Printed on 04 Sep 2008

2009 FORM 8E Status: COMPLETE

Employee's Remuneration For the Year Ended 31 Dec 2008
The income and deductions printed on this statement are NOT REQUIRED to be reported in your tax form.
It will automatically be included in your Income Tax notice of assessment. This statement is for your retention.

Employer's Tax Ref.No. : A1234567D Employee's Tax Ref.No. : S1234567D

Full Name of Employee or Pensioner : EMPLOYEE NAME

Residential Address :

Nationality : SINGAPORE CITIZEN Sex : MALE Designation : DIRECTOR

Date of Commencement : Date of Cessation : Date of Birth :
Bank Salary is Credited to : Date of Payroll :
INCOME

. $
0.00
a) Gross Salary, Fees, Leave Pay, Wages and Overtime Pay :
0.00
b) Bonus(non-contractual bonus declared on and /or contractual bonus for service rendered in null)
0.00
c) Director's fees approved at the company's AGM/EGM on
d) OTHERS : .
0.00
1. Gross Commission for period to
0.00
2. Pension :
0.00
3. Allowances : Transport $0.00 Entertainment $0.00 Others $0.00
0.00
4a. Gratuity/Notice-in-lieu/Ex-gratia payments
0.00
4b. Compensation or Retrenchment Benefits (Approval obtained from IRAS : , Date of approval: )
0.00
5. Retirement benefits including gratuities/pension/commutation of pension/lump sum payments, etc from
Pension/ProvidentFund
Name of Fund :
( Amount accrued up to 31 Dec 1992 : $0.00 ) Amount accrued from 1993 :
0.00
6. Contributions made by employer to any Pension/Provident Fund constituted outside Singapore :
0.00
7. Excess/Voluntary contribution to CPF by employer
0.00
8. Gains and profits from share options S10(1)(b)
0.00
9. Value of Benefits-in-kind
0.00
TOTAL of items d1 to d9 (excluding 4b):
0.00
e) Gains and Profit for share Options granted before 01/01/2003 (S 10(1)(g)) :
0.00
f) Employee's Income Tax borne by employer : Not applicable
0.00
g) Exempt Income/Income subject to Tax Remission : Not applicable
DEDUCTIONS
0.00
EMPLOYEE'S COMPULSORY contribution to CPF
EMPLOYEE'S VOLUNTARY contribution to CPF obligatory by contract of employment in respect of
0.00
Singapore NRIC holders who are posted overseas
Donations deducted through salaries for Yayasan Mendaki Fund/Community Chest of Singapore/ SINDA/ CDAC/ ECF/
0.00
Other tax exempt donations
0.00
Contributions deducted through salaries for Mosque Building Fund
0.00
Insurance
DECLARATION

Name of Employer : COMPANY NAME

Name of division/branch :

Address of Employer : COMPANY ADDRESS, 123456

Name of Authorised Person making the declaration : DECLARANT NAME

Designation : DECLARANT DESIGNATION Telephone : CONTACT NO