1
Borang yang ditetapkan di bawah Seksyen 152 Akta Cukai Pendapatan 1967
Form prescribed under Section 152 of the Income Tax Act 1967
(C.P 4 - Pin. 2002/STTS)
CUKAI PENDAPATAN MALAYSIA
BORANG
TAHUN TAKSIRAN
2002
E
ORANG PERSEORANGAN
PL
B
PENYATA PENDAPATAN
BAGI PENDAPATAN TAHUN 2002
M
RETURN OF INCOME BY AN INDIVIDUAL FOR THE YEAR 2002
SA
File No.
Identity Card No.
Return to:
LEMBAGA HASIL DALAM NEGERI MALAYSIA
Please ensure that your name is printed correctly as it appears in your identity card/passport. If not,
please make the necessary corrections by cancelling and inserting the correct particulars. Enclose
photostat copy of your identity card/passport. (Refer Note, Part A)
You are hereby required to declare all sources of income derived for the year 2002. This return must be completed, signed and furnished to the Inland
Revenue Board at the above address within THIRTY DAYS from the date of this notice. Failure to furnish a return within the time specified or furnishing
a return which is false or failure to notify a change of address may render you liable to prosecution or penalty. This return if posted in Malaysia in an
envelope marked “Income Tax” may be sent free of postage.
TERIMA KASIH ATAS KERJASAMA ANDA
”BERSAMA MENYUMBANG UNTUK PEMBANGUNAN NEGARA”
DATO’ ZAINOL ABIDIN BIN ABD. RASHID
Date :
Director General of Inland Revenue
PART
A
TAXPAYER’S PERSONAL PARTICULARS (REFER NOTE)
If a woman is married and received this form, please state husband’s particulars
and return this form incomplete (Refer note)
SELF
1. Identity Card (new)
-
1. Husband’s Name
-
2. Identity Card (old)
2. Identity Card (new)
3. Passport No.
3. Identity Card (old)
4. Date of Birth (Day / Month / Year)
4. Passport No.
5. Date of Marriage (Day / Month / Year)
5. Date of Marriage (Day / Month / Year)
6. Citizenship
6. Income Tax File No.
7. Telephone No. (House)
7. Employer’s Income Tax File No.
8. Sex (Tick ( ✓) in the relevant box)
Male
Female
DITERIMA PADA
-
-
E
8. IRB Branch
Present correspondence address
Postcode
-
Present residential address
Postcode
UNTUK KEGUNAAN PEJABAT / FOR OFFICE USE
BAHAGIAN KAWALAN
KETUA KUMPULAN (UNTUK ISIHAN)
(Tandakan (✓ ) di petak berkenaan)
Dividen
Perniagaan Bercukai
Bukan Pemastautin
Penggajian Bercukai
Bukan Warganegara
DISELESAIKAN OLEH
2
B
CODE
BUSINESS, TRADE, PROFESSION OR VOCATION
Adjusted Income / Loss (Attach signed copies of Trading and Profit and Loss Account, Balance Sheet and Income Tax
Computation).
SA
M
1
INCOME
PL
ITEM
(Refer Note)
INCOME AND DEDUCTION FOR THE YEAR ENDING 31ST DECEMBER 2002
E
PART
CAPITAL ALLOWANCE
Enclose Capital Allowance Schedule
BALANCING CHARGE
Add
Less
RM
RM
(i) Balancing allowance in the basis period 2002
(ii) Amount of capital allowance brought forward from last year RM
(iii) Amount of capital allowance in the basis period 2002
RM
SUB-TOTAL BUSINESS INCOME (after deducting capital allowances)
2
(a)
▼
Use a separate sheet if more than one business
SHARE OF PARTNERSHIP INCOME/LOSS
Partnership File No.
IRB Branch
▼
D
TOTAL BUSINESS INCOME (ITEM 1 AND 2)
Less: Brought forward losses from previous year
TOTAL NET BUSINESS INCOME ((a) add item 2 and deduct item 3)
4
EMPLOYMENT (Attach statement of salary from employer, form C.P 8A /8C)
- Salary, bonus, director’s fees, commission etc.
- Gratuity
- Compensation
- Value of benefits or amenities in kind
- Value of accommodation provided
- Refunds from unapproved pension schemes
- Subscriptions to professional bodies
Less
- Entertainment expenses
- Travelling expenses
NET EMPLOYMENT
012
(b)
▼
3
103-106
003
107
001
OTHER INCOME
5
DIVIDENDS (Gross) - Attach original dividend vouchers (Refer item 20, on page 3)
6
INTEREST OR DISCOUNT
005
7
RENTS, ROYALTIES OR PREMIUMS (Refer item 21, on page 3)
006
8
PENSIONS, ANNUITIES OR OTHER PERIODICAL PAYMENTS
007&010
9
ANY OTHER GAINS OR PROFITS
009
10
OCCUPATION OF PREMISES IN MALAYSIA FOR NON-BUSINESS PURPOSES
008
11
REMITTANCES RECEIVED FROM OUTSIDE MALAYSIA
009
▼
AGGREGATE INCOME ((b) add item 4 to 11)
004
LESS: DEDUCTION (Attach original receipt)*
12
CURRENT YEAR LOSS
13
CLAIM FOR PROSPECTING EXPENDITURE (SCHEDULE 4) AND/OR CAPITAL EXPENDITURE
ON APPROVED AGRICULTURAL PROJECTS (SCHEDULE 4A)
14
GIFTS OF MONEY TO THE GOVERNMENT, LOCAL AUTHORITY OR APPROVED INSTITUTIONS/
ORGANISATIONS*
016
15
GIFTS OF MONEY TO LIBRARIES*
017
16
GIFT OF ARTEFACTS, MANUSCRIPTS OR PAINTINGS TO THE GOVERNMENT
018
17
GIFTS OF MONEY OR CONTRIBUTION IN KIND FOR PROVIDING FACILITIES IN PUBLIC
PLACES FOR THE BENEFIT OF DISABLED PERSONS*
018A
18
GIFTS OF MONEY OR MEDICAL EQUIPMENT TO ANY HEALTHCARE FACILITY*
018B
19
GIFTS OF PAINTINGS TO NATIONAL OR STATE ART GALLERY
018C
014 &
014A
▼
TOTAL INCOME
013
SELF
WIFE
RM
RM
3
STATEMENT OF MALAYSIAN DIVIDENDS RECEIVED IN 2002*(Attach original dividend vouchers, Refer Note, Part B Item 5)
E
20
PL
Use a separate sheet if necessary
SELF
TAX DEDUCTED
GROSS DIVIDEND
TAX DEDUCTED
RM
RM
RM
RM
RM
SA
GROSS DIVIDEND
▼
M
WIFE
▼
NAME OF COMPANY
NET DIVIDEND
AS PER VOUCHER
TOTAL
▼
DATE OF
PAYMENT
▼
Enter this amount in Item 39, PART M on page 8.
Enter this amount in Item 5, PART B on page 2.
21
STATEMENT OF RENTS, ROYALTIES OR PREMIUM RECEIVED IN 2002* (Refer Note, Part B Item 7)
*Use a separate sheet if necessary
Tick (✓) in the relevant box
RENT
ROYALTY
WIFE
RM
GROSS [ a ]
▼
MONTHLY RENTAL
RENTAL SOURCE (address)
ROYALTY OR
PREMIUM
AMOUNT (RM)
EXPENSES (if any)
WIFE
SUB-TOTAL EXPENSES
▼
SELF
[b]
NET AMOUNT
[a]-[b]
▼
LESS:
SELF
RM
PREMIUM
▼
Enter this total in Item 7, PART B on page 2.
PART
C
RESIDENCE PROVIDED BY EMPLOYER DURING 2002
WIFE
SELF
Address of residence
Period occupied
Total rent payable by you for the period
State if furniture, refrigerator, air-conditioner, cooker provided
If shared, give details
PART
D
INCOME RECEIVED IN BASIS PERIOD 2002 IN RESPECT OF ANY EARLIER YEAR NOT PREVIOUSLY
DECLARED
SELF
YEAR
FOR WHICH PAID
TYPE OF INCOME
AMOUNT
(RM)
CONTRIBUTION TO PROVIDENT FUND
WIFE
AMOUNT
(RM)
CONTRIBUTION TO PROVIDENT FUND
(RM)
4
E
CLAIM FOR DOUBLE TAXATION RELIEF
E
PART
PL
DECLARATION OF FOREIGN INCOME REMITTED TO MALAYSIA IN 2002 (If claim for double taxation relief is made, enclose evidence of foreign tax suffered)
SELF
WIFE
AMOUNT (RM)
1
2
SELF
2
WIFE
M
1
SA
COUNTRY OF ORIGIN
NATURE OF INCOME
DATE RECEIVED
GROSS INCOME
FOREIGN TAX DEDUCTED
NET INCOME
NET INCOME IN MALAYSIAN RINGGIT
PART
F
CLAIM FOR EXEMPTION OF RESIDENTIAL PREMISES
THIS CLAIM IS IN RESPECT OF ONE HOUSE ONLY. RATEABLE VALUE OF ALL OTHER HOUSES OWNED AND OCCUPIED HAS TO BE DECLARED IN ITEM 10,
PART B ON PAGE 2.
SELF
WIFE
i. RESIDENTIAL ADDRESS
ii. PERIOD OCCUPIED IN 2002
PART
G
REAL PROPERTY GAINS TAX
HAVE YOU OR YOUR WIFE/WIVES DISPOSED OF ANY LAND OR BUILDINGS, OR ANY INTEREST,
OPTION OR OTHER RIGHTS INCLUDING SHARES IN A REAL PROPERTY COMPANY IN MALAYSIA
DURING THE YEAR 2002?
SELF
YES
WIFE
NO
YES
NO
Tick (✓) in the relevant box
PART
H
CLAIM FOR RELIEF (Refer Note, Part H Item 1 to 7)
*ATTACH ORIGINAL RECEIPT FOR ITEM 3 TO 7
1
PERSONAL AND DEPENDENT RELIEF (AUTOMATIC RELIEF)
2
DISABLED INDIVIDUAL (RELIEF AMOUNTING TO RM5,000)
SELF
SELF
(for separate assessment)
RM 8,000
RM 8,000
RM 5,000
RM 5,000
Tick ((✓) in the relevant box
3
MEDICAL EXPENSES FOR PARENTS INCURRED (ACTUAL EXPENDITURE, LIMITED TO A MAXIMUM OF RM5,000)*
RM
RM
4
EXPENSES INCURRED FOR PURCHASE OF SUPPORTING EQUIPMENT FOR OWN USE, HUSBAND, WIFE, CHILD OR
PARENT WHO IS DISABLED (ACTUAL EXPENDITURE, LIMITED TO A MAXIMUM OF RM5,000)*
RM
RM
EDUCATION FEES INCURRED ON ANY COURSE OF STUDY (ACTUAL EXPENDITURE, LIMITED TO A MAXIMUM OF RM5,000)* RM
RM
5
}
(i) MEDICAL EXPENSES INCURRED FOR A SERIOUS DISEASE SUFFERED
(ii) FULL MEDICAL EXAMINATION (ACTUAL EXPENDITURE, LIMITED TO A MAXIMUM OF RM500)*
(BOTH EXPENDITURE, LIMITED TO A MAXIMUM OF RM5,000)*
6
7
PURCHASE OF BOOKS/MAGAZINE (ACTUAL EXPENDITURE, LIMITED TO A MAXIMUM OF RM500)*
8
RM
RM
RM
RM
WIFE (Refer Note, Part H Item 8)
IDENTITY CARD NO.
i. FULL NAME OF WIFE/WIVES
WHO LIVED WITH YOU IN 2002
CITIZENSHIP
NEW
OLD
IF MARRIED IN 2002
STATE DATE OF
MARRIAGE
IF LEGAL SEPARATION OR DEATH
OCCURRED IN 2002
STATE DATE AND ATTACH DOCUMENT
ii. ADDITIONAL DEDUCTION FOR HUSBAND/WIFE WHO IS A DISABLED PERSON (IF YOUR HUSBAND/WIFE IS NOT ASSESSED SEPARATELY)
NAME
IDENTITY CARD NO. (NEW)
IDENTITY CARD NO. (OLD)
Tick (✓) in the relevant box
RM 2,500
RM 2,500
iii. FORMER WIFE TO WHOM ALIMONY WAS PAID IN 2002
NAME
IDENTITY CARD NO. (NEW)
IDENTITY CARD NO. (OLD)
AMOUNT PAID (RM)
5
9
DEPENDANT UNMARRIED CHILDREN* (Refer Note, Part H Item 9)
E
Use a separate sheet if necessary
Date of Birth
Name of
School / College / University /
Institution of Higher Education
SA
M
PL
Name of Child { }
Tick (✓) if wife selects
to claim child relief
Child whose age exceeds 18 years in 2002
Child whose age
Date of
is below 18 years commencement Outside Malaysia
of education in an Before/on 31.12.93
(Tick ( ✓) in
Institution of
the relevant box)
RM3,200
Higher
On/after 1.1.94
Education in and
RM1,600
outside Malaysia
On/after 17.10.97
RM800
In Malaysia
RM3,200
Child’s total
Amount of
contribution on income wherever
derived or
children’s
accrued
maintenance
in 2002
and education
State the amount applicable
Day Month Year
{
{
{
{
{
{
{
Day Month Year
}
}
}
}
}
}
}
RM
RM
RM
RM
RM800
RM800
RM800
RM800
RM800
RM800
RM800
Disabled child
{ }
{ }
RM5,000
FOR OFFICE USE
TOTAL
▼
RM5,000
TO BE COMPLETED BY WIFE IF SHE ELECTS TO CLAIM CHILD RELIEF
Husband and wife are entitled to make a choice (based on their own circumstances) as to who should claim the child relief.
hereby elect to claim wholly the appropriate child relief
I
Full Name
Identity Card No.
in respect of the child / children as indicated (✓) above.
Wife’s Signature
10
CONTRIBUTIONS TO APPROVED PROVIDENT AND PENSION FUNDS AND INSURANCE PREMIUM ON LIFE,
EDUCATION AND MEDICAL*
(Refer Note, Part H Item 10)
*Use a separate sheet if necessary
i
PROVIDENT AND PENSION FUNDS AND LIFE INSURANCE * (Attach original receipt)
NAME OF PROVIDENT AND
PENSION FUND/INSURANCE COMPANY
PROVIDENT FUND NO. /
POLICY NO.
ON OWN LIFE OR WIFE/WIVES
CONTRIBUTIONS / PREMIUM PAID IN 2002
SELF
WIFE
TOTAL
ii
EDUCATION AND MEDICAL INSURANCE * (Attach original receipt)
NAME OF INSURANCE COMPANY
POLICY NO.
ON SELF, WIFE OR CHILD
PREMIUM PAID IN 2002
SELF
WIFE
TOTAL
iii
EPF ANNUITY PREMIUM*
NAME OF INSURANCE COMPANY
POLICY NO.
ON SELF/WIFE
PREMIUM PAID IN 2002
SELF
WIFE
TOTAL
PART
I
CLAIM FOR REBATE (Refer Note, Part I Item 1 to 3)
ATTACH ORIGINAL RECEIPT FOR ITEM 1 TO 3
1
2
3
ZAKAT OR FITRAH
PURCHASE OF PERSONAL COMPUTER (Other than for business purpose)
FEE PAID BY HOLDER OF EMPLOYMENT PASS, VISIT PASS (Temporary Employment) OR WORK PASS
SELF
WIFE
RM
RM
6
J
EMPLOYMENT PARTICULARS
SELF
E
PART
WIFE
SA
M
PL
1. NAME AND ADDRESS OF PRESENT EMPLOYER
2. PRESENT EMPLOYER’S FILE NO.
E
E
3. TELEPHONE NO. (OFFICE)
4. STAFF NO. OR PAY NO.
PART
K
BUSINESS PARTICULARS*
*Use a separate sheet if necessary
BUSINESS
1.
NAME AND ADDRESS OF BUSINESS
AND PARTNERSHIP (Husband/Wife)
2.
NATURE OF BUSINESS
PARTNERSHIP
3.
ACCOUNTING PERIOD
(Opening and Closing date) (Day/Month/Year)
4. DATE OF COMMENCEMENT OF BUSINESS
(if new business) (Day/Month/Year)
5.
BUSINESS REGISTRATION NO.
6.
TELEPHONE NO.
7.
INCOME TAX FILE NO.
PART
L
OG C
D
DECLARATION
SELF
hereby declare
I
Full Name
Identity Card No.
that the information on my income and claim for deductions and reliefs given in this return and in any documents attached is true, correct and complete.
This return is made on my own behalf*
On behalf* .........................................................................................................
I wish to elect for combine assessment and assessment issued under wife’s name.
(If wife does not elect for combine assessment)
*Tick (✓) in the relevant box, if applicable
Date: ...............................................................
............................................................................
Signature
.........................................................................................................
If trustee, agent etc., state name and appointment
WIFE
I
hereby declare
Identity Card No.
Full Name
that the information on my income and claim for deductions and reliefs given in this return and in any documents attached is true, correct and complete.
I wish to elect for combine assessment*
*Tick (✓) in the relevant box, if applicable
Date: ...............................................................
..................................................................
Signature
7
M
PART
EDUCATION TOWARDS SELF COMPUTATION OF INCOME TAX (REFER TO NOTE)
PARTICULARS
E
CODE
SA
29
INCOME
001
004
INTEREST OR DISCOUNT
005
RENT, ROYALTIES OR PREMIUM
006
PENSIONS
007
OCCUPATION OF PREMISES IN MALAYSIA FOR NON-BUSINESS PURPOSE
008
OTHER INCOME
009
ANNUITIES OR OTHER PERIODICAL PAYMENTS
010
AGGREGATE INCOME [{C} ADD ITEM 4 - 11]
{D}
DEDUCTIONS
BUSINESS LOSSES FOR THE CURRENT YEAR
013
PROSPECTING EXPENSES (SCHEDULE 4)
014
CAPITAL EXPENDITURE ON APPROVED AGRICULTURAL PROJECT (SCHEDULE 4A)
014A
GIFTS OF MONEY TO THE GOVERNMENT/APPROVED INSTITUTIONS
016
GIFTS OF MONEY TO LIBRARIES
017
GIFTS OF ARTEFACTS, MANUSCRIPTS OR PAINTINGS
018
GIFTS OF MONEY OR CONTRIBUTION IN KIND
018A
GIFTS OF MONEY OR MEDICAL EQUIPMENT
018B
GIFTS OF PAINTING
018C
TOTAL DEDUCTIONS
{E}
TOTAL INCOME {D} LESS {E}
{F}
RELIEFS (Attach original receipts)*
PERSONAL & DEPENDENT RELATIVES
RM
022
MEDICAL EXPENSES FOR PARENTS
*Maximum
5,000
023
PURCHASE OF BASIC SUPPORTING EQUIPMENT
*Maximum
5,000
023A
5,000
023B
*Maximum
5,000
023C
*Maximum
5,000
023D
*Maximum
500
DISABLED PERSON
EDUCATION FEES
}
MEDICAL EXPENSES FOR SERIOUS DISEASES
FULL MEDICAL EXAMINATION
PURCHASE OF BOOKS/MAGAZINES
i)
i)
WIFE/HUSBAND (IF COMBINED ASSESSMENT)
(If husband has no total income or elects for assessment to be
issued under wifes name)
ALIMONY TO FORMER WIFE
DISABLED WIFE/HUSBAND
}
3,000
024
2,500
024A
Child whose age is below 18 years and not married
No. of Children
x
Reliefs (RM)
800
Total (RM)
=
ii) Child whose age exceeds 18 years in 2002, not married and is still studying
a) In Malaysia
b) Outside Malaysia and education begins
- On / after
17.10.97
iii) Disabled child
x
3,200
=
x
800
=
x
5,000
=
SUB-TOTAL
31
32
33
8,000
{C}
DIVIDENDS
ii)
iii)
30
8,000
102
EMPLOYMENT
Less
21
22
23
24
25
26
27
28
{B}
BROUGHT FORWARD LOSSES FROM PREVIOUS YEAR
(Limited to business income stated above)
SUB-TOTAL [{A} LESS {B} = {C}]
Less
12
13
14
15
16
17
18
19
20
{A}
Less
(Add)
4
5
6
7
8
9
10
11
RM
SHARE OF PARTNERSHIP INCOME
TOTAL BUSINESS INCOME
3
RM
BUSINESS INCOME (After deducting capital allowance)
M
1
2
WIFE
(for separate assessment)
PL
TYPE OF INCOME/DEDUCTIONS/RELIEFS
SELF
026
Provident Fund and Life Insurance
Education and Medical Insurance
*Maximum
*Maximum
RM5,000
RM3,000
027
028
EPF Annuity Premium
*Maximum
RM1,000
029
SUB-TOTAL RELIEFS (Item 21 - 33)
{G}
8
EDUCATION TOWARDS SELF COMPUTATION OF INCOME TAX
Continuation from previous page
CODE
PL
E
PARTICULARS
CHARGEABLE INCOME {F} less {G}
SELF
WIFE
RM
(for separate assessment)
RM
{H}
M
INCOME TAX COMPUTATION (Refer to the schedule below)
SA
SELF
WIFE
T ax on the first RM...................................
Tax on the balance RM..........................%
TOTAL INCOME TAX
Less
34
TAX REBATE
046
(For chargeable income (H) less than RM35,000 only) (Individual rebate for self is RM350 and RM350 for wife)
ZAKAT OR FITRAH
049
36
PURCHASE OF PERSONAL COMPUTER
049A
37
FEE
045A
▼
35
TOTAL TAX CHARGED
Less
38
39
042-043
RELIEF ON TAX DEDUCTED ON DIVIDEND (SECTION 110)
044
TOTAL TAX PAYABLE/REPAYMENT
40
N
PART
1
DOUBLE TAXATION RELIEF (SECTION 132/133)
TAX SUMMARY AND PAYMENT
TOTAL TAX PAYABLE/REPAYMENT (FROM M40)
2
Less
INSTALLMENT/SCHEDULAR TAX DEDUCTION THAT HAS BEEN PAID
3
TAX BALANCE PAYABLE
4
TAX PAID IN EXCESS
or
SCHEDULE OF TAX CHARGED ON INCOME
INCOME TAX
COMPUTATION
CHARGEABLE
INCOME
RM
RATE
%
TAX
RM
On every Ringgit of the first
2,500
0
0
On every Ringgit of the next
2,500
1
25
5,000
On every Ringgit of the next
15,000
3
15,000
On every Ringgit of the next
15,000
50,000
On every Ringgit of the next
7
450
On every Ringgit of the next
20,000
30,000
1,050
On every Ringgit of the next
150,000
RM
19
On every Ringgit exceeding
250,000
3,800
7,275
24
7,200
14,475
27
250,000
1,950
TAX
3,475
100,000
1,525
13
RATE
%
70,000
475
35,000
CHARGEABLE
INCOME
RM
50,000
25
20,000
On every Ringgit of the next
INCOME TAX
COMPUTATION
40,500
54,975
28
3,475
The above rates is applicable to a person resident in Malaysia and deceased individual domiciled in Malaysia for the basis year 2002
CHECKLIST
PLEASE ENSURE
1
2
3
4
5
6
7
8
9
10
Name, address, identity card number and file number are correctly printed. Please make the necessary corrections.
Signed copies of Trading and Profit and Loss Accounts, Balance Sheet, Capital allowance and Income Tax computation
have been enclosed.
Statement of remuneration (C.P. 8A/8C) from your employer has been enclosed.
Original dividend vouchers have been enclosed.
Statement of rental income and expenditure has been enclosed.
Original receipts of donations are enclosed (Part B, item 14, 15, 17 & 18).
Original receipts of relief claim are enclosed (Part H, item 3-7 and 10).
Certified letter from the Social Welfare Department if you/wife/children is/are disabled.
The declaration section provided in Part L have been signed by you/your wife.
Certified letter of children enrollment to IPTA/IPTS are enclosed.
Tick (✓) in the relevant box