!! !! !!!!
3. Tarikh Lahir
Wajib
4. Persaraan
5. No. Kad Pengenalan
Lama
7. Taraf Perkahwinan
Pilihan
! !!!!!!!
!! !!!!!!!!!!!
!
!
Berkahwin
[Sila tandakan X]
Baru
!!!!!!!!!!!!
[Sila tandakan X]
!!
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Lama
! !!!!!!!
Baru
!! !!!!!!!!!!!
Bagi warganegara Malaysia yang mempunyai Mykad, hanya No. Mykad sahaja perlu diisi.
!!!!!!!!!!!!
B. BUTIR-BUTIR SARAAN
Butir-butir pendapatan penggajian
RM
RM
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(ii)---------------------------------------
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(iii)---------------------------------------
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D. BUTIR-BUTIR LAIN
(1) Jumlah wang yang akan dibayar kepada pekerja dan dipegang oleh majikan
berikutan dengan subseksyen 83(5) Akta Cukai Pendapatan 1967.
RM
(2) Jumlah Potongan Cukai Pendapatan di bawah skim Potongan Cukai Bulanan
(PCB) dan dibayar ke LHDNM dalam tahun semasa.
RM
RM
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Nama:
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Jawatan:
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Kementerian / Jabatan:
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Tarikh:
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