EXHIBIT 1BORANG PCB/TP3 (1/2015) INLAND REVENUE BOARD OF MALAYSIA (IRBM) FORM FOR PREVIOUS EMPLOYMENT REMUNERATION INFORMATION IN CURRENT YEAR FOR MONTHLY TAX DEDUCTION (MTD PURPOSES) (KAEDAH-KAEDAH CUKAI PENDAPATAN (POTONGAN DARIPADA SARAAN) 1994) BORANG DITETAPKAN DI BAWAH SEKSYEN 152, AKTA CUKAI PENDAPATAN 1967 BAHAGIAN A : MAKLUMAT MAJIKAN A1 1ST EMPLOYER NAME : A2 EMPLOYER REFERENCE NO : A3 2ND EMPLOYER NAME : A4 EMPLOYER REFERENCE NO : E E *(Please use additional sheets for the third and subsequent employer) PART B: EMPLOYEE INFORMATION B1 NAME : B2 NRIC NO : B3 PASSPORT NO : B4 EMPLOYEE TAX NO : PART C: GROSS SALARY, EPF, FEE/ ZAKAT AND MTD (PLEASE STATE THE GRAND TOTAL FROM PREVIOUS EMPLOYERMENTS) ACCUMULATED AMOUNT C1 Total monthly gross salary and additional salary including taxable allowance/ perquisites/ gifts/ benefits C2 Total allowance/ perquisites/ gifts/ benefits which are tax exempted i Travel allowance, petrol card, petrol allowance for travelling between home and place of work RM ii Child care allowance RM iii Consumable business products of the employer provided free of charge or at a partly discounted price RM iv Perquisite whether in money or otherwise provided to the employee pursuant to his employment in respect of past achievement award, service excellence award and long service award that the employee has exervised an employment for more than 10 year with the same employer. v Other allowance/ perquisites/ gifts/ benefits which are tax exempted. Please refer to the explanation note of BE for further reference. C3 Total EPF contribution RM RM RM C4 Total Zakat/ Fee RM C5 Total MTD (not included CP38) RM PART D: DEDUCTION INFORMATION (PLEASE STATE THE GRAND TOTAL FROM THE PREVIOUS EMPLOYMENTS ACCUMULATED YEARLY LIMIT D1 Medical expenses for own parents certified by medical practitioners DEDUCTION LIMITED TO RM5,000 RM LIMITED TO RM6,000 RM LIMITED TO RM5,000 RM D2 Basic supporting equipment for disable self, spouse, child or parents D3 Education fees (self): (i) other than a degree at Master or Doctor level – for acquiring law, accounting, Islamic financing, technical, vocational, industrial, scientific or technological skills or qualification. (ii) Degree at Master or Doctor Level – for acquiring any skill or qualification D4 Medical expenses on serious diseases for self, Spouse or child D5 Complete medical examination for self, spouse or child RM LIMITED TO RM6,000 LIMITED RM500 RM RM D6 Purchase of books/ magazines/ journals/ similar publications (except newspaper and banned reading materials) for self, spouse and child LIMITED RM1,000 D7 Purchase of personal computer for individual (deduction allowed once in every 3 years) LIMITED RM3,000 D8 Net savings in the National Education Savings Scheme (the amount of deposits in the current year minus total expenditure in the current year) LIMITED RM6,000 D9 Purchase of sports equipment for any sports activity as defined under the Sport Development Act 1997 LIMITED RM300 RM RM RM RM D10 Husband/ wife/ payment of alimony to former spouse LIMITED RM3,000 D11 Life insurance LIMITED RM6,000 (Including EPF) D12 Education of medical insurance LIMITED RM3,000 D13 Private Retirement Scheme and Deferred Annuity (deferred annuity) LIMITED RM1,000 D14 Interest on housing loan (conditions for eligibility to claim must be fulfilled) LIMITED RM10,000 D15 Contributions to Social Security Organisation (SOCSO) LIMITED RM250 RM RM RM RM RM PART E: DECLARATION of employee I, hereby declare that the information which stated in this form is true, correct and complete. If the given information is not true, court action can be taken against me under paragraph 113 (1) (b) Income Tax Act 1967. - Date Day Month ---------------------------------------------------------------------------Year Signature NOTE 1. This form has to be filled by employee and submitted to employer without providing receipts and supporting documents for the purpose of the adjustment calculation MTD. 2. Employer has to request employee to submit this form if the employee has worked with other employment within the current year. 3. Employer needs to keep this form for up to 7 years. This form must be presented upon request from IRBM.