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A2
EMPLOYER REFERENCE NO
A3
A4
EMPLOYER REFERENCE NO
*(Please use additional sheets for the third and subsequent employer)
NAME
B2
NRIC NO
B3
PASSPORT NO
B4
EMPLOYEE TAX NO
PART C: GROSS SALARY, EPF, FEE/ ZAKAT AND MTD (PLEASE STATE THE GRAND TOTAL FROM PREVIOUS
EMPLOYERMENTS)
ACCUMULATED AMOUNT
C1 Total monthly gross salary and additional salary including taxable allowance/ perquisites/ gifts/ benefits
C2 Total allowance/ perquisites/ gifts/ benefits which are tax exempted
i
Travel allowance, petrol card, petrol allowance for travelling between home and place of work
RM
iii
Consumable business products of the employer provided free of charge or at a partly discounted
price
RM
iv Perquisite whether in money or otherwise provided to the employee pursuant to his employment in
respect of past achievement award, service excellence award and long service award that the
employee has exervised an employment for more than 10 year with the same employer.
Other allowance/ perquisites/ gifts/ benefits which are tax exempted. Please refer to the
explanation note of BE for further reference.
RM
RM
RM
RM
RM
PART D: DEDUCTION INFORMATION (PLEASE STATE THE GRAND TOTAL FROM THE PREVIOUS EMPLOYMENTS
ACCUMULATED
YEARLY LIMIT
DEDUCTION
LIMITED TO RM5,000
RM
LIMITED TO RM6,000
RM
LIMITED TO RM5,000
RM
RM
LIMITED TO
RM6,000
LIMITED
RM500
RM
RM
LIMITED RM1,000
LIMITED RM3,000
D8 Net savings in the National Education Savings Scheme (the amount of deposits
in the current year minus total expenditure in the current year)
LIMITED RM6,000
D9 Purchase of sports equipment for any sports activity as defined under the
Sport Development Act 1997
LIMITED RM300
RM
RM
RM
RM
LIMITED RM3,000
LIMITED RM6,000
(Including EPF)
LIMITED RM3,000
LIMITED RM1,000
D14 Interest on housing loan (conditions for eligibility to claim must be fulfilled)
LIMITED RM10,000
LIMITED RM250
RM
RM
RM
RM
RM
Date
Day
Month
---------------------------------------------------------------------------Year
Signature
NOTE
1. This form has to be filled by employee and submitted to employer without providing receipts and supporting documents for the
purpose of the adjustment calculation MTD.
2. Employer has to request employee to submit this form if the employee has worked with other employment within the current year.
3. Employer needs to keep this form for up to 7 years. This form must be presented upon request from IRBM.