Appendix 6-2

CPA Tax & Investment Review 2003Appendix 6-2: Form ICA 1 (97)ICA 1 (97)PERMOHONAN BAGI LESEN PENGILANG DI BAWAH AKTAPENYELARASAN PERINDUSTRIAN, 1975DAN / ATAUGALAKAN DI BAWAH AKTA PENGGALAKAN PELABURAN, 1986UNTUK PROJEK PENGILANGAN BARUAPPLICATION FOR MANUFACTURING LICENCE UNDER THEINDUSTRIAL COORDINATION ACT, 1975AND / ORINCENTIVE UNDER THE PROMOTION OF INVESTMENTS ACT, 1986FOR A NEW MANUFACTURING PROJECTPermohonan untuk: [ tandakan (√) di ruang yang berkenaan ]Application for: {tick (√) whichever is relevant}(i) Lesen Pengilang ❒Manufacturing Licence(ii) (a) Taraf Perintis ❒Pioneer Status(b) Elaun Cukai Pelaburan ❒Investment Tax AllowanceKeluaran/aktiviti dicadangkanProposed products/activitiesNo. kod tarifTariff code no.330

Appendix 6-2ICA 1 (97)A. BUTIR-BUTIR PEMOHON/SYARIKATPARTICULARS OF APPLICANT COMPANY1. Nama pemohon/syarikat dan alamat surat-menyuratName of applicant/company and correspondence addressTelefon Faks Pegawai dihubungiTelephone Fax Contact personJawatanDesignation2. (a) Nama syarikat yang akan mengusahakan projek pengilanganName of company which will undertake the manufacturing project(b)(c)Tarikh diperbadankanDate of incorporationAlamat pejabat berdaftarAddress of registered officeNo. TelefonTelephone No.No. FaksFax No.3. Tapak kilang yang dicadangkanProposed factory location331

CPA Tax & Investment Review 2003ICA 1 (97)4. Butir-butir pengarahParticulars of directorsNama dan alamat kediaman Warganegara % saham dipegangName and residential address Nationality dalam syarikat% shares heldin the company332

ICA 1 (97)B. KOS PROJEKPROJECT COST1. Harta tetapFixed assetsa. Tanah (nyatakan keluasan)Land (specify area)Fasa 1 Fasa 2 JumlahPhase 1 Phase 2 TotalRM RM RMb. Bangunan kilang(nyatakan keluasan kawasan binaan)Factory building (specify built-up area)333c. Loji dan jenteraPlant and machineryd. Kelengkapan lainOther equipmentJumlah harta tetapTotal fixed assetsAppendix 6-2

334Nota: Jika tanah, bangunan kilang, loji atau jentera disewa/dipajak, nyatakan kos sewaan/pajakan tahunan.Note: If the land, factory building, plant or machinery is rented/leased, specify the annual cost of rental/lease.2. Perbelanjaan sebelum pengendalianPre-operational expenditure3. Modal kerjaWorking capitalJumlahTotalFasa 1 Fasa 2 JumlahPhase 1 Phase 2 TotalRM RM RMICA 1 (97)CPA Tax & Investment Review 2004

CPA Tax & Investment Review 2003ICA 1 (97)RM3. PinjamanLoanTempatanDomesticAsingForeign4. Sumber lainOther sourcesJumlahTotalJumlahTotalJumlah 2, 3 dan 4Total of 2, 3 and 45. Berikan nama mana-mana syarikat lain yang mengilangkankeluaran yang sama/seumpamanya yang dalam mana-manapemegang saham syarikat pemohon atau syarikat pemohonmempunyai penyertaan ekuiti.State the names of any other company manufacturing the same/similarproducts in which any shareholders of the applicant company or the applicantcompany has equity participation.336

Appendix 6-2ICA 1 (97)D. GUNATENAGAMANPOWERPekerjaan sepenuh masaFull-time employmentGolongan Rakyat RakyatCategory Malaysia asing JumlahMalaysian Foreign Totalnational national1. Kakitangan pengurusan denganManagerial staff witha. Kelulusan teknikalTechnical qualificationsb. Kelulusan sainsScience qualificationsc. Kelulusan/pengalaman lainOther qualifications/experience2. Kakitangan teknikal dan penyeliaan denganTechnical and supervisory staff witha. Kelulusan teknikalTechnical qualificationsb. Kelulusan sainsScience qualificationsc. Kelulusan/pengalaman lainOther qualifications/experience3. Pekerja jualan, perkeranian dan pekerja lainSales, clerical and other workers4. Pekerja kilangFactory workersa. MahirSkilledb. Tak mahirUnskilledJumlahTotal337

CPA Tax & Investment Review 2003ICA 1 (97)E. PROSES PENGILANGAN DAN KAWALAN PENCEMARANMANUFACTURING PROCESS AND POLLUTION CONTROL1. Berikan carta aliran proses pengilangan dan terangkan prosesprosesutama. Tandakan proses-proses mengikut jenis jenterayang digunakan seperti berikut:Provide the manufacturing process flow chart and explain the major processes.Indicate processes according to type of machinery used as follows:RASMbagi jentera robotikfor robotic machinerybagi jentera automatikfor automatic machinerybagi jentera separa automatikfor semi-automatic machinerybagi pengendalian tanganfor manual operation2. Daripada carta aliran proses pengilangan, berikan butir-butirmengenai pengeluaran bahan cemar.From the manufacturing process flow chart, provide details on emissionpollutants.(a) Tempat pengeluaran (b) Jenis bahan cemar (c) KuantitiType of pollutants Point of emission Quantity338

Appendix 6-2ICA 1 (97)F. JENTERA DAN KELENGKAPAN KAWALAN PENCEMARAN UTAMAMAIN POLLUTION CONTROL MACHINERY AND EQUIPMENT1. Jentera dan kelengkapanMachinery and equipmentPerihalan Jenis* Unit Baru atau Fungsi Negara KosDescription Type* Unit terpakai Function asal CostNew or Country RMusedof origin* CatatkanIndicateRASMbagi jentera robotikfor robotic machinerybagi jentera automatikfor automatic machinerybagi jentera separa automatikfor semi-automatic machinerybagi pengendalian tanganfor manual operation339

CPA Tax & Investment Review 2003ICA 1 (97)2. Kelengkapan kawalan pencemaranPollution control equipmentPerihalan Unit Baru atau Fungsi Negara asal KosDescription Unit terpakai Function Country CostNew or of origin RMusedG. SUMBER PENGETAHUAN TEKNIKALSOURCES OF TECHNICAL KNOW-HOWNama dan alamat pembekal Tempoh pengalaman Hubungan dengan pemohonName and address of supplier Year of experience (contohnya pembekaljentera, syarikatinduk/bersekutu)Relationship with applicant(e.g. machinery supplier,parent/associate company)340

ICA 1 (97)H. JADUAL PENGELUARANPRODUCT SCHEDULEKeluaranProductsKuantiti*Quantity*Tahun 1Year 1Nilai di kilangEx-factory valueRMKuantiti*Quantity*Tahun 2Year 2Nilai di kilangEx-factory valueRMKuantiti*Quantity*Tahun 3Year 3Nilai di kilangEx-factory valueRMKeupayaan pengeluarantahunan maksimum bagi setiapgiliran 8 jamMaximum annual productioncapacity per 8 hour shiftJumlahTotal341* Unit seperti yang dinyatakan dalam “Malaysian Trade Classification and Customs Duties Order”.Units as specified in the “Malaysian Trade Classification and Customs Duties Order”.Appendix 6-2

CPA Tax & Investment Review 2003ICA 1 (97)I. PASARANMARKET% pasaranKeluaran % of market Pengguna dan tempatProductstujuan eksport utamaTahun 1 Tahun 2 Tahun 3 Principal consumersYear 1 Year 2 Year 3 and export destinationsUntuk pasaran tempatanFor domestic marketUntuk pasaran ZB/GPB*For FZ/LMW* marketUntuk pasaran eksportFor export market* Zon Bebas/Gudang Pengilangan Berlesen* Free Zone/Licensed Manufacturing Warehouse342

Appendix 6-2ICA 1 (97)J. BAHAN MENTAH DAN KOMPONEN UTAMAMAIN RAW MATERIALS AND COMPONENTSBahan mentah dan Kuantiti* Nilai Sumberkomponen setahun setahun SourceRaw materials and Quantity Valuecomponents per annum per annum Pengilang tempatan ImportRM Local manufacturer Import% nilai Nama dan alamat % nilai% of value Name and address % of value* Unit seperti yang dinyatakan dalam “Malaysian Trade Classification andCustoms Duties Order”.Units as specified in the “Malaysian Trade Classification and Customs Duties Order”.343

CPA Tax & Investment Review 2003ICA 1 (97)K. PENENTUAN HARGA KELUARANPRODUCT PRICINGPerkaraItem% harga di kilang untuksetiap keluaran% of ex-factory price foreach productKeluaranProduct(a) Kos bahan mentah/komponen yang diimportCost of imported raw materials/components(b) Kos bahan mentah/komponen tempatanCost of local raw materials/components(c) Kos tenaga dan bahan apiCost of energy and fuel(d) Kos buruhCost of labour(e) SusutnilaiDepreciation(f) Bayaran faedah, cukai tak langsung, cukaitanah, dsb.Interest payments, indirect taxes, quit rent, etc.(g) Kos pentadbiran dan pemasaranAdministrative and marketing costs(h) Kos teknologi (termasuk kos royalti,kos perkhidmatan pengurusan dan kos lainyang berhubunganCost of technology (including royalty, managementservices and other related costs)(i) Keuntungan pengilanganManufacturing profitJumlahTotal 100%344

Appendix 6-2ICA 1 (97)L. PENGAKUANDECLARATIONSaya,, mengaku bahawa sebaik-baikyang saya tahu dan percaya butir-butir yang diberikan dalampermohonan ini adalah benar.I, , hereby declare that to the best of myknowledge and belief the particulars furnished in this application are true.Tarikh:Date: ...................................................(Tandatangan pemohon)(Signature of applicant)(Jawatan)(Designation)345