CP55D [3/2020]

LEMBAGA HASIL DALAM NEGERI MALAYSIA

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

Nama
1
Name

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

3 No. Cukai Pendapatan

Income Tax No.

4 Alamat Surat-Menyurat
Correspondence Address

Poskod Bandar
Postcode Town

Negeri
State

5 No. telefon
Telephone Number

e-Mel
6
e-mail

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

Nota : Note :
Jika wakil membuat permohonan bagi pihak If this application is made on behalf of the taxpayer,
pembayar cukai, sila kemukakan : please enclose :
a. Surat Kebenaran Pembayar Cukai a. a written consent from the taxpayer
b. Salinan Pengenalan Diri Pembayar Cukai b. a copy of taxpayer’s identification document
c. Salinan Pengenalan Diri Wakil c. a copy of representative’s identification document