TAX CALCULATION FOR THE ASSESSMENT YEAR 2011 - 2012(SALARIED W.B. GOVT. EMPLOYEE)INFORMATION OF EMPLOYEE

NAME OF EMPLOYEE DESIGNATION

PAN NO. ader GENDER Male DATE OF BIRTH 8/11/1985

VILLAGE POST OFFICE AREA/LOCALILY

DISTRICT PIN CODE STATE

DESIGNATION OF ASSESSING OFFICE(WARD/CIRCLE) STATUS

NAME & ADDRESS OF EMPLOYER TAN NO. OF EMPLOYER

DEDUCTION UNDER CHEPTER VI - A (Sec 80C ) DEDUCTION UNDER CHEPTER VI - A OTHER THAN 80C,80CCC & 80CCDG.P.F. 12,000

u/s 80DP.P.F 12,000 children,dependent,Maximum Rs 15000/-

L.I.C. + P.L.I. + U.LIP. 32,018 u/s 80DD Medical treatment for self or dependent as Handicapped

N.S.C. u/s 80DDB Medical Treatment for self or dependent for sever desease

H.B. LOAN PRINCIPAL u/s 80E For Higher Education Loan Maximum No Limit

GROUP INSURANCE (G.I.)u/s 80U

Permanent disability including blindnes as

TUITION FEES handicapped(Max Rs.75000/-)

TAX SAVINGS BOND( Maximum Rs. 20,000/-) u/s 80G Donation in Charitable Fund Maximum 100% of donation)

u/s 80CCC Contribution To Pension Fund

56018

Premium in health insurance of self,spouse,

u/s 80CCD Contribution To Pension Scheme(New Govt. Servents)

Total Deduction U/S 80C (Max.limit 1,00,000/-) + 20,000/- New declared Infrustructure Bond

PARTICULARS OF SALARY

Income from Bank Interest/N.S.C/Others Source

Income from House Property

House Rent Paid

13,650

80,146

Relief under Section 89(1) 0

Net Tax Payable -5,500

Details of Advance Tax and Self Assessment Tax Payments

Name of Bank & Branch

0

Abdul Gaffar Mondal

Gross Income from Salary (Salary+H.R.A.+Bonus+Arrear, if any+Int.Bank/NSC+House Property)

Total income of financial year 2008-09(col-11 of Form no.16 For F.Y. 2008-09) + One instalment which already received

If the employee have not given any ArrearsRelief in previous year,you can not add with the Taxable amount of F.Y. 2008-09

BSR Code :Date of Deposit (dd/mm/yyyy) :Serial Number of Challan : Amount (Rs.) :

Copyright © , Email : gaffar.jim@gmail.com

TAX CALCULATION FOR THE ASSESSMENT YEAR 2011 - 2012(SALARIED W.B. GOVT. EMPLOYEE)INFORMATION OF EMPLOYEE

DESIGNATION

8/11/1985

AREA/LOCALILY

METROPOL CITY No

DEDUCTION UNDER CHEPTER VI - A OTHER THAN 80C,80CCC & 80CCD

children,dependent,Maximum Rs 15000/-

Medical treatment for self or dependent as Handicapped

Medical Treatment for self or dependent for sever desease

For Higher Education Loan Maximum No Limit

Permanent disability including blindnes as

handicapped(Max Rs.75000/-)

Donation in Charitable Fund Maximum 100% of donation)

FIRST FILLTHE PAY SHEET

Premium in health insurance of self,spouse,

PARTICULARS OF SALARY

If the employee have not given any ArrearsRelief in previous year,you can not add with the Taxable amount of F.Y. 2008-09

Call on.+919038020713(for purchase)

, Email : gaffar.jim@gmail.com

D.A. H.R.A. M.A. Bonus TOTAL

Mar-10 0 0 22% 0 15% 300 0 10050 300

Apr-10 0 0 0 27% 0 15% 300 300

May-10 0 0 0 27% 0 15% 300 300

Jun-10 0 0 0 27% 0 15% 300 300

Jul-10 0 0 0 27% 0 15% 300 300

Aug-10 0 0 0 27% 0 15% 300 300

Sep-10 0 0 0 27% 0 15% 300 300

Oct-10 0 0 0 27% 0 15% 300 300

Nov-10 0 0 0 27% 0 15% 300 300

Dec-10 0 0 0 35% 0 15% 300 300

Jan-11 0 0 0 35% 0 15% 300 300

Feb-11 0 0 0 35% 0 15% 300 300

TOTAL 0 0 0 0 3600 0 10050 3600

Pay Calculation Sheet for the financial year 2010-2011, Assessment Year 2011-12 For West Bengal Govt Employees only

MONTH &Year

Basic +Grade

Pay

Conv. Allown. If

any

D.A. Rate

(March 10-Feb-

11)

H.R.A. Rate(March 10-Feb 11)

Arrear Receive

d

G.P.F. P.Tax

TOTA

L EA

RN

FO

R T

HIS

YEA

R

1000 0 0 0 0

1000 0 0 0 0

1000 0 0 0 0

1000 0 0 0 0

1000 0 0 0 0

1000 0 0 0 700

1000 0 0 0 700

1000 0 0 0 700

1000 0 0 0 700

1000 0 0 0 700

1000 0 0 0 2000

1000 0 0 0 0

13650 12000 0 0 0 5500

Pay Calculation Sheet for the financial year 2010-2011, Assessment Year 2011-12 For West Bengal Govt Employees only

Total Earn

H.B. Loan. Princpl

H.B.Int Paid

Deposited as

monthly TDS

Date of Deposite

d TDS

T.V No./Vid

e Chln.N

o

INCOME TAX STATEMENT FOR THE FINANCIAL YEAR 2010-2011ASSESSMENT YEAR 2011-2012

A. Name & Designation of the Assesses - - - - B. Residential Address - - - Pin 0C. Pan No. ader Office permanent A/C No.1 a) Salary income with allowance excluding H.R.A.:-…………………………… Rs. 3600

b) House Rent Allowance :-…………………………………………………………… Rs. 0c) Bonus :-………………………………………………………………………………… Rs. 0d) Arrear,if any :-………………………………………………………………………….. Rs. 10050

2 Any other income as stated by the Assesses :-a) Income from N.S.C./Bank interest etc:-…………………………………………. Rs. 0b) Income from House Property:-……………………………………………………. Rs. 0

3 Gross Income(Col.1 + 2 ) :-……………………………………………………………… Rs. 136504 Interest paid as H.B.Loan (1.5 Lacks maximum) U/S 24(B):-………………………. Rs. 05 Professional Tax U/S 16(iii) :-………………………………………………………… Rs. 06 Exemption of Conveyance Allowances U/s 10(14)(i)[Max.Rs 9600/-P.A. Rs. 07 Exemption U/S 10(13A) :-

a) H.R.A.Received :- Rs. b) House Rent paid - 10% of B.Pay + D.A. :- Rs. c)50% of B.Pay + D.A.,In Metropol City ors 40% Rs. Rs. 0

8 Total Income(Col.3-4-5-6) :-………………………………………………………. Rs. 136509 Deduction U/S 80 C (Maximum Rs.1,20,000/- including T.Svngs Bond)

a) Contribution to G.P.F.:- ……………………………………………. Rs. 12000b) Contribution to P.P.F. :- 12000c) Contribution to New Flexible Bond……………….. Rs. 0d) Group Insurance Savings Scheme :- Rs. 0e) L.I.C./P.L.I./U.Lip Premiam paid(including Notified Pension Scheme for maximum Rs.10,000/-:- Rs. 32018f)Purchase of N.S.C. :- Rs. 0g) Amount paid as excluisively tuition fees to any University/College/School for maximum of two Children( 2 )Maximum Rs.75000/- Rs. 0h) Payment of H.B.Loan (Principal) :- Rs. 0i) Equity linked savings scheme/tax savings bond etc.{Max-20000/-) Rs. 0j) Others, if any as notified :- 80G 0 80D 080E 0 80DD 0 80DDB 0 80CCC 080CCD 0 80U 0 Rs. 0k) Total Amount Deducted (a to j) :-………………………. Rs. 56018 Rs. 56018

10 Taxable Income (8-9) :-……………………………………………………………. Rs. -4237011 i) Upto Rs.1,60,000/- Tax Nil, (ii)Rs.1,60,001/-to 5,00,000/-Tax 10%

iii) Rs.5,00,0001/- to 8,00,000/- Tax 20%, iv)Rs.8,00,001/-to Onwards Tax 30%v) For Women employee upto Rs.1,90,000/- Tax Nil

12 Total Tax :-…………………………………………………………………………. Rs. 013 3% Educational cess on tax :-…………………………………………………… Rs. 014 Tax Payable including educational cess(Col.12 + 13) :-………………….. Rs. 015 Relief U/S 89(1)[Arrears Relief from Salary] Rs. 016 Net Tax Payable ( 14-15) Rs. 017 Tax already deducted from source :-…………………………………………. Rs. 550018 Balance Tax Payable :-………………………………………………………….. Rs. -5500

Countersigned By Signature of the employeeDesignationDate

Salary Statement For The Year 2010 - 2011Salary Statement Of 0 0 0

D.A. H.R.A. M.A.

Mar-10 0.00 0 0 0 300 300

Apr-10 0.00 0 0 0 300 300

May-10 0.00 0 0 0 300 300

Jun-10 0.00 0 0 0 300 300

Jul-10 0.00 0 0 0 300 300

Aug-10 0.00 0 0 0 300 300

Sep-10 0.00 0 0 0 300 300

Oct-10 0.00 0 0 0 300 300

Nov-10 0.00 0 0 0 300 300

Dec-10 0.00 0 0 0 300 300

Jan-11 0.00 0 0 0 300 300

Feb-11 0.00 0 0 0 300 300

TOTAL 0.00 0 0 0 3600 3600

Total Arrears Received from March 2010 to February 2011 10050

Total Bonus Received from March 2010 to February 2011 0

MONTH &Year

Basic +Grade Pay

Conv. Allown.

If anyGross Salary

Salary Statement For The Year 2010 - 20110

G.P.F. P.Tax H.B.Int Paid

1000 0 0 0 0

1000 0 0 0 0

1000 0 0 0 0

1000 0 0 0 0

1000 0 0 0 0

1000 0 0 0 700

1000 0 0 0 700

1000 0 0 0 700

1000 0 0 0 700

1000 0 0 0 700

1000 0 0 0 2000

1000 0 0 0 0

12000 0 0 0 5500

H.B. Loan. Princpl

Deposited as monthly TDS

FORM NO.16

Name and address of the Employer Name and designation of the employee

- - 0

PAN NO.of Deductor TAN No.of the Deductor PAN NO. of the Employee

- ader

Period

2010-2011

Quarter Acknowledgement No From To

Apr-10 Mar-11

1 Gross Salary IN RUPEES IN RUPEES

(a) 13,650

(b) 0

(c) 0

(d) TOTAL 13,650

2 Less: Allowance to the extent exempt u/s 10

AllowanceRs.

(a) HRA Exempt u/s 10(13A) 0.00

(b) Conv.Alw.Exempt u/s 10(14)(i) 0.00 0

3 Balance(1-2) Rs. 13,650

[See rule 31(1)(a)]Certificate under section 203 of the Income-tax Act, 1961 for Tax deducted at source from Income

chargable under the head on Salary

Acknowledgement Nos. of all quarterly statements of TDS under sub-section (3) of section 200 as provided by TIN Facilitation Centre or NSDLWebsite.

DETAILS OF TAX DEDUCTED AND DEPOSITED INTO CERTRAL GOVERNMENT ACCOUNT

Salary as per provisions contained in section 17(1)

Value of perquisites under section 17(2)(as per Form No. 12BA,wherever applicable)

Profits in lieu of salary under section 17(3)(as per Form No. 12BA, wherever applicable)

4 Deductions : Rs.

(a) 0.00

(b) Tax on employment 0.00

5 Aggregate of 4(a) to (b) Rs. 06 Rs. 13,650

7 Add: Any other income reported by the employee

a)Income form N.S.C./Bank int.etc. Rs. 0

8 Gross total income (6+7) Rs.

9 Deductions under Chapter VIA

A

(a) G.P.F. Rs. 12,000

b) P.P.F 12,000

c) G.I.S. Rs. 0

Rs. 32,018

e) H.B.LOAN(PRINCIPAL) Rs. 0 56,018

B Other sections e.g.,80E,80G,etc under chapter VI

a) Section 80 E Rs. 0 0

b) Section 80 G Rs. 0 0

c) Section 80U Rs. 0 0

d) Section 80DD Rs. 0 0

e) Section 80D Rs. 0 0

f)Section 80CC Rs. 0 0

g)Section 80CCD Rs. 0 0

g)Section 80DDB Rs. 0 0

10 Aggregate of deductible amount under Chap. VIA

11 Total Income (8-10)

H.B.Loan Int.(Max-1,50,000/-)u/s 24(B)

Income chargeable under the head 'salaries' (3-5)

U/s 80C (Aggregate amount Max.Rs.1,20,000/-)

Gross Amount

d) L.I.C.+P,L.I.+U.LIP+Tuition Fees+NSC+Tax Savings Bond

Gross Amount

Qulfy amount

12 Tax on total income

13 Surcharge on col.12

14 Education & cess @3% on col.no.12

15 Tax payable (12+13+14)

16 Relief U/s 89(1)

17 Tax payable/refundable (15-16)

18 Less (a) Tax deducted at source

19 Net Tax col.No.17-18) - -

Sl. No TDS Rs.

1 0 0

2 0

3 0

4 0

5 0

6 700

7 700

8 700

9 700

10 700

11 2,000

120

I, son/daughter of

working in the capacity of

(designation)do hereby certify that a sum of Rs :

DETAILS OF TAX DEDUCTED AND DEPOSITED INTO CERTRAL GOVERNMENT ACCOUNT (The employer is to provide transaction-wise details of tax deducted and deposited)

Surcharge Rs.

Education Cess Rs.

Total Tax Deposited

Rs.

Cheque No/DD No (if

any)

BSR Code of Bank Branch

Rupees

has been deducted at source and paid to the credit of the Central Government. I further certify that the information

given above is true and correct based on the books of account, documents and other available records.

Place: Signature of the person responsible for deduction of tax

Date: Full Name :

Desitgnation :

FORM NO.16

Name and designation of the employee

0 0

PAN NO. of the Employee

ader

Assessment Year

2011-2012

IN RUPEES

Certificate under section 203 of the Income-tax Act, 1961 for Tax deducted at source from Income

DETAILS OF TAX DEDUCTED AND DEPOSITED INTO CERTRAL GOVERNMENT ACCOUNT

13,650

Deductible Amount Rs.

56,018Deductible Amount Rs.

56,018

-42,368

0

0

0

0

0

0

5,500

-5,500

12/30/1899 0

12/30/1899 0

12/30/1899 0

12/30/1899 0

12/30/1899 0

12/30/1899 0

12/30/1899 0

12/30/1899 0

12/30/1899 0

12/30/1899 0

12/30/1899 0

12/30/1899 0

son/daughter of

working in the capacity of

DETAILS OF TAX DEDUCTED AND DEPOSITED INTO CERTRAL GOVERNMENT ACCOUNT (The employer is to provide transaction-wise details of tax deducted and deposited)

Dt.of which tax

deposited (dd/mm/yy

Transfer voucher

No/Challan Identification

No.

(In words)

has been deducted at source and paid to the credit of the Central Government. I further certify that the information

given above is true and correct based on the books of account, documents and other available records.

Signature of the person responsible for deduction of tax

FORM

INDIAN INCOME TAX RETURNPE

RSO

NAL

INFO

RMAT

ION

First name Middle name Last name

- - - Flat /Door/Block No. Name Of Premises/Building/Village

- Road/Street/Post Office Area/Locality

- - Town/City/District State Pin code

- - 0Email Addrs. (STD Code) - Phone Number

FILI

NG

STA

TUS Designation of Assessing Officer (Ward/Circle) Return Filed Under Section-[Please see instruction numbe

Whether original or Revised return? (Tick) √ Original

Residential Status (Tick) √ Resident Non-Resident

INCO

ME

& D

EDU

CTIO

NS

1 Income chargeable under the Head 'Salaries'(Salart/Pension)2 Income chargeable under the Head 'House Property'(enter-ve sign in case of loss, if any)3 Income chargeable under the Head 'Other Sources' (enter-ve sign in case of loss, if any)4 Gross Total Income (1+2+3)5 Deductions under chapter VIA (Section

a 80C 56,018.00 e 80DD 0.00 I 80GG 0.00b 80CCC 0.00 f 80DDB 0.00 j 80GGA 0.00c 80CCD 0.00 g 80E 0.00 k 80GGC 0.00d 80D 0.00 h 80G 0.00 l 80U 0.00

6 Deductions (Total of 5a to5i) 7 Total Income (4-6)

TAX

COM

PUTA

TIO

N

8 Tax Payable on Total Income9 Secondary and Higher Education cess on 8

10 Total Tax and Education cess payable (8+9)11 Relief under Section 89 12 Relief under Section 90/91 13 Balance Tax Payable (10-11-12)14 Total interest payable u/s 234A/234B/234C15 Total Tax and Interest payable (13+14)

Seal and signature of receiving official

SARAL-II (ITR-I)

[For Individual having Income from Salary/Pension/income from One House Property(Excluding loss brought forward from previous years)/Income from Other Sources

(Excluding Winning from Lottery and income from Race Horses)](Please see Rule 12 of the Income-tax Rules, 1962)(Also see attached instuctions)

If revised, enter Receipt No and Date of filing original return (DD/MM/YYYY)

Do not write or stamp in this areas for office use onlyReceipt No

Date

TAXE

S PA

ID

16 Taxes Paidabc

17 Total Taxes paid (16a+16b+16c)18

REFU

ND

1920 Enter your bank account number (mandatory in case of refund)21 Do you want your refund by Cheque, or 22 In case of direct deposit to your bank account give additional details

MICR Code:23 Details of Tax Deducted at Source from Salary [As per Form 16 issued by Employer(s)]

TDS

ON

SAL

ARY

(1) (2) (3) (4) (5) (6)

0 0 13,650 56,018 0

24 Details of Tax Deducted at Source on Interest [As per Form 16 A issued by Deductor(s)]

TDS

ON

INTE

REST

(1) (2) (3) (4) (5)

NOTE Enter the total of column (7) of 22 in Sl.No.15b of TAXES PAID25 Details of Advance Tax and Self Assessment Tax Payments

TAX

PAYM

ENTS Name of Bank & Branch BSR Code Serial Number of Challan

(i) 0 0 30-Dec-99 0(iii)

NOTE Enter the total of Advance tax and Self Assessmen tax in Sl.No.15a and 15c of TAXES PAID26Sl. Code Amount (Rs.) Sl. Code Amount (Rs.) Sl.a e hb f ic g j

27 Exempt Income only for reporting putpose(from Dividend,Capital gains etc.) 27VERIFICATION

Do not write or stamp in this areas for office use onlyReceipt No

Date

Advance Tax (from item 25)TDS (column 7 of item23+column 7 of item 24)Self Assessment Tax (from item 25)

Tax Payable (15-17) (Enter if 15 is greater than 17, else leave blank)Refund (17-15) (enter if 17 is greater than 15, also give Bank account details below)

deposited directly into your bank account?

Type of Account (tick as applicable)

Sl No

Tax Deduction Account Number(TAN) of the Employer

Namee and address of the Employer

Income chargeable under the

head salaries

Deduction under

Chapter VI-A

Tax payable (incl. surch. And

edn. Cess)

Sl No

Tax Deduction Account Number(TAN) of the

DeductorNamee and address of

the DeductorAmount paid/

creditedDate of Payment

/Credit

Sl No

Date of Deposit (DD/MM/YYYY)

Other Information (Transactions reported through Annual Information Return) (Please see instruction number-9(ii) for code)

I, son/ daughter of

Place Date Sign here

28 If the return has been prepared by a Tax Return Preparer (TRP) give further details as below :Identification No. of TRP Name of TRP Counter Signature of TRP

29 If TRP is entitled for any reimbursement from the Government, amount thereof (to be filled by TRP)

declare that to the best of my knowledge and belief, the information given in the return thereto is correct and complete and that the amount of total income and other particulars shown therein are truly stated and are in accordance with the provisions of the Income-tax Act, 1961, in respect of income chargeable to Income-tax for the previous year relevant to the Assessment Year 2011-12.

INDIAN INCOME TAX RETURN Assessment Year

2 0 1 1 - 1 2

Pan No

- ader Date of Birth (DD/MM/YYYY)

- 8/11/1985Area/Locality Employer Category (Tick) (√)

- Govt. PSU Others

Pin code Sex (Tick) (√)

0 √ Male Female

(+91) 9 8 3 0 8 5 8 0 8 8

Return Filed Under Section-[Please see instruction numbe

Revised

Resident but not ordinarily Resident

Income chargeable under the Head 'Salaries'(Salart/Pension) 1 13,650Income chargeable under the Head 'House Property'(enter-ve sign in case of loss, if any) 2 0Income chargeable under the Head 'Other Sources' (enter-ve sign in case of loss, if any) 3 0Gross Total Income (1+2+3) 4 13,650

0.000.000.000.00

6 56,0187 -42,3688 09 010 011 012 013 014 015 0

Seal and signature of receiving official

[For Individual having Income from Salary/Pension/income from One House Property(Excluding loss brought forward from previous years)/Income from Other Sources

(Excluding Winning from Lottery and income from Race Horses)](Please see Rule 12 of the Income-tax Rules, 1962)(Also see attached instuctions)

Taxes Paid16a16b 5,50016c 0

Total Taxes paid (16a+16b+16c) 17 018 019 0.00

√ Savings Details of Tax Deducted at Source from Salary [As per Form 16 issued by Employer(s)]

(6) (7) (8)

0 5,500 5,500

Details of Tax Deducted at Source on Interest [As per Form 16 A issued by Deductor(s)]

(5) (6) (7)00

00

Serial Number of Challan Amount (Rs.)

0 00

Enter the total of Advance tax and Self Assessmen tax in Sl.No.15a and 15c of TAXES PAID 0

Code Amount (Rs.)

VERIFICATION

deposited directly into your bank account? (tick as applicable

Tax payable (incl. surch. And

edn. Cess)Total tax deposited

Tax payable/ refundable

Date of Payment /Credit

Total tax deposited

Amount out of (6) claim

for this year

(Please see instruction number-9(ii) for code)

solemnly

If the return has been prepared by a Tax Return Preparer (TRP) give further details as below :Counter Signature of TRP

If TRP is entitled for any reimbursement from the Government, amount thereof (to be filled by TRP) 29

declare that to the best of my knowledge and belief, the information given in the return thereto is correct and complete and that the amount of total income and other particulars shown therein are truly stated and are in accordance with the provisions of the Income-tax Act, 1961, in respect of income chargeable to Income-tax for the previous year relevant to the

Government of India

INCOME TAX DEPARTMENT ACKNOWLEDGEMENT

Received with thanks form: 0 - a return of

PER

SON

AL

INFO

RM

ATI

ON Name PAN NO

0 0 0 ader Flat/Door/Block No: Name of Premises/Building/Village:

0 Road/Street/Post Office: Area/Locality:

0 0 Town/City/District: State:

0 0Designation of Assessing Officer(Ward/Circle) Original/Revised Original

1 Gross total income 1

2 Deduction under Chapter-VI-A 2

3 Total Income 3

4 Net tax payable 4

5 Interest payable 5

6 Total tax and interest payable 6

7 Taxes paid

a Advance Tax 7a 0

b TDS 7b 5,500

c TCS 7c 0

d Self Assessment Tax 7d 0

e Total Taxes paid (7a+7b+7c+7d) 7e

8 Tax payable (6-7e) 8

9 Refund (7e-6) 9

Receipt No. Seal and Signature of receiving official:

Date:

income &/returnof fringe benefits in Form No ITR - 1 for assessment year 20011-2012, having the following particulars:

Status(fill the code)

CO

MPU

TATI

ON

OF

INC

OM

E &

TA

X TH

EREO

N

Government of India

INCOME TAX DEPARTMENT ACKNOWLEDGEMENT

a return of

0

11

Original

13,650

56,018

-42,368

0

0

0

5,500

0

-5,500

income &/returnof fringe benefits in Form No ITR - 1 for assessment year 20011-2012, having the following

FORM NO.10 E

[See rule 21AA]

1 Name and address of the employee 0 0

0 0

2 Permanent account number ader

3 Residential status PERMANENT RESIDENT

1 (a)

(b)

(c)

(d) Payment in commutation of pension in accordance with the provisions of sub-rule (5) of rule 21A

2

…………………………………………..Signature of the employee

VerificationI, 0 0 0

what is stated above is true to the best of my knowledge and belief.Verified today, the Day of

Place: …………………….………………………………………

Date:…………………… Signature of the employee

Form for furnishing particulars of income under section 192(2A) for the year ending 31 st March, 2010 for claiming relief under section 89(1) by a Government servant or an employee in a 2[company,co-operative society,local authority ,university, institution,

association or body

Particulars of income referred to in rule 21A of the Income-tax Rules, 1962,during the previous year relevant to assessment year 2011-12

Salary received in arrears or in advance in accordance with the provisions of sub-rule (2) of rule 21A.

Payment in the nature of gratuity in respect of past services, extending over a period of not less than 5 years in accordance with the provisions of sub-rule (3) of rule 21A.Payment in the nature of compensation from the employer or former employer at or in connection with termination of employment after continuous service of not less than 3 years or where the unexpired portion of term of employment is also not less than 3 ye

Detailed particulars of payments referred to above may be given in Annexure I,II,IIA,III, or IV as the case may be.

FORM NO.10 E

[See rule 21AA]

0

0

ader

10,050

Not Applicable

Not Applicable

Not Applicable

ANNEX-I

…………………………………………..

Verificationdo hereby declare that

what is stated above is true to the best of my knowledge and belief.

………………………………………

Form for furnishing particulars of income under section 192(2A) for the year ending 31 st March, 2010 for claiming relief under section 89(1) by a Government servant or an employee in a 2[company,co-operative society,local authority ,university, institution,

Particulars of income referred to in rule 21A of the Income-tax Rules, 1962,during the previous year relevant to assessment year 2011-12

ANNEXURE-I[See item 2 of Form No.10E]

Arrears or advance salarySl No. Particulars

1 Total income (excluding salary received in arrears or advance)

2 Salary received in arrears or advance

3 Total income (as increased by salary received in arrears or advance) [Add item 1 and item 2]

4 Tax on total income [as per item 3]

5 Tax on total income [as per item 1]

6 Tax on salary received in arrears or advance [Difference of item 4 and item 5]

7 Tax computed in accordance with Table "A"[Brought from column 7 of Table A]

8 Relief under Section 89(1) [Indicate difference between the amounts mentioned against item 6 and item 7]

TABLE "A"[See item 7 of Annexure 1]

(1) (2) (3) (4) (5)

2009-10 80,146 10,050 90,196 0

Signature:Place: Name: 0Date: Designation: 0

Previous year

Total income of the relevent previous

year (Rs.)

Salary received in arrears or advance

relating to the relevent previous year

as mentioned in column (1) (Rs.)

Total income (as increased by salary

received in arrears or advance) of the

relevent previous year mentioned in column (1) [add colmn 2 & 3]

(Rs.)

Tax on total income [as per

column (2)-After Rebate and

including Edn Cess and

Surcharge](Rs.)

ANNEXURE-I[See item 2 of Form No.10E]

Arrears or advance salaryParticulars Amount (Rs.)

Total income (excluding salary received in arrears or advance) -52,420Salary received in arrears or advance 10,050Total income (as increased by salary received in arrears or advance) [Add item 1 and item 2] -42,370Tax on total income [as per item 3] 0Tax on total income [as per item 1] 0Tax on salary received in arrears or advance [Difference of item 4 and item 5] 0Tax computed in accordance with Table "A"[Brought from column 7 of Table A] 0Relief under Section 89(1) [Indicate difference between the amounts mentioned against item 6 and item 7] 0

TABLE "A"[See item 7 of Annexure 1]

(6) (7)

0 0

0 00

Tax on total income[as per

column (4) After Rebate and

including Edn Cess and

Surcharge] (Rs.)

Difference in tax [Amount under

column (6) minus amount under column

(5)] (Rs.)