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<text><![CDATA[Total number of person charged with departure levy*]]></text>
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<text><![CDATA[Jumlah Orang yang dikenakan levi pelepasan*]]></text>
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<text><![CDATA[Ekonomi<br>
<i>Economy</i>]]></text>
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<text><![CDATA[(c) Selain ASEAN <br>
<i>Other than ASEAN </i>]]></text>
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<text><![CDATA[5.]]></text>
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<text><![CDATA[Selain Ekonomi<br>
<i>Other than Economy</i>]]></text>
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<text><![CDATA[(b) ASEAN<br>
<i>ASEAN</i>]]></text>
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<text><![CDATA[(a) Kelas <br>
<i>Class</i>]]></text>
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<text><![CDATA[Amaun Levi Pelepasan Kena Dibayar (RM)
(Butiran 5 (b) + (c) )*]]></text>
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<text><![CDATA[6.]]></text>
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<text><![CDATA[BAHAGIAN B: MAKLUMAT PENYATA ]]></text>
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<text><![CDATA[PART C: DECLARATIONS
]]></text>
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<text><![CDATA[BAHAGIAN C: AKUAN ]]></text>
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<text><![CDATA[Name of Applicant *]]></text>
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<text><![CDATA[Tandatangan Pemohon *]]></text>
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<text><![CDATA[Identity Card / Passport No. *
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<text><![CDATA[Tarikh / Date*]]></text>
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<text><![CDATA[I, hereby declare that the information stated in this form and any supporting documents attached as true, accurate and complete and agree any notice to be served to me through electronic service.*]]></text>
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<text><![CDATA[7.]]></text>
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<text><![CDATA[Saya, mengaku bahawa maklumat dinyatakan dalam borang ini dan dokumen sokongan disertakan adalah benar, tepat dan lengkap dan bersetuju apa-apa notis disampaikan kepada saya melalui perkhidmatan elektronik.* ]]></text>
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