NR/R/PS1/Pin.Rev.

1/2011

Baru New
Lanjutan Extension
LEMBAGA HASIL DALAM NEGERI MALAYSIA
INLAND REVENUE BOARD OF MALAYSIA

BORANG NR/R/PS1
A. MAKLUMAT PELAWAT SEMENTARA / DETAIL OF FOREIGN VISITORS

A1. Nama penuh seperti dalam pasport: A2. Warganegara:

Full Name as in passport: Citizenship:
Mr./Mrs./Ms................................................................................... ..……..........................................................
DD MM YYYY
A3. No. pasport: A4. Tarikh Lahir:
Passport No.: Date of Birth:

A5. No. Fail Cukai Pendapatan Malaysia, jika ada: SG/OG

Income Tax File No., if any:

A6. Alamat Address:

.......................................................................................................................................................................................
.......................................................................................................................................................................................
.......................................................................................................................................................................................
.......................................................................................................................................................................................
DD MM YYYY DD MM YYYY
A7. Tempoh lawatan: dari from hingga to
Duration of stay:

A8. Tujuan lawatan:

Purpose of stay:

.......................................................................................................................................................................................
.......................................................................................................................................................................................
.......................................................................................................................................................................................
.......................................................................................................................................................................................

B. MAKLUMAT KONTRAK / CONTRACT DETAILS

DD MM YYYY DD MM YYYY
B1. Tempoh kontrak: dari from hingga to
Duration of contract:

B2. Nilai kontrak: RM ................................

contract value:

B3. Manfaat berbentuk barangan:

Benefit in kind:

Nilai tempat kediaman: @ RM ............................ X ............................ hari = RM ................................

Value of accommodation: day
Nilai tiket kapal terbang / pengangkutan: RM ................................
Value of airfare/transport:
Nilai makanan: @ RM ............................ X ............................ hari = RM ................................
Value of food: day
Nilai manfaat-manfaat lain yang disediakan, nyatakan jenis manfaat:
Value of other benefits in kind provided, state the type of such service or facility:
.......................................................................................................................................................
....................................................................................................................................... RM ................................

JUMLAH TOTAL RM ...............................

4. Nyatakan nama dan alamat individu/syarikat yang berhak menerima bayaran (B2),
jika, lain dari penama di atas (A1):
State name and address of the individual / company who is entitled to the contract payment (B2),
if, other than the above named person (A1):

.......................................................................................................................................................
.......................................................................................................................................................
.......................................................................................................................................................

No. Fail cukai pendapatan Malaysia, jika ada:

Income Tax File No., if any:

Sila lihat sebelah [PTO]

C. PERAKUAN / DECLARATION

Saya .......................................................................................No. Kad Pengenalan ..............................................

I NRIC No:
penganjur kepada penama di atas dengan ini mengaku bahawa butiran di atas adalah benar dan lengkap.
Sponsor for the above named person, do hereby declare that the particulars given above are true and complete.

.........................................................................................
Tandatangan Penganjur:
Sponsor's Signature:

.........................................................................................
Jawatan:
Designation: COP PENGANJUR
SPONSOR STAMP
Tarikh: ....................................................................
Date:

No. Fail Majikan: E

Employer's File No:
# [ Jika tiada , sila mendaftar di pejabat LHDNM yang berhampiran ]
[ If not available, please register with the nearest LHDNM office ]

Kembalikan:
Return to:

Pengarah,
Lembaga Hasil Dalam Negeri Malaysia,
Cawangan Tidak Bermastautin, Kemukakan salinan dokumen-dokumen berikut:
Unit Profiling dan Khidmat Pelanggan Furnish copies of the following documents:
Tingkat 3(Kanan), Blok 8 Kompleks Bangunan
Kerajaan, Jalan Tuanku Abdul Halim, Surat Permohonan
50600 KUALA LUMPUR Written application
Kontrak/surat tawaran dan penerimaan atau lain-lain
Director, dokumen yang berkenaan.
Inland Revenue Board of Malaysia, Contract/letter of offer and acceptance or other relevant
Non Resident Branch, documents.
Profiling and Customer Services Unit, Kontrak antara syarikat tempatan dan asing, jika
3rd Floor (Right), Block 8 Government Building
berkenaan;
Complex, Jalan Tuanku Abdul Halim
Contract between local and foreign company, where relevant.
50600 KUALA LUMPUR.
Salinan risalah seminar/kursus bagi kes penceramah
seminar/kursus latihan.
Hubungi talian ini untuk keterangan lanjut:
Copy of the seminar brochure for seminar/training course
Contact these numbers for further assistance:
lectures.
Kes penggajian:
No. Telefon Am : 03-6209 1000 Employment cases:
General Lines
Surat pengesahan dari majikan negara asal;
Letter of confirmation from the employer of the country
Samb / Ext. : 121646/121614/121639 origin;
Butir-butir saran dan gaji yang diterima dari negara
Faks / Fax : 03-6201 2417 State the details of remuneration and emolument received
from home country
emel / e.Mail : norazlina.b@hasil.gov.my Salinan Pasport;
Copy of passport;
Lampiran A, jika lebih dari lima pelawat
Appendix A, if more than five visitor's
Surat kuasa, jika permohonan melalui wakil
Letter of authorization, if application is done by agent

"BERSAMA MEMBANGUN NEGARA"

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