JABATAN KASTAM DIRAJA MALAYSIA ROYAL MALAYSIAN CUSTOMS DEPARTMENT

GST - Adm 03

BUTIRAN BARANG SIAP / PERKHIDMATAN DIBEKALKAN DI BAWAH SKIM PEDAGANG DILULUSKAN / SKIM PENGILANG TOL DILULUSKAN /

SKIM TUKANG EMAS DILULUSKAN DETAILS OF FINISHED GOODS / SERVICES SUPPLIED UNDER APPROVED TRADER SCHEME /

APPROVED TOLL MANUFACTURER SCHEME / APPROVED JEWELLER SCHEME

Nota Penting (Important Notes)

1)

2)

No. CBP * GST No. *

No. Pendaftaran Perniagaan Business Registration No.

Nama Perniagaan * Name of Business *

No. Skim Khas (Jika berkenaan) Special Scheme No. (If applicable)

BAHAGIAN A : BUTIRAN PERMOHONAN SKIM KHAS PART A : SPECIAL SCHEME APPLICATION DETAILS

Jenis Permohonan (Type of Application) Jenis Skim Khas (Type of Special Scheme)

Permohonan Baru Penamatan Skim Pedagang Diluluskan (SPL) New Application Removal Approved Trader Scheme (ATS)

Skim Pengilang Tol Diluluskan (SPT) Penambahan Pembaharuan Approved Toll Manufacturer Scheme (ATMS) Inclusion Renewal

Skim Tukang Emas Diluluskan (STE) Approved Jeweller Scheme (AJS)

Borang ini ditetapkan di bawah Peraturan-Peraturan Cukai Barang dan Perkhidmatan 2014 (This form is prescribed under Goods and Services Tax Regulations 2014)

3)

4)

5)

Sila gunakan borang ini untuk menyenaraikan perihal barang / perkhidmatan dibekalkan.Please use this form to list the description of goods / services supplied.Sila rujuk lampiran bagi mengisi butiran yang memerlukan kod.Please refer to the attachment to fill in the item(s) that requires code.Sekiranya ruangan tidak mencukupi, sila kemukakan Lampiran tambahan.If the space provided is not enough, please provide an attachment.Ruangan yang bertanda (*) adalah wajib diisi.Column with (*) is a mandatory field.Sila tandakan ( X ) dalam petak yang berkenaan.Please tick ( X ) accordingly.Sila hubungi Pusat Panggilan Kastam di talian 1-300-88-8500 / 03-78067200 atau emel ccc@customs.gov.my untuk pertanyaan lanjut.Please contact Customs Call Center at 1-300-88-8500 / 03-78067200 or email ccc@customs.gov.my for further enquiry.

6)

No. SPL (ATS No.)

No. SPT (ATMS No.)

No. STE (AJS No.)

*GSTADM1A*

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No. CBP * GST No. *

BAHAGIAN B : BUTIRAN BARANG / PERKHIDMATAN DIBEKALKAN PART B : GOODS / SERVICES SUPPLIED DETAILS

Perihal Barang / Perkhidmatan Dibekalkan(Description of Goods / Services Supplied)

Kod MSIC (5 Digit) MSIC Code (5 Digits)

Borang ini ditetapkan di bawah Peraturan-Peraturan Cukai Barang dan Perkhidmatan 2014 (This form is prescribed under Goods and Services Tax Regulations 2014)

Kod Jenis Skim Scheme Type Code

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No. CBP * GST No. *

Perihal Barang / Perkhidmatan Dibekalkan(Description of Goods / Services Supplied)

Kod MSIC (5 Digit) MSIC Code (5 Digits)

Alasan Pindaan * Reason for change *

Borang ini ditetapkan di bawah Peraturan-Peraturan Cukai Barang dan Perkhidmatan 2014 (This form is prescribed under Goods and Services Tax Regulations 2014)

(Tidak terpakai untuk permohonan baru / Not applicable for new application).

Kod Jenis Skim Scheme Type Code

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No. CBP * GST No. *

BAHAGIAN C : AKUAN PART C : DECLARATION

Saya, dengan ini mengaku bahawa maklumat dinyatakan dalam borang ini dan dokumen sokongan disertakan adalah benar, betul dan lengkap. I, hereby declare that the information stated in this form and in any supporting documents attached are true, correct and complete.

1) Nama Pegawai yangDiberi Kuasa *Name of Authorized Person *

2) No. Kad Pengenalan Baru (New) * Identity Card No.

Lama (Old)

3) No. Pasport *Passport No. *

Wajib untuk warga negara asing (Mandatory for foreign citizen)

4)

JawatanDesignation

6)

Tarikh *Date *

7)

Tandatangan *Signature *

UNTUK KEGUNAAN PEJABAT (FOR OFFICE USE ONLY)

No. Akuan Terima (Acknowledgement Receipt No.) *

Tarikh Diterima (Received Date) *

Borang ini ditetapkan di bawah Peraturan-Peraturan Cukai Barang dan Perkhidmatan 2014 (This form is prescribed under Goods and Services Tax Regulations 2014)

HH (DD) - BB (MM) - TTTT (YYYY)

HH (DD) - BB (MM) - TTTT (YYYY)

5)

No. Telefon *Telephone No. *

Kewarganegaraan * Nationality *

8)

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LAMPIRAN (ATTACHMENT)

SENARAI KOD (CODE LIST)

1. Kod Jenis Skim (Scheme Type Code)

No. Kod (Code) Keterangan Description

1. AJS Skim Tukang Emas Diluluskan Approved Jeweller Scheme

2. ATMS Skim Pengilang Tol Diluluskan Approved Toll Manufacturer Scheme

3. ATS Skim Pedagang Diluluskan Approved Trader Scheme