Employer And Spouse Income Tax Declaration printable pdf download

Employer And Spouse Income Tax Declaration

Work Pass Division

18 Havelock Road

Singapore 059764

Tel: 6438 5122

mom_wpd@mom.gov.sg

Annex A

Employer and Spouse Income Tax Declaration

This form may take you 1 minute to fill in.

Please complete this form only if you do not wish to submit your Income Tax Notice of Assessment when

applying for a Work Permit (WP) for a foreign domestic worker.

Part I – Monthly Combined Income of Employer and Spouse

Please tick ( ) the appropriate box.

Below $2,000

$2,000 to $2,499

$2,500 to $2,999

$3,000 to $3,499

$3,500 to $3,999

$4,000 to $4,999

$5,000 to $5,999

$6,000 to $7,999

$8,000 to $9,999

$10,000 to $12,499

$12,500 to $14,999

$15,000 to $19,999

$20,000 to $24,999

$25,000 and above

Part II – Authorisation by Employer and His/Her Spouse

If either you and/or your spouse do not wish to submit a copy of your Income Tax Notice of Assessment, please

complete Part II and authorise the Comptroller of Income Tax to verify your income range stated in Part I above and

communicate the results of the verification to the Controller of Work Passes.

I, _______________________________________________, *NRIC/WP No/FIN:_____________________________,

(Name of employer)

and/or I, ____________________________________, *NRIC/WP No/FIN:__________________________________,

(

Name of the employer’s spouse)

authorise the Comptroller of Income Tax to verify *my/our income tax range stated in Part I above, based on *my/our

assessment record(s) for the current Year of Assessment and the two previous Years of Assessment, for the Controller

of Work Passes. *I/We also authorise the Comptroller of Income Tax to thereafter communicate the results of the

verification to the Controller of Work Passes.

In the event that *my/our assessment record(s) for the current Year of Assessment *is/are not available or finalised at

the point of verification, I*/we understand that the Comptroller of Income Tax will verify *my/our income range stated in

Part I against *my/our assessment record(s) for the two previous Years of Assessment.

Employer

Employer’s Spouse

Income Tax Notice of Assessment No:

Signature:

Date:

*Delete where inapplicable

This form is updated on 1 July 2007

WPDP

004

Employer And Spouse Income Tax Declaration

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