) B15 , , , .

B16 <>_>>_>>_>>_>?

, , , .

C4 Tax paid in excess ( C2 – C1 )

Or

C4

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

C1 Tax payable ( from B15 ) , , , C1 .

C2A

C3 Balance of tax payable ( C1 – C2 ) C3 <>_>>_>>_>>_>?

, , , .

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

, , , .

Less:

PART C: STATUS OF TAX

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

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

<>?

Amount

, ,

D3

D2

D1

D4

D5

D11

Claim Code Amount

TOTAL CLAIMED

PART D: SPECIAL DEDUCTION, DOUBLE DEDUCTION AND FURTHER DEDUCTION

Claim Code

D8

D7

D6

D9

D10

<>?

, ,

<>? <>?

, ,

<>?

, ,

, ,

<>?

, ,

<>?

, ,

<>?

, ,

<>?

, ,

<>?

, ,

, , , D11

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

, , , C2 .

PART E: CLAIM FOR SCHEDULE 3 ALLOWANCE

E1

E2

E3

E4

E5

E6

E7

E8

Business 1

Amount Absorbed

E1(a)

E5(a)

E4(a)

E3(a)

E2(a)

Partnership Amount Absorbed

E6(a)

E8(a)

E7(a)

Balance Carried Forward

E1(b)

E5(b)

E4(b)

E3(b)

E2(b)


E6(b)

E8(b)

E7(b)

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

, , ,

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

, , ,

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

, , ,

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

, , ,

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

, , ,

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

, , ,

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

, , ,

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

, , ,

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

, , ,

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

, , ,

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

, , ,

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

, , ,

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

, , ,

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

, , ,

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

, , ,

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

, , ,

Business 2

Business 3

Business 4

Business 5 + 6 and so forth

Business

Partnership 1

Partnership 2

Partnership 3 + 4 and so forth

4

Instalments paid pursuant to the provision under section 107C

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

, , , C2B Instalments paid pursuant to the provision under

paragraph 107A(1)(a)

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

, , ,

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

……………………………..……………………………………………………………...

5

C <>>>>>>>>?

Total capital allowance on assets acquired in the basis period

E10 E10 <>_>>_>>_>>?

, , , Tota l capi ta l a l lowance brought forward but disregarded due to substantial change in shareholding E11 E11 <>_>>_>>_>>?

, , ,

CLAIM FOR LOSSES

PART F:

F1

Type of Loss

<_>>_>>_>>?

, , ,


F1(b) F1(a) <_>>_>>_>>?

, ,

Amount Disregarded

F2

F5

F4

F3

Pioneer losses

Losses from approved service projects

Business losses from Operational Headquarters / Foreign Fund Management

Section 54A

shipping losses

Business / partnership losses

F2(a)

F3(a)

F4(a)

F5(a)

<_>>_>>_>>?

, , ,

<_>>_>>_>>?

, , ,

<_>>_>>_>>?

, , ,

F2(b)

F3(b)

F4(b)

F5(b) <_>>_>>_>>?

, , ,

<_>>_>>_>>?

, , ,

<_>>_>>_>>?

, , ,

<_>>_>>_>>?

, , ,

<_>>_>>_>>?

, , ,


Amount Surrendered

Amount Absorbed

<_>>_>>_>>?

, , ,


F1A(b) F1A(a) <_>>_>>_>>?

, , , F1A Losses surrendered under Group Relief provision

E9 E9(a) E9(b) <>_>>_>>_>>?

, , , <>_>>_>>_>>?

, , Total accelerated capital allowance

INCENTIVE CLAIM

PART G:

Amount Absorbed Jenis Insentif Balance Carried Forward

, , , G1 Investment Tax Allowance

G1(a) G1(b) <>_>>_>>_>>?

, , , <>_>>_>>_>>? G2 Industrial

Adjustment Allowance

G2(a) G2(b) <>_>>_>>_>>?

, , , <>_>>_>>_>>?

, , ,

G3 Infrastructure Allowance

G3(a) G3(b) <>_>>_>>_>>?

, , , <>_>>_>>_>>?

, , ,

G4 Schedule 7A Allowance

G4(a) G4(b) <>_>>_>>_>>?

, , , <>_>>_>>_>>?

, , ,

G6 Increased Exports Allowance

G6(a) G6(b) , , , <>_>>_>>_>>?

, , ,

G6A Allowance for Increased Agriculture Exports

G6A(a) G6A(b) <>_>>_>>_>>?

, , , <>_>>_>>_>>?

, , ,

G6B Increased Exports Allowance for Malaysian International Trading Company

G6B(a) G6B(b) <>_>>_>>_>>?

, , , <>_>>_>>_>>?

, , ,

G5 Schedule 7B

Allowance G5(a) G5(b) <>_>>_>>_>>?

, , , <>_>>_>>_>>?

, , ,

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

G6C Value of Increased Export of Services

G6C(a) G6C(b) <>_>>_>>_>>?

, , , <>_>>_>>_>>?

, , ,

G6D Special Incentive for Exports

G6D(a) G6D(b) <>_>>_>>_>>?

, , , <>_>>_>>_>>?

, , ,

G6E Allowance for BioNexus status company

G6E(a) G6E(b) <>_>>_>>_>>?

, , , <>_>>_>>_>>?

, , ,

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

……………………………..……………………………………………………………...

6

C <>>>>>>>>?

G10 TOTAL TRANSFERRED TO EXEMPT ACCOUNT [ G1(a) to G6E(a) ]

G10

G7 Schedule 4 expenditure G7 <>_>>_>>_>>?

, , ,

G8 G8 <>_>>_>>_>>?

, , ,

G9 TOTAL CLAIMED [ A24, A25 and G1(a) to G6E(a) ] G9 <>_>>_>>_>>?

, , ,

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

, , ,

Schedule 4B expenditure

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

Amount

H11

Income Code Amount

TOTAL TRANSFERRED TO EXEMPT ACCOUNT

PART H: INCOME TRANSFERRED TO EXEMPT ACCOUNT

, , , H11

Income Code

<>?

H3

H2

H1

H4

H5

H8

H7

H6

H9

H10

<>? <>? <>? <>?

<>? <>? <>? <>? <>?

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

, , ,

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

, , ,

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

, , ,

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

, , ,

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

, , ,

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

, , ,

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

, , ,

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

, , ,

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

, , ,

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

, , ,

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

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

, , ,

I2

I1

, , ,

PART I: EXEMPT ACCOUNT

I1

I2

Credit in account

Tax exempt dividend paid

Amount

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

I3 , , , I3 Balance carried forward !

(Enter ‘X’ if value is negative)

PART J: INCOME OF PRECEDING YEAR NOT DECLARED

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

K1 Disposal of asset under the Real Property Gains Tax Act 1976 (If ‘Yes’, also complete item K2)

K2 Disposal declared to LHDNM

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

, , , J1 <>>?

Amount Year of Assessment Type of Income

!

1 = Yes 2 = No

!

1 = Yes 2 = No

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

……………………………..……………………………………………………………...

7

C <>>>>>>>>?

Business Income:

Business code

Sales / Turnover

L1

L2

L1

L2 <>_>>_>>_>>?

, , ,

<>>>?

L3

L4

L5

L6

L7

L8

Less:

Opening stock

Purchases

Cost of production

Closing stock

Cost of sales

GROSS PROFIT / LOSS ( L2 – L7 )


L3

L4

L5

L6

L8

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

, , ,

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

, , ,

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

, , ,

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

, , ,

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

, , ,

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

, , !

FINANCIAL PARTICULARS OF COMPANY ( MAIN BUSINESS ) PART L:

L10

L11

L12

Other business income

Other income

Non-taxable profits

L10

L11

L12

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

, , ,

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

, , ,

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

, , ,

L9 Foreign currency exchange gain

L9 <>_>>_>>_>>?

, , ,

L19 Cost of Employee Stock Options

L19 <>_>>_>>_>>?

, , ,

L20

L21

L22

Royalties

Rental / Lease

Maintenance and repairs

L20

L21

L22

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

, , ,

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

, , ,

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

, , ,

L16

L18

Contract payments

Salaries and wages

L16

L18

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

, , ,

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

, , ,

L13

L14

Expenditure:

Interest

Professional, technical, management and legal fees

L13

L14

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

, , ,

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

, , ,

L15 Technical fee payments to non-resident recipients

L15 <>_>>_>>_>>?

, , ,

Type of business activity

L1A <>>>>>>>>>>>>>>>>>>>>>>>>?

<>>>>>>>>>>>>>>>>>>>>>>>>?

L17 Directors’ fee

L17 <>_>>_>>_>>?

, , ,


L7 !

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

……………………………..……………………………………………………………...

8

C <>>>>>>>>?

TOTAL FIXED ASSETS

Other fixed assets

L34

L35

L34

L35

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

, , ,

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

, , ,

L36 Total cost of fixed assets acquired in the basis period

L36 <>_>>_>>_>>?

, , ,

L24

L25

Promotion and advertisement

Travelling and accommodation

L24

L25

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

, , ,

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

, , ,

L23 Research and development

L23 <>_>>_>>_>>?

, , ,

L26 Foreign currency exchange loss

L26 <>_>>_>>_>>?

, , ,

L30 Non-allowable expenses

L30 <>_>>_>>_>>?

, , ,

L27

L28

L29

Other expenditure

TOTAL EXPENDITURE

NET PROFIT / LOSS

(Enter ‘X’ if value is negativef)

L27

L28

L29

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

, , ,

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

, , ,

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

, , , !

Motor vehicles

Fixed Assets:

Plant and machinery

Land and buildings

L31 L31 <>_>>_>>_>>?

, , ,

L32

L33

L32

L33

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

, , ,

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

, , ,

L41

L42

L43

L44

L45

Loans to directors

Cash in hand and cash at bank

Other current assets

TOTAL CURRENT ASSETS

TOTAL ASSETS ( L35 + L37 + L44 )

L41

L43

L44

L45

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

, , ,

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

, , ,

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

, , ,

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

, , ,

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


L42 !

L38

L39

Current Assets:

Trade debtors

Sundry debtors

L38

L39

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

, , ,

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

, , ,

L37 Investments

L37 <>_>>_>>_>>?

, , ,

L40 Stock

L40 <>_>>_>>_>>?

, , ,

L26A Input tax not claimable from the Royal Malaysian Customs Department

L26A <>_>>_>>_>>?

, , ,

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

……………………………..……………………………………………………………...

9

C <>>>>>>>>?

L46

L47

L48

Current Liabilities:

LIABILITIES AND OWNERS’ EQUITY

Loans and overdrafts

Trade creditors

Sundry creditors

L46

L47

L48

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

, , ,

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

, , ,

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

, , ,

L54

L55

L56

L57

L58

Shareholders’ Equity:

Paid-up capital

Profit and loss appropriation account


Reserve account

Total Equity

TOTAL LIABILITIES AND EQUITY



L54

L55

L56

L57

L58

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L52 Long-term liabilities

L52 <>_>>_>>_>>?

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L53 TOTAL LIABILITIES

L53 <>_>>_>>_>>?

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L49

L50

L51

Loans from directors

Other current liabilities

TOTAL CURRENT LIABILITIES

L49

L50

L51

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Section

107A

109

109A

109B

M1

M2

M3

M4

Total gross amount paid Total tax withheld and remitted to LHDNM

Total net amount paid

PART M: PARTICULARS OF WITHHOLDING TAXES

Payments made in the basis period which are subject to the withholding tax provision under sections 107A, 109, 109A, 109B, 109E, 109F and 109G.

109E M5

109F M6

109G M7

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

……………………………..……………………………………………………………...

10

C <>>>>>>>>?

N9

N10

N11

N12

N9

N10

N11

Loans from related companies in Malaysia

Loans from related companies outside Malaysia

Other income from related companies in Malaysia

Other income from related companies outside Malaysia

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

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N1

N2

N3

N4

N5

N2

N3

N4

N5

Total sales to related companies in Malaysia

Total sales to related companies outside Malaysia

Total purchases from related companies in Malaysia

Total purchases from related companies outside Malaysia

Total of other expenses to related companies in Malaysia

PART N: TRANSACTION BETWEEN RELATED COMPANIES

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Amount

N6 N6 Total of other expenses to related companies outside Malaysia <>_>>_>>_>>?

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N7

N8

N7

N8

Loans to related companies in Malaysia

Loans to related companies outside Malaysia

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

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N1

PART P: PARTICULARS OF COMPANY

P2 Registered address

P1 Status of company (Enter ‘X’ in the relevant box)

State

Town Postcode <>>>?

<>>>>>>>>>>>>>>?

<>>>>>>>>>>>>>>>>>>>>>>?

<>>>>>>>>>>>>>>>>>>>>>>?

<>>>>>>>>>>>>>>>>>>>>>>?

<>>>>>>>>>>>>>>>>>>>>>>?

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!

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!

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Public Venture Capital

International Procurement Centre

Charitable Organisation

Operational Headquarters

Foreign Fund Management

MSC BioNexus

Investment Holding

Closed-end Fund

Real Property

Institution

!

!

!

Regional Distribution Centre

Others (Specify: )

Malaysian International Trade

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

……………………………..……………………………………………………………...

11

C <>>>>>>>>?

PART P:

P4

P8

Address of business premise

<>>>>>>>>>>>>>>>>>>>>>>?

P7 <>>>>>>>>>>>>>>>>>>>>>>?

Name of bank *

Bank account no. *

<>>>>>>>>>>>>>>>>>>>>>>?

<>>>>>>>>>>>>>>>>>>>>>>?

<>>>>>>>>>>>>>>>>>>>>>>? <>>>>>>>>>>>>>>>>>>>>>>?

<>>>?

<>>>>>>>>>>>>>>?

Town

<>>>>>>>>>>>>>>>>>>>>>>? <>>>>>>>>>>>>>>>>>>>>>>?

Town

<>>>>>>>>>>>>>>>>>>>>>>? <>>>?

<>>>>>>>>>>>>>>?

P3 Correspondence address

P9 !

!

!

Address where company’s records are kept (Enter ‘X’ in the relevant box)

Address as per P2 Address as per P3 Address as per P4

State

Postcode

P6 <>>>>>>>>>>>>>>>>>>>>>>?

Website / Blog address

P5 Telephone no. of business premise <>>>>>>>>>>?

* Note: Enter the name of the bank and bank account no. for the purpose of electronic income tax refund

Postcode

<>>>>>>>>>>>>>>>>>>>>>>?

State

<>>>>>>>>>>>>>>>>>>>>>>?

P10 Other address if P9 does not apply

Postcode

<>>>>>>>>>>>>>>>>>>>>>>?

<>>>>>>>>>>>>>>>>>>>>>>?

<>>>>>>>>>>>>>>>>>>>>>>? <>>>>>>>>>>>>>>>>>>>>>>?

<>>>?

<>>>>>>>>>>>>>>?

State

Town

<>>>>>>?

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

……………………………..……………………………………………………………...

12

P14 Directors’ income tax no.

Director I

Director II

Director III

SG / OG

SG / OG

SG / OG

<?

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<?

<>>>>>>>>>?

<>>>>>>>>>?

<>>>>>>>>>?

C <>>>>>>>>?

P17 Directors’ salary / bonus

Director I

Director II

Director III

P16 Directors’ equity shareholding (%)

<>_>?

.

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P18 Directors’ fee / commission / allowance

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P12 Directors’ identification / passport no.

Director I

Director II

Director III

<>>>>>>>>>>?

<>>>>>>>>>>?

<>>>>>>>>>>?

P13 Directors’ date of birth

P11

Director I

Director II

Director III

Directors’ Name

<>>>>>>>>>>>>>>>>>>>>>>>>>>?

<>>>>>>>>>>>>>>>>>>>>>>>>>>?

<>>>>>>>>>>>>>>>>>>>>>>>>>>?

<>>>>>>>>>>>>>>>>>>>>>>>>>>?

<>>>>>>>>>>>>>>>>>>>>>>>>>>?

<>>>>>>>>>>>>>>>>>>>>>>>>>>?

P19 Total loan to Directors

Director I

Director II

Director III

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P20 Total loan from Directors

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P15 Directors’ telephone no.

<>>>>>>>>>>?

<>>>>>>>>>>?

<>>>>>>>>>>?

<>>>>>>?

<>>>>>>?

Day Month Year

Day Month Year

Day Month Year

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

……………………………..……………………………………………………………...

13

C <>>>>>>>>?

PARTICULARS OF FIVE MAJOR SHAREHOLDERS OF THE COMPANY

PART Q:

Q1

Q2

Q3

Q5

Q4

Identification / Passport / Registration No.

Name

<>>>>>>>>>>?

<>>>>>>>>>>>>>>>>>>>>>>>>>>?

<>>>>>>>>>>>>>>>>>>>>>>>>>>?


Name

<>>>>>>>>>>?

<>>>>>>>>>>>>>>>>>>>>>>>>>>?

<>>>>>>>>>>>>>>>>>>>>>>>>>>?


Name

<>>>>>>>>>>?

<>>>>>>>>>>>>>>>>>>>>>>>>>>?

<>>>>>>>>>>>>>>>>>>>>>>>>>>?


Name

<>>>>>>>>>>?

<>>>>>>>>>>>>>>>>>>>>>>>>>>?

<>>>>>>>>>>>>>>>>>>>>>>>>>>?


Name

<>>>>>>>>>>?

<>>>>>>>>>>>>>>>>>>>>>>>>>>?

<>>>>>>>>>>>>>>>>>>>>>>>>>>?

Controlled company

!

1 = Yes 2 = No

<>>>>>>?

<>>>>>>?

<>>>>>>?

<>>>>>>?

<>>>>>>?

Day Month Year

Direct shareholding (%)

Country of origin (Use the Country Code) <>_>?

<?

. Shareholder’s date of birth

Day Month Year



<?


Day Month Year



<?


Day Month Year



<?


Day Month Year



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PARTICULARS OF LABUAN ENTITY / ENTITIES

No. Name

( R6a )

Registration No.

( R6b )

Income Tax No.

( R6c )

i. LE

ii. LE

iii. LE

iv. LE

v. LE

vi. LE

vii. LE

viii. LE

ix. LE

x. LE

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

……………………………..……………………………………………………………...

14

C <>>>>>>>>?

OTHER PARTICULARS PART R:

R1 (Enter ‘X’ in the relevant box)

!

!

Yes No R2a Advance Ruling

R2c Material difference in arrangement (To be completed if R2a = ‘Yes’)

!

!

Yes No

R2b Compliance with Advance Ruling (To be completed if R2a = ‘Yes’)

Foreign equity in comparison with paid-up capital:

Advance Ruling: (Enter ‘X’ in the relevant box) R2

!

!

Yes No

!

!

Yes No R3a Advance Pricing Arrangement

R3c Material difference in arrangement (To be completed if R3a = ‘Yes’)

!

!

Yes No

R3b Compliance with Advance Pricing Arrangement (To be completed if R3a = ‘Yes’)

Advance Pricing Arrangement: (Enter ‘X’ in the relevant box) R3

!

!

Yes No

Transfer pricing documentation prepared (Enter ‘X’ in the relevant box) R4 !

!

Yes No

R5a Name of ultimate holding company

Particulars of holding company R5

<>>>>>>>>>>>>>>>>>>>>>>>>>>?

<>>>>>>>>>>>>>>>>>>>>>>>>>>?

<?

Country code

R5b Name of immediate holding company

<>>>>>>>>>>>>>>>>>>>>>>>>>>?

<>>>>>>>>>>>>>>>>>>>>>>>>>>?

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Country code

R6 Has subsidiary company or related company in Labuan F.T. (If ‘Yes’, enter the particulars of the Labuan entity / entities in the following schedule) !

!

Yes No

!

!

> 70% - 100% > 50% - 70% > 20% - 50% NIL !

!

!

< 20%

<>>>>>>?

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

……………………………..……………………………………………………………...

15

C <>>>>>>>>?

PARTICULARS OF THE FIRM AND SIGNATURE OF THE PERSON WHO COMPLETES THIS RETURN FORM

PART T:

T1 Name of firm <>>>>>>>>>>>>>>>>>>>>>>? <>>>>>>>>>>>>>>>>>>>>>>?

T3

T4

Telephone No.

Tax agent’s approval no. <>>>>>>>>>>>>>?

T6

T5

e-Mail

Business registration no.

<>>>>>>>>>>>>>>>>>>>>>>?

<>>>>>>>>>>?

T2 Address of firm

Postcode

State

<>>>>>>>>>>>>>>>>>>>>>>? <>>>>>>>>>>>>>>>>>>>>>>? <>>>>>>>>>>>>>>>>>>>>>>? <>>>?

<>>>>>>>>>>>>>>?

Town

<>>>>>>>>>>>>>>>>>>>>>>?

Signature Date

<>>>>>>>>>>>?

PARTICULARS OF AUDITOR

PART S:

S1 Name of firm <>>>>>>>>>>>>>>>>>>>>>>? <>>>>>>>>>>>>>>>>>>>>>>?

S3 Telephone No.

S2 Address of firm

Postcode

State

<>>>>>>>>>>>>>>>>>>>>>>? <>>>>>>>>>>>>>>>>>>>>>>? <>>>>>>>>>>>>>>>>>>>>>>? <>>>?

<>>>>>>>>>>>>>>?

Town

<>>>>>>>>>>>>>>>>>>>>>>? <>>>>>>>>>>?

Day Month Year

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

……………………………..……………………………………………………………...

16

C <>>>>>>>>? DECLARATION

I

Identification / Passport No. *

hereby declare that this return form has been prepared based on audited accounts and contains information that is true, correct and complete pertaining to the income tax of this company as required under the Income Tax Act 1967.

( * Delete whichever is not relevant )

<>>>>>>>>>>?

<>>>>>>>>>>>>>>>>>>>>>>>>>>? <>>>>>>>>>>>>>>>>>>>>>>>>>>?

Signature Date

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

Day Month Year <>>>>>>?

Documents

AMPLE COMPANY RETURN FORM FOR YEAR OF A … REMINDER b) orders and bank drafts must be Tol Free Line SAMPLE COMPANY RETURN FORM FOR YEAR OF ASSESSMENT 2017 1) Due date to furnish Form