The document is a declaration form submitted by Norliza Binti Abu Talib on behalf of her company to request e-filing of tax forms. It includes the company name, tax and registration numbers, and Norliza's signature and designation confirming she has authority under section 75 of the Income Tax Act 1967 to represent the company.

1. eP55B[2011 I
LEUBAGA HAS.L DeLAr NEqERt IriAtsY€lA
BORANG PERIIiOHONAil NOilIBOR PIN e-FILING ORGANISASI
T.ndaken 'X" di pehk yang be*enaan / Prease tick X in the relevant box
r=-'l Nama $yarikat
trcuwnnlrs sox gHo
Name of @mpany
r-ut No. Rujukan [No.Pendaftamnl
Reference No. [No. Registration]
454753 -T
t"l No.Cukai Pendapatan
lncome Tax No.
c 0787770210
AKUAN I DECLARAT'ON
Saya,
NORLIZA BINTIABU TALIB
I
(namt p6nu.n d{lam nurur DeBlt t tuil ndme tn D,QCK telrers)
Ito. Ruiuk n I No.Pengenalanl 680503 - 01 -5506
Referen(E No. I l&nlification No.I
l{o. Gukai Pendapatan ,*l SG 03351152071
lnconre Tax No.
yeng menialankrn ku:8. dl brwah scksyen 75 Altta Gukai Pendrpatsn 1967, dongan ini m€ngekui bahewaF
,n ff,e exercise of authotity confu,r€d un&r seclion 75 of frb lncome Tax Act 1967, &fJale tbat:
saya dibcri ku$a rntuk mowakili plhak syaril(at bagi mongemukakan borang yang dlteft{kan secara elcktrcnik
given the authoty fo,ep/esen, frre co firryny totumistt ilrypresctbodfotms
seDerti marayaqgl dlngarntllkXtt dl b.uEtrtoklyen !52A AkE Q$a! Peldrp!tsn !967
as ilovided under @ction 1524 Qfthe lncoma Tax Act 1967
Tandatangan
SignaluB.
Jawetan
Designalion
Tarlkh
Dete
23.11.2012