CP55D [2/2016]
LEMBAGA HASIL DALAM NEGERI MALAYSIA
BORANG PERMOHONAN NOMBOR PIN e-FILING INDIVIDU
APPLICATION FORM FOR INDIVIDUAL e-FILING PIN NUMBER
Nama
1
Name
No. Pengenalan
2
Identification No.
(Kad Pengenalan Baru / Polis /
Tentera / Pasport)
(New IC / Police / Army / Passport)
No. Cukai Pendapatan
3
Income Tax Number
Alamat Surat-Menyurat
4
Correspondence Address
Poskod Bandar
Postcode Town
Negeri
State
No. Telefon
5
Telephone Number
Tandatangan Pemohon / Wakil
Signature of Applicant / Representative
Nama Pemohon / Wakil
Name of Applicant / Representative
No. Pengenalan Pemohon / Wakil
Identification Number of Applicant / Representative
Tarikh
Date
Jika wakil membuat permohonan bagi pihak * If this application is made on behalf of the taxpayer,
pembayar cukai, sila kemukakan : please enclose :
- surat kebenaran daripada pembayar cukai - a written consent from the taxpayer
- salinan pengenalan diri pembayar cukai - a copy of taxpayer’s identification document
- salinan pengenalan diri wakil - a copy of representative’s identification document