1. Page 1 FORM B1 2013 IRIN 100/2013/C/1 G5328710M Tax Reference Number 10001 The Income Tax Act (Cap. 134) YEAR OF ASSESSMENT 2013 For the year ended 31 Dec 2012 INCOME TAX RETURN Comptroller of Income Tax (2 nd language for Comptroller of Income Tax) 55 Newton Road Revenue House Singapore 307987 Tel: 1800-3568300 www.iras.gov.sg Reserved for second language There are penalties for failing to furnish a tax return by the due date or furnishing an incorrect tax return. TAXPAYER’S PARTICULARS Date: For Office Use 3 2 4 1 7 6 8 5 LCPNSA1A2RR BK AT Signature I certify that the information (other than those that will be automatically included in the assessment by IRAS) on my income and claim for deductions and reliefs given in this tax return and in any documents attached is true, correct and complete. TAXPAYER’S DECLARATION Nationality Telephone Number LINA LE ROY AECOM HOUSE 8 MAHUHU CRESCENT, AUCKLAND 1010 G5328710M 11 AUG 1981 IRAQI FEMALE 01 MAR 2013 Date NRIC/FIN/Passport Number Date of Birth Gender Please cancel and insert correct particulars as appropriate. For change of name, please send us a photocopy of your Deed Poll or other official documents. If there is a change in your marital status and you have not informed us, please fill in the details in Appendix 2 – Change in Marital Status. Please quote the Tax Reference Number (e.g. NRIC, FIN, etc) in full when corresponding with us. Please use this form to declare all your income. You are required to submit this form even if you do not have any income to declare. Please do so by entering a ‘0’ in each item in Section A. You may wish to read “Your Guide To Completing Form B1”. This form may take up to 10 minutes to complete if you have all relevant information on income, deductions and reliefs ready, such as the following:- (a) Form IR8A (Return of Employee’s Remuneration) if your employer is NOT in the Auto-Inclusion Scheme for Employment Income. (b) Other supporting documents for income declaration such as rental statements. (c) Particulars of dependants for new relief claims or if the claims for this year are different from last year’s. Please send in your completed form by 15 April 2013. You can use SingPass or IRAS PIN to access myTaxPortal at https://mytax.iras.gov.sg to perform various e-Services with IRAS, including e-Filing of tax returns. You can log on to http://www.singpass.gov.sg/sppubsvc/location1.html for a list of SingPass counter locations. Thank you. DR TAN KIM SIEW Comptroller of Income Tax GIRO APPLICATION: Join GIRO to enjoy income tax payment up to 12 months interest-free instalments. Please complete this section if you are a Singapore NRIC holder with a POSB/DBS account. For accounts with other banks or if you are a non-Singapore NRIC holder, please use the GIRO form which can be downloaded from http://www.iras.gov.sg (Quick links > Forms > GIRO Application Forms). Applicable for Singapore NRIC holder with a POSB/DBS account only. Please tick one Account number: POSB / DBS Telephone Number:

2. Identification Type: 1 - Singapore NRIC Number 2 - Foreign Identification Number (FIN) Enter '0' for your employment income, donations, CPF contributions and life insurance premiums deducted through your salary if your employer has sent IRAS your salary information (i.e. under the Auto-Inclusion Scheme for Employment Income). Page 2IRIN /100/2013/C/1 10002 S$ SECTION B (c) Parent/Handicapped Parent (f) CPF/Provident Fund (Enter ‘0’ if your employer is under the Auto-Inclusion Scheme for Employment Income) (g) Life Insurance (Enter ‘0’ if your life insurance premium is deducted through your salary and employer is under the Auto-Inclusion Scheme for Employment Income) (h) Course Fees (b) Bonus ( a) Salary (Exclude NSman Pay) SECTION A 1 EMPLOYMENT (Enter ‘0’ if your employer is under the Auto-Inclusion Scheme for Employment Income) (c) Director’s fees (d) Others (e.g. part-time income, gratuity, pay in lieu of notice, allowance, benefits-in- kind, etc) EMPLOYMENT EXPENSES (e.g. subscriptions paid to professional bodies, etc) 2 OTHER INCOME (e.g. sole-proprietorship/self-employed/partnership, rent, etc) (Please also complete and attach Appendix 1. Cross box if total of Other Income is negative.) 3 TOTAL INCOME LESS EXPENSES Cross box if negative (Items (a) + (b) + (c) + (d) - + ) 4 RELIEFS (The following relief(s) will be allowed only on due claim. If you wish to claim for the relief, please complete all the relevant boxes and indicate the amount of claim. Otherwise, the relief will not be allowed. If you are claiming the relief(s) from (a) to (e) and (g) for the first time, please complete Appendix 2.) 5 DONATIONS (Only for those shown in Form IR8A - See Page 6 of the Guide) 0 Claim Type (1or 2) 6 Identification Type: 1 - Singapore NRIC Number 2 - Foreign Identification Number (FIN) 5 6 00 For Office Use EC: 00 Identification Type (1 or 2) 00 Identification Number Identification Type (1 or 2) 00 Identification Type (1 or 2) Identification Number (e) Handicapped Brother/Sister Identification Type: 1 - Singapore NRIC Number 2 - Foreign Identification Number (FIN) Enter the total claim for the 3rd and subsequent dependants at this row (See Page 12 of the Guide) (b) Child Claim Type: Q - Qualifying Child Relief H - Handicapped Child Relief *WMCR - Working Mother’s Child Relief ( Y-Yes, N-No ) *child must be a Singapore citizen Child Order Identification Type (1,2,3,4 or 5) Identification Number Claim Type (Q or H) Claiming for WMCR? (Y or N) 111132 27,308 0 0 643 0 0 27,951 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 G5328710M 0 Identification Type: 1-Singapore Birth Certificate or Singapore NRIC Number 2-Foreign Identification Number (FIN) 3-Passport Number 4-Malaysia IC Number 5-Other Identification Number If you are claiming for more than 5 children, enter the total claim for the 5 th and subsequent children at this row. (See Pages 9 & 10 of the Guide) TOTAL DONATIONS AND RELIEFS ( Items + ) 7 (a) Spouse/Handicapped Spouse Claim Type: 1 - Spouse Relief 2 – Handicapped Spouse Relief (d) Grandparent Caregiver ( Only for working mothers who are married / divorced / widowed) (i) Foreign Maid Levy ( Only for female taxpayers who are married / divorced / widowed) S$

3. 00 Name of Estate / Trust S$ ¢ 3 ROYALTY 4 CHARGE 5 ESTATE / TRUST INCOME 6 INTEREST - Please refer to Page 5 of the Guide. 7 GAINS OR PROFITS OF AN INCOME NATURE NOT INCLUDED UNDER THE ABOVE CATEGORIES Type of Income S$ ¢ 8 TOTAL (total of items 1 to 7, excluding net loss from item 2) TO BE ENTERED HERE OF FORM B1 (Cross box if AND IN ITEM ON PAGE 2 OF FORM B1 (Cross box if negative) 9 INCOME NOT PREVIOUSLY REPORTED - Please complete this item if you received income for any period prior to 1 Jan 2012 that was not previously reported. Attach separate list if income reported was for more than one year. 1 TRADE, BUSINESS, PROFESSION OR VOCATION - Please attach certified accounts if your revenue is $500,000 or more. For Office Use Please indicate the Type of Business (1) Sole-proprietorship / Self-employed (2) Partnership (3) Profession (4) Vocation 10101 STATEMENT OF OTHER TYPES OF INCOME For Year Ended 31 Dec 2012 2013 APPENDIX 1FORM B1 If you have the following types of income, please complete this Appendix and attach it with your completed Form B1. IRIN 101/2013/C Name of Taxpayer Tax Reference Number LINA LE ROY G5328710M Type of Business Name and Nature of Net Profit / Loss (Cross box if negative) (1), (2), (3) or (4) Address of Business Business Unique Entity No. / Partnership Tax Ref No. S$ ¢ 00 Period Type of Income Date Income Received From (Year) To (Year) S$ ¢ 00 Your share of total net rent * (C ross box if negative) SEE COMPUTATION ATTACHED 2 RENT FROM PROPERTY - See explanatory notes in point 3(2) on Page 4 of the Guide. If you derived rent, please furnish the details of gross rent and expenses incurred. If your property was not let out for the whole year in 2012, apportion the expenses based on the period of letting out. Enter your share of total net rent based on legal ownership in the box provided. Attach separate list if space is insufficient or you derived rent from more than 3 properties. If you are a co-owner, state the full amount of gross rent, expenses incurred and your share of net rent based on legal ownership. Property 1Property 2Property 3 Address Period From Period To Gross Rent ($) Expenses: Property Tax ($) Mortgage Interest ($) Fire Insurance ($) Maintenance ($) Repairs ($) Commission ($) Others ($) Net Rent ($) (Gross Rent – Expenses) Your share of Net Rent (%) * Your share of Net Rent ($) * 3 * Based on legal ownership

4. 1b PARTICULARS OF EX-SPOUSE For completion by male taxpayers only Name, NRIC Number and Date of divorce/ Whether ex-wife was Amount of alimony/maintenance current address of ex-spouse separation maintained by you? paid to her in 2012 as per court order CHANGE IN MARITAL STATUS / NEW CLAIMS / CHANGES IN CLAIMS FOR PERSONAL RELIEF(S) For Year Ended 31 Dec 2012 2013 APPENDIX 2FORM B1 Please use this Appendix if: (a) there is a change in your marital status; (b) you are claiming the following relief(s) for the first time; and/or (c) the particulars relating to the claim(s) for this year are different from last year. You may refer to the Guide for the conditions of claims. Please complete and send in this Appendix with your completed Form B1. IRIN 102/2013/C *Delete as necessary Name of Taxpayer Tax Reference Number LINA LE ROY G5328710M 1(a) If you are newly married or have not informed us of your change in marital status NRIC/FIN/Passport No. Name /Other Identification No. Nationality Date of Birth Date of Marriage CHANGE IN MARITAL STATUS NEW CLAIMS / CHANGES IN CLAIMS FOR PERSONAL RELIEF(S) ONNO LEROY DUTCH16/01/1969 No 10201 2 HANDICAPPED-RELATED TAX RELIEFS (HANDICAPPED EARNED INCOME / SPOUSE / CHILD / PARENT / BROTHER / SISTER) If you are claiming the handicapped-related tax relief(s) for the first time, you are required to complete “Application for Claim of Handicapped- Related Tax Reliefs” form from http://www.iras.gov.sg by clicking on under Quick links at the right-hand menu bar. 3 CHILDREN - Children maintained by you during the year 2012 (Attach separate list if space is insufficient) Types of child relief: QCR, HCR, WMCR - See Pages 9 and 10 of the Guide *Birth Certificate/ Amount If 16 years old and Date Date NRIC/FIN/ of Child’s above, state the name of of Passport/Other Singapore own of the educational Name Gender Birth Adoption Identification No. Citizen? income establishment 4 PARENTS, HANDICAPPED PARENTS, HANDICAPPED BROTHERS/SISTERS, ETC Residential *NRIC/FIN Date of Income Relationship Name Address Number Birth for 2012 to you 7 PARENTHOOD TAX REBATE (PTR) - ELECTION FOR APPORTIONMENT AS AGREED BY YOU AND YOUR SPOUSE (See Page 15 of the Guide). Self Spouse Child Order Birth Certificate Number State percentage/amount of PTR claimed by you and your spouse 6 PREMIUMS PAID TO LIFE INSURANCE COMPANIES Name and Address of Company Policy Number On Whose Life Capital Sum Secured on Death 5 GRANDPARENT CAREGIVER (for working mothers only) Living in *NRIC/FIN Employed/Self-Employed Relationship Particulars of child being looked after Name Singapore? Number in 2012? to you Singapore Birth Certificate Citizen? Number