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LEMBAGA HASIL DALAM NEGERI MALAYSIA CP57 [Pin.

1/2020]
INLAND REVENUE BOARD OF MALAYSIA
PEMBERITAHUAN KEMATIAN PEMBAYAR CUKAI
NOTIFICATION OF TAXPAYER’S DEMISE
Borang ini ditetapkan di bawah seksyen 152 Akta Cukai Pendapatan 1967 dan seksyen 57 Akta Cukai Keuntungan Harta Tanah 1976
This form is prescribed under section 152 of the Income Tax Act 1967 and section 57 of the Real Property Gains Tax Act 1976

 Borang ini disediakan bagi tujuan subseksyen 74(3) Akta Cukai Pendapatan 1967 dan subseksyen 14(4) Akta Cukai
Keuntungan Harta Tanah 1976.
This form is provided for the purpose of subsection 74(3) of the Income Tax Act 1967 and subsection 14(4) of the Real Property Gains Tax Act 1976.
 Borang ini hendaklah dikemukakan ke cawangan di mana fail cukai pendapatan pembayar cukai diuruskan.
This form must be submitted to the branch where the taxpayer’s income tax file is administered.

AKUAN WASI / PENTADBIR


DECLARATION BY EXECUTOR / ADMINISTRATOR

Saya / I

(nama penuh dalam huruf besar / full name in block letters )


No. kad pengenalan / Pasport / Pendaftaran * /
Identification card / Passport / Registration no. *
(* Potong yang tidak berkenaan / * Delete whichever is not relevant)

No. cukai pendapatan / Income tax no.


Isikan : / Enter : SG / OG / C

No. telefon / Telephone no.

Alamat surat-menyurat wasi / Pentadbir utama /


Correspondence address of main executor / Administrator

Poskod / Bandar /
Postcode Town
Negeri /
State

Dengan ini, mengakui bahawa saya adalah wasi / pentadbir harta pusaka si mati seperti butiran berikut : /
I hereby declare that I am the executor / administrator of the estate of the deceased person as detailed below :

Nama / Name

(nama penuh dalam huruf besar / full name in block letters )

No. cukai pendapatan / Income tax no.


Isikan : / Enter : SG / OG

Tarikh kematian / Date of demise


Hari / Bulan / Tahun /
Day Month Year

Domisil di Malaysia semasa kematian /


1 = Ya / Yes 2 = Tidak / No
Domicile in Malaysia at the time of demise

Wasiat / Will 1 = Ada / Yes 2 = Tiada / None

Surat kuasa mentadbir / Geran probet /


1 = Ada / Yes 2 = Tiada / None
Letter of administration / grant of probate

Tarikh pemerolehan surat kuasa mentadbir / geran probet /


Date of letter of administration / grant of probate
Hari / Bulan / Tahun /
Day Month Year

Tandatangan / Signature Tarikh / Date


Hari / Bulan / Tahun /
Day Month Year

SILA KEMUKAKAN : / PLEASE SUBMIT :


a) Salinan geran probet / Copy of grant of probate
atau / or
b) Salinan surat kuasa mentadbir / Copy of letter of administration
Dan / and
Salinan Sijil Kematian / Copy of death certificate

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