LEMBAGA HASIL DALAM NEGERI MALAYSIA

UNDER SECTION 77 INCOME TAX ACT 1967 RETURN FORM OF A DECEASED PERSON'S ESTATE

CP2C-Pin. 2011 TP

Form YEAR OF ASSESSMENT

2011 <>>>>>>>>>>>>>>>>>>>>>>>>>?

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Correspondence Address of Executor/ Administrator

FOR OFFICE USE

Day Month Year

1 = Yes (Fill in Part B)

1 = Yes

Postcode

State

2 = No

2 = No (Fill in Part C)

Day Month Year

PART A : PARTICULARS OF DECEASED PERSON'S ESTATE Domicile in Malaysia at the Time of Demise

1 = Yes 2 = No

2 = No 1 = Yes Date of Demise

Letter of Administration / Grant of probate

Compliance with Public Rulings

A2

A4

A6

A3

A5

A1

A7

A8

Income Tax No.

TP

Will

Date of Letter of Administration / Grant of Probate

Country of Domicile at Time of Demise

-

1

2

-

1

Name of Deceased Person's Estate

A7a Record-keeping ! 2 = No 1 = Yes

(Use Country Code)

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

This form is prescribed under section 152 Income Tax Act 1967

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<>>>? Town Postcode

State

Business Premise Address of Deceased Person's Estate

A9

Status of Tax ( f rom page 7 ) ( Ind ica te in the re levant box)

Tax Repayable: (item D7)

Tax paid in excess (item E4)

There is balance of tax payable (item D6/E3 whichever is relevant)

Not taxable / Nil balance (if D6/D7/E3/E

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Particulars of Executors / Administrators Name

Income Tax No.

Passport No.

2

Type of file: SG/OG/C

(* delete whichever is not relevant)

A12e A12d

A12c A12b

A12a A12

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Executor / Administrator I

Executor / Administrator II

Executor / Administrator I

Executor / Administrator II

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Telephone No.

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<>>>>>>>>>? Executor / Administrator I

Executor / Administrator II

Identity Card/ Police/ Army/ Registration No *

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State <>>>>>>>>>>>>>>>? Town

A11

A10 Address where records of deceased person's estate are maintained

Other address (if A10 = 3)

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<>>>>>>>>>>>>>>? <>>>? Town Postcode

State

Address of Bank

Bank Account No.

Name of Bank

Particulars of Executor's / Administrator's Bank (for purpose of income tax refund, if any)

A13c

A13b

A13a

A13

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<>>>>>>>>>>>>>>>>>>>>>>>>? A11a Website / Blog Address

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If maintained at address as per A8 If maintained at address as per A9 If maintained at an address other than A8 and A9

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Name of Deceased Person's Estate

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B1

B2

B3

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B7

B8

B9

Statutory Income From Business Business Code Amount (RM)

Business 1

Business 2

Business 3 + 4 and so forth (if any)

Income Tax No. Statutory Income From Partnership

B4

B5

B6

B7

B8

B9

Partnership 1

Partnership 2

Partnership 3 + 4 and so forth (if any)

Aggregate statutory income from businesses (B1 to B6)

LESS: Business losses brought forward (Restricted to amount in B7)

TOTAL (B7 - B8)

BAHAGIAN B: PENDAPATAN BERKANUN, JUMLAH PENDAPATAN DAN JUMLAH CUKAI YANG DIKENAKAN

Note: Fill in Part B if the taxpayer is DOMICILED in Malaysia at the time of his demise (If A1 = 1)

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

B10 B10

B11

B12

B13

B14

B15

B16

B17

B18

<>_>>_>>_>>? B11

B12

B13

B14

B15

B16

B17

B18

Dividends STATUTORY INCOME FROM OTHER SOURCES

Interest and discounts

Rents, royalties and premiums

Annuities and other periodical payments

Other gains or profits

Additions pursuant to paragraph 43(1)(c)

Aggregate statutory income from other sources (B10 to B15)

AGGREGATE INCOME (B9 + B16)

LESS: Current year business losses (Restricted to amount in B17)

D

D

D

3

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Declare amount in Ringgit Malaysia (RM) currency

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Name of Deceased Person's Estate

Amount (RM)

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B21

B22

B23

B24

TOTAL (B19 - B20) (Enter '0' if value is negative) LESS:

LESS: Other expenditure

B29

B27

B30

B32 TOTAL INCOME (B23 B31)

Total donations and gifts (B24 to B30)

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B36

Tax on the first

Tax on the balance

TOTAL TAX CHARGEABLE (B35a + B35b)

4

At Rate (%)

B35

B35a

LESS: Personal relief

COMPUTATION OF TAX CHARGEABLE (Refer to the tax rates schedule provided)

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B26

B27

B29

B30

B31

B32

B34

B23

B25

B22

B20

B21

TOTAL (B21 - B22) (Enter '0' if value is negative) LESS: Donations and Gifts

B24

Annuities payable / periodical payments

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(Enter '0' if value is negative)

(Enter '0' if value is negative) CHARGEABLE INCOME (B32 - B33)

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B31

B35b

B34

B36

B28 B28 <>_>>_>>_>>? , , ,

B24A

Gift of money to the Government, State Government, local authorities

Gift of artefacts, manuscripts or paintings

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

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

Business zakat (restricted to 2.5% of aggregate income in B17)

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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

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Gift of money to approved institutions and organisations

Restricted to 7% amount in B17

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B19 B19 TOTAL (B17 - B18) <>_>>_>>_>>? , , ,

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Name of Deceased Person's Estate

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Note: Fill in Part C if the taxpayer is NOT DOMICILED in Malaysia at the time of his demise (A1=2)

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

5

Statutory Income From Business

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Income Tax No. Statutory Income From Partnership

C7

C8

C9

C10

C11

C12

C13

C14

C15

C16

C17

C18

C17

C18

C13

C14

C15

C16

C8

C9

C10

C11

C12

C4

C5

C6

C7

C1

C2

C3

Business 1

Business 2

Business 3 + 4 and so forth ( if any )

Partnership 1

Partnership 2

Partnership 3 + 4 and so forth ( if any )

LESS: Business losses brought forward (Restricted to amount in C7)

Dividends

STATUTORY INCOME FROM OTHER SOURCES

Rents and premiums

Annuities and other periodical payments

Other gains or profits

Additions pursuant to paragraph 43(1)(c)

Discounts

Aggregate statutory income from other sources (C10 to C15)

AGGREGATE INCOME (C9 + C16)

LESS: Current year business losses (Restricted to amount in C17)

D

D

D

Aggregate statutory income from businesses (C1 to C6)

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[Declare amount in Ringgit Malaysia (RM) currency]

Business Code Amount (RM)

Amount (RM)

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Name of Deceased Person's Estate

TOTAL (C7 - C8)

6

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<>_>>_>>_>>? C22

C23

C24

C31

C32

C33a

C33b

C33c

C33d

C34

C30

C22

C23

C24

C26

C27

C29

C31

C25

C32

C33

C33a

C33b

C33c

C33d

C34 TOTAL INCOME/CHARGEABLE INCOME (C32 to C33d)

TOTAL (C23 C31)

Gross income subject to tax at other rates

Royalties

Interest

Special classes of income under section 4A

Other income (please specify )

LESS:

TOTAL (C21 - C22) (Enter '0' if value is negative)

(Enter '0' if value is negative)

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C29

C30 <>_>>_>>_>>?

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C28C28 <>_>>_>>_>>? , , ,

C24A

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C21 C21 TOTAL (C19 - C20) (Enter '0' if value is negative) <>_>>_>>_>>? , , ,

C19

C20

C19

C20

TOTAL (C17 - C18)

LESS: Other expenditure <>_>>_>>_>>?

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Income Tax No.

Name of Deceased Person's Estate

Qualifying prospecting expenditure - Schedule 4 and paragraph 44(1)(b)

Annuities payable / periodical payments

LESS: Donations and Gifts Gift of money to the Government, State Government, local authorities Gift of money to approved institutions and organisations

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

Restricted to 7% amount in C17

Gift of artefacts, manuscripts or paintings

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

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

Business zakat (restricted to 2.5% of aggregate income in C17)

Total donations and gifts (C24 to C30)

* Please enter the tax position (D6 / D7 / E3 / E4 whichever is applicable) under the item Statusof Tax on page 1

7

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25

5

8

10

12

15

C35

C35a

C35b

C35c

C35d

C35e

C35f

Gross income subject to tax at other rates

COMPUTATION OF TAX CHARGEABLE

Chargeable Income Rate (%) Tax Chargeable

C36

Division of chargeable income according to the rate applicable

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TOTAL TAX CHARGEABLE (C35a to C35g)

C35g

C36

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D6

D2

D3

D1

BAHAGIAN D : TAX PAYABLE / REPAYABLE

D4

D5

D6

Tax deduction under section 51 Finance Act 2007 (dividends)

Section 132 tax relief

OR

LESS

D3

D2

D1

Section 110 tax deduction (others)

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Section 133 tax relief

D7 TAX REPAYABLE * [(D2 to D5) - D1] D7

TAX PAYABLE * [D1 - (D2 to D5)]

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TOTAL TAX CHARGEABLE (from B36 or C36)

BAHAGIAN E : STATUS OF TAX FOR YEAR OF ASSESSMENT 2011

E1 E1 Tax payable (from D6) ->>_>>_>>_>? , , , . E2

E3

E2

E3

LESS: Installments paid

Balance of tax payable * (E1 - E2)

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E4 E4 Tax paid in excess * (E2 - E1) ->>_>>_>>_>? , , , .

Restricted to D1

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D4

D5

Income Tax No.

Name of Deceased Person's Estate

[ A13a, A13b and A13c on page 2]

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G3

G3a

G3b

G3c

G3d

Section

107A

PARTICULARS OF WITHHOLDING TAXES

109

109A

109B

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Total Tax Withheld and Remitted to LHDNM

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PARTICULARS OF BUSINESS INCOME

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G1a

G1b

G1c

Allowance Absorbed

Balanced Carried Forward

Losses carried forward (G1a + G1b)

Business 1

LOSSES

Balance from previous years' losses

Balance from current year losses

CAPITAL ALLOWANCES

G1

G1a

G1b

G1c

G2

G2e

G2f

G2a

G2b

G2c

G2d

Partnership 2

Partnership 3 + 4 and so forth (if any)

Balanced Carried Forward

Business 2

Partnership 1

Business 3 + 4 and so forth (if any)

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PART G :

Year for which paid Type of Income Gross Amount

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PART F : PRECEDING YEARS' INCOME NOT DECLARED

F1

F3

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H3

H4

PART H : SPECIAL DEDUCTION, FURTHER DEDUCTION AND DOUBLE DEDUCTION Claim Code Amount Amount

H1

H2

TOTAL CLAIMED H5 H5

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Total Gross Amount Paid

<>>>>>>>>? Income Tax No.

Name of Deceased Person's Estate

9

PART K: FINANCIAL PARTICULARS OF DECEASED PERSON'S ESTATE TRADING, PROFIT, AND LOSS ACCOUNT

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K1

K2

K3

K4

K5

K7

K8

K9

K11

K10

K6

K12

K13

K14

K15

K16

K17

K1

K2

K3

K4

K5

K6

K7

K8

K9

K10

K11

K12

K13

K14

K15

K16

K17

INCOME:

TOTAL INCOME (K8 to K12)

EXPENSES:

LESS:

Contracts and subcontracts

Salaries and wages

Rental / lease /

Loan interest

Other business income

Dividends

Interest and discounts

Other income

Rents, royalties and premiums

(Enter "X" if negative)

Closing stock

Opening stock

Business Code

Sales or Turnover

Purchases and cost of production

Cost of sales (K3 + K4 - K5)

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GROSS PROFIT / GROSS LOSS (K2 - K6)

K18 K18 Commissions <>_>>_>>_>>? , , ,

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J3

PART J: INCENTIVE CLAIM

Type of Incentive Amount Absorbed

J1

J3 Schedule 4 Qualifying Expenditure

Schedule 7A Allowance

J2 Increased Exports Allowance For Qualifying Services

Balance Carried Forward

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<>>>>>>>>? Income Tax No.

Name of Deceased Person's Estate

10

K19

K20

K21

K19

K20

K21 Repairs and maintenence

Travelling and transportation

Bad debts <>_>>_>>_>>?

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K22 K22 Promotion and advertisement <>_>>_>>_>>? , , ,

K23 K23 Other expenses <>_>>_>>_>>? , , ,

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K24

K25

K26

K27

K28

K24

K25

K26

K27

K28

TOTAL EXPENSES (K14 to K23)

NET PROFIT/ LOSS

BALANCE SHEET Fixed Assets:

(Enter "X" if negative)

Non-allowable expenses

Land and buildings

Plant and machinery

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Current Assets:

K33 K33

K34

K35

K36

K37

K38

K39 <>_>>_>>_>>?

K34

K35

K36

K37

K38

K39 TOTAL CURRENT ASSET (K33 to K38)

Stock

Trade debtors

Cash in hand

Sundry debtors

Cash at bank

Other current assets

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K29

K30

K29

K30

Motor vehicles

Other fixed assets <>_>>_>>_>>?

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K31

K32

TOTAL FIXED ASSETS (K27 to K30)

Investments

K31

K32

(Enter "X" if negative) !

K40 K40 TOTAL ASSET (K31 + K32 + K39) <>_>>_>>_>>? , , ,

<>>>>>>>>? Income Tax No.

Name of Deceased Person's Estate

11

L5 L5 Other income <>_>>_>>_>>?

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K41

K42

K43

K44

K45

K46

K47

K48

K49

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K41

K42

K43

K44

K45

K46

K47

K48

K49

LIABILITIES:

OWNER'S EQUITY: TOTAL LIABILITY (K41 to K43)

Loans

Trade creditors

Sundry creditors

Capital account

Special fund

Net advance/drawing

Current account balance brought forward

Current year profit/loss

(Enter "X" if negative)

(Enter "X" if negative)

(Enter "X" if negative)

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K50

PARTICULARS OF EXEMPT INCOME

L2

L4

L3

L1

L4

L3

L2

L1

Interest

Business and Partnership

Rents

Dividends

K50 Current account balance carried forward

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PART L :

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Designation

I

Identity Card / Police / Army / Passport No. * *Delete whichever is not relevant hereby declare that the information regarding the income and claim for deductions given by me in this return form and in any document attached is true, correct and complete.

Signature

EXECUTOR'S DECLARATION

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<>>>>>>? - - Date: Day Month Year

<>>>>>>>>? Income Tax No.

Name of Deceased Person's Estate

12

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

Postcode

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Town

State

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Name of Firm

Address of Firm

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b

c

d

e

f

Telephone No.

Handphone No.

e-Mail

Tax Agent Approval No.

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Designation

Signature

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Income Tax No.

Name of Deceased Person's Estate

RM

REMITTANCE SLIP DIRECTOR GENERAL OF INLAND REVENUE To:

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

INCOME TAX NO. PAYMENT CODE INSTALLMENT NO.

Amount of Payment

Reference No. (Identity Card / Police / Army / Passport No.)

Cheque No. and Others

Name of Bank

Telephone No.

Date :

CP501 [Pin. 1/2011]

Name and Postal Address

084 99

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

Please ensure that this return form is completed and in order. Carefully check all information given before it isfurnished to Lembaga Hasil Dalam Negeri Malaysia (LHDNM). Check to ensure that the following have been done. (Tick ‘ ’ in the relevant box):

Payment can be made as follows: (a) Bank - Counter of CIMB Bank Berhad (CIMB), Public Bank Berhad (PBB), Malayan Banking

Berhad (Maybank), EON Bank and Affin Bank Berhad (ABB) by using the bank payment slip. - CIMB, PBB, Maybank & EON Bank internet banking and Maybank phone banking.- Auto Teller Machine (ATM) of PBB, Maybank & CIMB, PBB Cheque Deposit Machine and

CIMB Cash Deposit Machine.(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 ofassessment 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 above 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 2012 (does not carry on business) OR 30 June 2012 (carry on business). Any balance remaining unpaid upon the expiration of 60 days from the date of such increase, shall be further increase by 5% under subsection 103(4) ITA 1967 of the balance unpaid.

PENINSULAR MALAYSIA

SABAH & FT LABUAN

SARAWAK

Lembaga Hasil Dalam Negeri Malaysia Cawangan Pungutan, Tingkat 15, Blok 8A Kompleks Bangunan Kerajaan, Jalan Duta Karung Berkunci 11061 50990 Kuala Lumpur

Postal Address

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

Payment Counter 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

Please read the following reminder before signing this return form

REMINDER

Tax computation has been done on the appropriate working sheets (according to the Form TP Explanatory Notes and Guidebook) and the amounts accurately transferred to this return form. All working sheets, records and documents are properly kept for examination by LHDNM.

All information has been clearly filled in the spaces provided. Name and income tax number are clearly indicated at the top of 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:-

YEAR OF ASESSMENT

2011

MALAYSIA INCOME TAX Remittance Slip

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

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

Lembaga Hasil Dalam Negeri Malaysia Cawangan Pungutan, Tingkat 15, Blok 8A Kompleks Bangunan Kerajaan, Jalan Duta Karung Berkunci 11061 50990 Kuala Lumpur

Postal Address Payment Counter PENINSULAR MALAYSIA

SABAH & FT LABUAN

SARAWAK

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

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

1. Payment can be made as follows: 1.1 Bank - counters of CIMB Bank Berhad (CIMB), Public Bank Berhad (PBB), Malayan Banking Berhad (Maybank), EON Bank and

Affin Bank Berhad (ABB) by using the bank payment slip. - CIMB, PBB, Maybank & EON Bank internet banking and Maybank phone banking. - Auto Teller Machine (ATM) of PBB, Maybank and CIMB, PBB Cheque Deposit Machine and CIMB Cash Deposit Machine.

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