BAHAGIAN INDUSTRI - MIDA
|[pic] | |.my |
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| | |BORANG PIA ’86 (ITA)-95(II) | | |
| | |(2.1.2014) | | |
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PENGESAHAN PEMATUHAN SYARAT GALAKAN BAGI ELAUN
CUKAI PELABURAN
DIBAWAH AKTA PENGGALAKAN PELABURAN, 1986
Verification of Compliance to Investment Tax
Allowance Under the Promotion of Investments Act, 1986
BORANG II
Form II
1. LATARBELAKANG SYARIKAT
Background of Company
(a) Nama Syarikat seperti yang tercatat pada Sijil Pendaftaran Syarikat
Name of Company as in the Certificate of Incorporation
________________________________________________________
________________________________________________________
________________________________________________________
(b) Alamat Berdaftar Syarikat
Registered Address of Company
________________________________________________________
________________________________________________________
________________________________________________________
(c) Nombor Telefon dan Faks
Telephone Number and Fax
Telefon _________________
Faks _________________
2. SILA NYATAKAN:
Please state:
(a) Syarat Galakan
Incentive Conditions
________________________________________________________
________________________________________________________
________________________________________________________
3. PENGGUNAAN BAHAN-BAHAN/KOMPONEN UNTUK PENGELUARAN DAN MAKLUMAT NILAI TAMBAH (SYARIKAT-SYARIKAT YANG DIKENAKAN SYARAT GALAKAN PENGGUNAAN BAHAN/KOMPONEN TEMPATAN DAN NILAI TAMBAH SAHAJA)
Usage of materials/components for production and the information on value added (companies with local contents and value added condition imposed in granting incentive)
a) Jumlah kos bahan-bahan/komponen yang diimport.
(Sila senaraikan tiap-tiap bahan/komponen)
Total cost of imported materials/components (please itemise the cost of each material/component.
|Bil. |Bahan/Komponen |Kuantiti |Nilai (RM) |
|No. |Materials/Components |Quantity |Value |
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(b) Jumlah kos bahan-bahan/komponen tempatan yang dibeli.
(sila senaraikan tiap-tiap bahan/komponen)
Total cost of locally purchased material/component.
|Bil. |Bahan/ |Nama dan Alamat |Kuantiti |Nilai (RM) |
|No. |Komponen |Pembekal |Quantity |Value |
| |Materials/ |Name & Address of | | |
| |Components |Supplier | | |
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(c) Jumlah kos bahan-bahan/komponen yang dikeluarkan sendiri.
(sila senaraikan tiap-tiap bahan/komponen)
Total cost of sell-manufactured materials/components (Please itemise cost of each material/component)
| | | | |
|Bil. |Bahan/Komponen |Kuantiti |Nilai (RM) |
|No. |Materials/Components |Quantity |Value |
| | | | |
(d) Jumlah kos bahan-bahan/komponen (a+b+c) : RM_________________
Total materials/components cost: a+b+c
(e) Kos pengeluaran (kos seunit/berat/ukuran)
Production cost (cost per unit/weight/size)
- kos bahan-bahan/komponen : RM_________________
materials/components cost
- kos buruh langsung : RM___________________
direct labour cost
- kos ‘overhead’ kilang : RM_________________
factory overhead
Jumlah : RM_________________
Total
(f) Harga jualan dikilang seunit/berat : RM_________________
ukuran (sila senaraikan jenis-jenis
keluaran).
Ex factory price per unit/weight/
size (please itemise products)
Nota:
Note
Sila gunakan format yang sama sekiranya syarikat tuan mengeluarkan lebih dari satu keluaran perintis.
Please use similar format if your company manufacturers more than one pioneer product.
4. MAKLUMAT MENGENAI STRUKTUR PEKERJA SEPENUH MASA
Information on full time employment structure
Struktur Pekerja Sepenuh Masa Pada: ___________________________
Full time employment structure as at
| | | | |
|Peringkat |Rakyat Malaysia |Rakyat |Jumlah |
|Pekerjaan |Malaysian Citizen |Asing |Besar |
|Category of |Bumi-putera |
|Employment |Bumi- |
| |putera |
|Modal Dibenar | |
|Authorised capital | |
|Modal Berbayar | |
|Paid-up capital | |
(b) Pegangan Ekuiti Semasa
Existing Equity Holding
| | | |
|Ekuiti Yang Wujud |Bil.Saham |Peratusan |
|Existing Equity |No. of share |Percentage |
| | | |
|Rakyat Malaysia | | |
|Malaysian | | |
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|i) Bumiputera | | |
|Bumiputera | | |
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|Bukan Bumiputera | | |
|Non-Bumiputera | | |
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|Jumlah | | |
|Total | | |
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|Asing | | |
|Foreign | | |
|Jumlah Besar | | |
|Grand Total | |100% |
Pada :
As at:
Nota:
Note:
Sila kemukakan Borang ‘Annual Return”, Borang 24 yang terakhir dan disahkan oleh Suruhanjaya Syarikat/ Setiausaha Syarikat
Please submit the latest Form of Annual Return, Form 24 and Form 49 certified by the Company’s Commission/Company’s Secretary.
7. MAKLUMAT MENGENAI EKSPORT
Information on export
|Syarat Eksport |Eksport Sebenar |
|Export Condition |Actual Export |
|Keluaran |% Eksport |Keluaran |% Eksport |
|Product |% of Export |Product |% of Export |
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Nota:
Note
Sila kemukakan salinan borang eksport pengisytiharan Kastam. Di mana sesuai syarikat bolehlah membuat ringkasan mengenai maklumat jumlah eksport yang telah dilakukan.
Please provide a copy of the Customs Export Declaration Form. Wherever applicable company may provide a summary of the total export information.
8. DISEDIAKAN OLEH
Prepared By
Saya dengan ini mengaku bahawa sepanjang pengetahuan dan kepercayaan saya, semua butir-butir dalam permohonan ini adalah betul dan benar.
I here declare that to the best of my knowledge and belief all particulars contained in the application are true and correct.
Nama : ____________________________________
Name
Jawatan: __________________________________
Designation
No. IC: ____________________________________
IC No.
No. Telefon: ________________________________
Telephone No.
Tarikh : ____________________________________
Date
9. PENGAKUAN
Declaration
Saya dengan ini mengaku bahawa sepanjang pengetahuan dan kepercayaan saya, semua butir-butir dalam permohonan ini adalah betul dan benar.
I here declare that to the best of my knowledge and belief all particulars contained in the application are true and correct.
Tarikh: ______________ __________________________
Date: Tandatangan Pengarah Urusan/
Pengurus Besar
Signature of Managing Director/
General Manager
Nama: __________________________________
Name
Mohor Syarikat: __________________________
Company’s seal
10. PENGESAHAN OLEH JURUAUDIT LUAR BERTAULIAH
Verification by Qualified External Auditor
Saya dengan ini mengesahkan bahawa semua butir-butir dalam permohonan ini adalah betul dan benar.
I hereby confirm that all the particulars contained in this application are true and correct.
Tarikh: ____________ __________________________
Date: Tandatangan
Signature
Nama: _______________________________
Name
Cop Syarikat: _______________________
Company’s Stamp
Alamat: ______________________________
Address
No. Telefon: ____________________
Telephone No.
No Faks: _______________________
Fax No.
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