CP55D [2/2016]

LEMBAGA HASIL DALAM NEGERI MALAYSIA

BORANG PERMOHONAN NOMBOR PIN e-FILING INDIVIDU
APPLICATION FORM FOR INDIVIDUAL e-FILING PIN NUMBER

Nama LAI JIA JIA

Name

No. Pengenalan
2 960416135426
Identification No.
(Kad Pengenalan Baru / Polis /
Tentera / Pasport)
(New IC / Police / Army / Passport)

No. Cukai Pendapatan

3 SG40157441050
Income Tax Number

Alamat Surat-Menyurat
4 11, JALAN S.P.10,
Correspondence Address
TAMAN SRI PUTRA.

Poskod Bandar
Postcode 47000 Town SUNGAI BULOH
Negeri
State SELANGOR

No. Telefon 011-31893258

5
Telephone Number

Tandatangan Pemohon / Wakil

Signature of Applicant / Representative

Nama Pemohon / Wakil

Name of Applicant / Representative LAI JIA JIA

No. Pengenalan Pemohon / Wakil

Identification Number of Applicant / Representative 960416135426

Tarikh 5 APRIL 2020

Date

 Jika wakil membuat permohonan bagi pihak
pembayar cukai, sila kemukakan :
- surat kebenaran daripada pembayar cukai
- salinan pengenalan diri pembayar cukai
- salinan pengenalan diri wakil
* If this application is made on behalf of the taxpayer,
please enclose :
- a written consent from the taxpayer
- a copy of taxpayer’s identification document
- a copy of representative’s identification document