borang permohonan sijil taraf mastautin · pdf filestm1 (pind. 2014) 1 borang permohonan sijil...

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STM1 (Pind. 2014) 1 BORANG PERMOHONAN SIJIL TARAF MASTAUTIN APPLICATION FORM FOR CERTIFICATE OF RESIDENCE Nama Pembayar Cukai / Name of Taxpayer Nombor Rujukan Cukai Pendapatan / Income Tax Reference Number Perniagaan Utama (Dalam Bahasa Inggeris)/ Principal business activity (In English) Alamat Perniagaan / Business Address Negara Pejanji / Treaty Country Tahun Taksiran diperlukan / Year of Assessment required Jenis Pendapatan diterima / Type of Income received Tempoh Bayaran / Period of Payment Jumlah Pendapatan diterima / Amount of payment received RM Nama dan alamat pembayar Asing / Name and address of Foreign Payer Pengakuan oleh Pemohon/ Declaration by Applicant Saya mengesahkan bahawa permohonan ini dibuat untuk menuntut manfaat di bawah Perjanjian Pengelakan Pencukaian Dua Kali, dan semua maklumat yang diberikan adalah benar dan betul / I confirm that the application is made for the purpose of claiming the benefit under the Avoidance of Double Taxation Agreement, and all information given in this application is true and correct Tandatangan / Signature …………………………………… Tarikh / Date ………………………….. Nama Pemohon / Name of Applicant: ……………………………………………………………………………………… Nombor Pengenalan (KP/ Pasport/ Tentera/ Polis)/ Identification Number (IC/ Passport/ Military / Polis): ………………………………………………………………………… Jawatan Pemohon / Designation of Applicant: …………………………………………………………………………… Alamat Surat-menyurat Pembayar Cukai/ Correspondence Address of Taxpayer: …………………………… ……………………………………………………………………………………………………………………………………… Alamat e-mel Pemohon/ Applicant’s email address: ……………………………………………………………………. Nama dan Nombor Telefon orang boleh dihubungi/ Name and telephone number of contact person

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Page 1: BORANG PERMOHONAN SIJIL TARAF MASTAUTIN · PDF fileSTM1 (Pind. 2014) 1 BORANG PERMOHONAN SIJIL TARAF MASTAUTIN APPLICATION FORM FOR CERTIFICATE OF RESIDENCE Nama Pembayar Cukai/ Name

    STM1 (Pind. 2014) 

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BORANG PERMOHONAN SIJIL TARAF MASTAUTIN APPLICATION FORM FOR CERTIFICATE OF RESIDENCE Nama Pembayar Cukai / Name of Taxpayer

Nombor Rujukan Cukai Pendapatan / Income Tax Reference Number

Perniagaan Utama (Dalam Bahasa Inggeris)/ Principal business activity (In English)

Alamat Perniagaan / Business Address

Negara Pejanji / Treaty Country

Tahun Taksiran diperlukan / Year of Assessment required

Jenis Pendapatan diterima / Type of Income received

Tempoh Bayaran / Period of Payment

Jumlah Pendapatan diterima / Amount of payment received

RM

Nama dan alamat pembayar Asing / Name and address of Foreign Payer

Pengakuan oleh Pemohon/ Declaration by Applicant Saya mengesahkan bahawa permohonan ini dibuat untuk menuntut manfaat di bawah Perjanjian Pengelakan Pencukaian Dua Kali, dan semua maklumat yang diberikan adalah benar dan betul / I confirm that the application is made for the purpose of claiming the benefit under the Avoidance of Double Taxation Agreement, and all information given in this application is true and correct Tandatangan / Signature …………………………………… Tarikh / Date ………………………….. Nama Pemohon / Name of Applicant: ……………………………………………………………………………………… Nombor Pengenalan (KP/ Pasport/ Tentera/ Polis)/ Identification Number (IC/ Passport/ Military / Polis): ………………………………………………………………………… Jawatan Pemohon / Designation of Applicant: …………………………………………………………………………… Alamat Surat-menyurat Pembayar Cukai/ Correspondence Address of Taxpayer: …………………………… ……………………………………………………………………………………………………………………………………… Alamat e-mel Pemohon/ Applicant’s email address: ……………………………………………………………………. Nama dan Nombor Telefon orang boleh dihubungi/ Name and telephone number of contact person

Page 2: BORANG PERMOHONAN SIJIL TARAF MASTAUTIN · PDF fileSTM1 (Pind. 2014) 1 BORANG PERMOHONAN SIJIL TARAF MASTAUTIN APPLICATION FORM FOR CERTIFICATE OF RESIDENCE Nama Pembayar Cukai/ Name

    STM1 (Pind. 2014) 

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PERINGATAN/ NOTES:

PASTIKAN SEMUA BORANG NYATA CUKAI PENDAPATAN TELAH DIKEMBALIKAN DALAM TEMPOH/ ALL RETURN FORMS SHOULD HAVE BEEN SUBMITTED DURING THE STIPULATED PERIOD

Cara memohon / How to apply

1. Borang STM1 hendaklah dilengkapkan dengan sempurna untuk semua permohonan STM/ Form STM1 duly completed for all COR application 2. Gunakan Borang STM1A bagi memohon lebih daripada 1 sijil / Use Form STM1A if application is for more than 1 certificate. 3. Dokumen yang perlu disertakan/ Documents need to be attached

i. Syarikat / Company

a. Jika borang nyata masih belum patut dikemukakan, sertakan salinan Minit Mesyuarat Lembaga Pengarah atau surat pengesahan pengarah berkenaan pengurusan dan kawalan syarikat dilakukan di Malaysia/ If the return form is not due yet, a copy of the Minutes of Board of Directors’ Meeting, or a letter signed by a director confirming the management and control of the company are exercised in Malaysia;

b. Borang 49 dari Suruhanjaya Syarikat Malaysia (SSM) / Form 49 from Companies Commission of Malaysia (CCM)

ii. Individu / Individual

a. Pasport asal dan salinan / Original passport and photocopy

b. Senarai pergerakan keluar / masuk Malaysia / List of movement in / out of Malaysia

iii. Perkongsian / Partnership

a. Pasport asal ahli kongsi individu serta salinannya / Original passport (and photocopy) of the partner applying;

b Senarai pergerakan ahli kongsi individu keluar/masuk Malaysia / List of movement of the individual partner in/out of Malaysia.

iv. Badan Amanah / Trust

Salinan suratikatan penubuhan Badan Amanah (bagi fail baru daftar) / A copy of the trust deed (for newly registered file)