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CP37
LEMBAGA HASIL DALAM NEGERI MALAYSIA
INLAND REVENUE BOARD OF MALAYSIA
 Seksyen 109 Akta Cukai Pendapatan, 1967
 Section 109 Income Tax Act, 1967
AKAUN POTONGAN-POTONGAN DARIPADA BAYARAN ROYALTI DAN FAEDAH
KEPADA ORANG YANG TIDAK BERMASTAUTIN

ACCOUNT OF DEDUCTION FROM ROYALTY AND INTEREST TO A NON-RESIDENT PERSON

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Click explanatory notes before filling out this form
A.                                                                                     BUTIR-BUTIR PEMBAYAR
                                                                                                                           PARTICULARS OF PAYER



 
No. Cukai Pendapatan *(sila lengkapkan)
Income Tax No.*(please complete)
Nama Pembayar
Name of Payer
Alamat Pos
Postal Address
Poskod
Postcode
Bandar Town
Negeri
State
B.                       BUTIR-BUTIR MENGENAI ORANG YANG TELAH DIBAYAR / DIKREDITKAN FAEDAH / ROYALTI
                                                              PARTICULARS OF PERSON TO WHOM INTEREST / ROYALTY HAD BEEN PAID / CREDITED



 
No. Cukai Pendapatan Malaysia (jika ada)
Malaysian Income Tax No.(if any)
Nama Penuh Penerima
Name of Payee
Alamat
Address
Poskod
Postcode
Bandar Town
Negeri
State
Negara Asing
Foreign Country
C.                                                            BUTIR-BUTIR MENGENAI POTONGAN-POTONGAN
                                                                                                                PARTICULARS OF DEDUCTIONS
Kategori Bayaran
Category of Payment
Tempoh diliputi oleh
bayaran royalti/
faedah
Period for which royalty/interest paid/
credited.
(hhbbtttt)
Tarikh bayaran royalti/faedah telah dibayar/dikreditkan
Date royalty/interest
paid/credited.
(hhbbtttt)
Amaun kasar
(sertakan salinan invois)
Gross Amount
(attach copy of invoice)
Amaun Potongan
Amount of deduction
Amaun bersih
dibayar/dikreditkan
(sertakan salinan dokumen)
Net Amount paid/credited(attach copy of document)

RM RM RM
Saya, bagi pihak saya sendiri / bagi pihak pembayar di atas telah membuat potongan-potongan dari amaun faedah/royalti
yang disebutkan di atas yang telah dibayar / dikreditkan dan mengemukakan akaun ini menurut peruntukan Subseksyen 109(1) bersama dengan bukti dokumen tarikh pembayaran yang telah dibuat/dikreditkan.
I, on my own behalf/on behalf of the above mentioned payer have made deductions from the above-mentioned amount of Interest/Royalty paid/credited and render this account in accordance with the provisions of Subsection 109(1) together with documentary evidence of the date payment was paid/credited.
Saya sertakan bersama ini wang tunai/cek No:
I enclose herewith cash/cheque No:
Amaun
Amount
RM
Nama
Name
Jawatan
Designation
No. Telefon
Telephone No.
Tarikh:
Date:
27/06/2022
                                                              
        

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