INCOME TAX CALCULATION STATEMENT

FOR THE FINANCIAL YEAR 2014-2015

SELECT FROM LIST BUTTON OR ENTER MANUALLY
Name
:
Designation
:
Office Address :

Phone No
Bank A/C No :
1.
2.

3.
4.
5.
6.

7.
8.

0
Department

0
0

Cell No
MICR code No : 0

GROSS SALARY INCOME (including all allowances)

LESS
HRA exempted under I.T. rules under section 10(13A)
a. Actual rent paid
b. 10% of salary paid (pay + DA)
c. Difference (excess over 10 % pay + DA) i.e., (a-b)
d. HRA received
e. 40% of salary (Pay + DA)
HRA exempted c (or) d (or) e whichever is less
GROSS INCOME (1-2)
Taxable Perquisites
Gross Salary Income (3)+(4)
Less : Deduction U/S 16
i. Entertainment allowance
ii. Tax on employment (Professional Tax)
NET SALARY INCOME (5-6)
a.

Accured interest on housing loan for self occupied house property(HBA U/S 24(i)) (up to max 1,50,000)

b. Add Income from other source

c. Accured interest from NSC
d. Other deposit interest
9.
GROSS TOTAL INCOME (7+8)
10. LESS DEDUCTIONS : UNDER CHAPTER VI
a. 1. 80-CCC-LIC Jeevan Suraksha ICICI Life Time Pension
2. GPF/CPF Contribution
3. FBF, SPF
4. LIC premiums paid
5. Tuition fee paid to any School / College
6. NSC Deposits
7. UTI Mutual fund / Notified Fixed Deposits with Bank
8. Housing Loan Principal Repayment (HBA)
9. Other items permissible
Total 1 to 9
(Subject to maximum of Rs. 1,50,000/-)
b. 80-D up to Rs.15,000 (Mediclaim)+(HF)
Health Insurance

c. 80-DD up to Rs.50,000 (Medical treatment - Handicapped dependent)

(Rs.1,00,000 in case of severe disability)
d. 80-DDB up to Rs.40,000 (Medical treatment - individual dependent relative)
e. 80-E up to Rs. 40,000 (Interest on Loan for Higher Studies)
f. 80 EE Payment of interest on Loan for the acquistion of a Residential House Property
- ( up to 1,00,000)

g. 80-G (Donations ) made through employer

h. 80 TTA Maximum of Rs. 10,000/-, interest income, {Note-7}
g. 80-U up to Rs. 50,000 (Permanent Physical Disability cases)
(Rs.1,00,000 in case of severe disability)

TOTA

11. TAXABLE INCOME (9-10) (rounded to nearest ten rupees)

12. TAX ON TOTAL INCOME (FOR COL.11) (rounded to nearest rupee)
A. Individual below 60 years
1. On the first (Rs. 2,50,000) - NILL
2. On the next (Rs. 2,50,001 to 5,00,000) @ 10%
3. On the next (Rs.5,00,001 to 10,00,000) @ 20%
4. On the balance (Above Rs. 10,00,001) @ 30%
Total (2+3+4)
12(a) Total Tax
12(b) (Less) Rebate U/S 87 A (See Note 8)
13.Tax payable for the year 2013-2014 [12(a) - 12(b)]
14. Education cess @2% Secondary & Higher Education cess @ 1% on col.No. 13
15. Tax & Education Cess (13+14)
16. Tax Relief under section 89 (1) as per annexure (Form No. 10E)
17. Tax Payable (15-16)
18.
Tax Paid outside
19. So for deducted in pay bill
19 (a) IT Cess already deducted in monthly salary bill
20. Balance of income tax to be deducted [17-(18+19+19a)]
21.
Tax paid in excess
CERTIFICATE:
1. Certified that I am occupying house allotted by the accommodation controller / PWD /
2. Certified that I am occupying rental house and paying monthly rent of Rs.
0
towards LIC premium and the polic
3. Certified that I am paying a sum of rupees

Counter Signed

Signature of Em
Head of Office
IMPORTANT NOTE
1.

The salary bill for febrauary - 2015 shall be presented along with the pre-checked income tax statement of

for Feb. 2015 with income statement without precheck by this office will be returned with a request to pres

2. Basic Exemption Limited to Rs. 2,50,000.

3. 80-D Medical Insurance Premium.
I. Premium Paid for Assessee / Spouse / Dependent Parents / Children
II. Premium should be paid by cheque
III.Quantum of Deduction actual or Rs. 15,000/- (In case of Senior Citizen Rs. 20,000/-) whichever is less
4.80-DDB Medical Treatment.
I. Medical expenditure actually incurred or Rs. 40,000/- (Rs.60,000/- for Senior Citizen) whichever is less
statement of expenditure to be enclosed.

 II. Doctor certificate in Form No. 10-1 should be furnished

III. Any claim from Insurance Company / Employer shall be reduced from the deduction allowable
5. 80-E deduction in respect of interest (Not Principal) on Loan taken for Higher Education for himself or his c
I. Applicable for any Course or study pursued after passing +2 or its equivalent from any Govt. recognis
II. Entire amount of interest paid during the year shall be deducted from income
6.

80-G Donation
I.

Donations made through employer such as Gujarat Relief fund alone can be considered by employer.
be considered while filing the return of income

7.

80 TTA. Where the gross total income of an individual or a HUF includes an income of interest on deposits

bank, a co-op society carrying a banking business or a post office, such interest income up to Rs. 10,000 is
8.

When total income of the Resident Individual does not exceed Rs. 5 Lakhs, Rebate U/S 8A = 100% of Tax p

Note:

Taxable income less than Rs. 5,00,000/- can be filed return of income with the Department.

TAX PAID
SI NO

TDS
Rs.

BILL NO. (or)

CHALLAN NO.

BILL DATE
CHALLAN

Particulars of INSURANCE Premium paid during the financial year 2

Policy No.

Name of the Company

Nature of Policy

Amount In

Particulars of N.S.C purchased during the financial year 2013Post Office

Issue No

N.S.C Number

TOTA
DETAILS OF INTEREST ACCURED ON N.S.C (VIII ISSUE)
NSC & Name of Post
Office

Date of purchase of the NSC

Rate of Interest (%)

TOTA
Particulars of details towards Infrastructure Bonds
Nature of Deposit

Account No.

Date of Deposit

Place of D

CHOOSE FROM LIST BUTTON (DROP

THE
FINANCIAL YEAR 2014-2015 (ASST. YEAR 2015-2016)
ST BUTTON OR ENTER MANUALLY

PAN
TAN

:
:

0
CHOOSE FROM LIST BUTTON

CHOOSE FROM LIST BUTTON

0 Pin

Branch :

#N/A
0

Rs.

Rs.
598266

A)
0
56775
0
0
227100
0

598266
598266

2636
0
0
0
0

BA U/S 24(i)) (up to max 1,50,000)

595630
595630

CHANGE THE POLICY NAMES T

595630

Pension
0
360
0

FILL
FILL THE
THE MAXIMUM
MAXIMUM ELIGIB
ELIGIB
ACCORDINGLY
ACCORDINGLY

FILL THE MAXIMUM ELIGIB

ACCORDINGLY

Bank

,50,000/-)

360
1800

595270

FILL THE MAXIMUM ELIGIB

ACCORDINGLY

icapped dependent)

vidual dependent relative)

Studies)
on of a Residential House Property
000)

{Note-7}
lity cases)
TOTAL

upees)
nearest rupee)

1800
593470

593470

25000
18694
0
43694
43694
0
43694
cess @ 1% on col.No. 13

1311
45005

m No. 10E)
45005
0
11000
330

19a)]

33675
0

accommodation controller / PWD / TNHB on payment of rent.

0
towards LIC premium and the policies are kept alive.

Signature of Employee with Designation

PORTANT NOTE

the pre-checked income tax statement of this office salary bill

ffice will be returned with a request to present on or after March 2015

ildren

ior Citizen Rs. 20,000/-) whichever is less

,000/- for Senior Citizen) whichever is less. Copy of the bills &

ced from the deduction allowable

n for Higher Education for himself or his children & spouse
or its equivalent from any Govt. recognised School, board of University.
cted from income

nd alone can be considered by employer. Donations of other types are to

cludes an income of interest on deposits in a savings bank account with a

, such interest income up to Rs. 10,000 is allowed as deduction.

. 5 Lakhs, Rebate U/S 8A = 100% of Tax payable or Rs. 2000 whichever is less

f income with the Department.

10

TAX PAID
BILL DATE (or)
CHALLAN DATE

BSR CODE

um paid during the financial year 2014-2015

Amount Insured

Premium per annum

Rs.
Ps.

TOTAL
sed during the financial year 2013-2014
N.S.C Number

0
Amount Insured
Rs.

TOTAL
T ACCURED ON N.S.C (VIII ISSUE)
Rate of Interest (%)

Ps.

0
Amount
Rs.

TOTAL
ls towards Infrastructure Bonds

Ps.

0
Amount
Rs.

Place of Deposit

11

Ps.

TOTAL

Signature of the employee

12

STATEMENT SHOWING SALARY DRAWN DURING THE PERIOD FROM MARCH 2014 TO FEBRAUARY 2015
BANK ACCOUNT NO :
NAME
PAN NO
:
RESIDENTIAL ADDRESS WITH PI
BRANCH
FATHERS NAME
:
PHONE NO :
:
DATE OF BIRTH
CELL NO
:
MICR NO
:
TAN NO
:
Format: dd/mm/yyyy 0R mm/dd/yyyy DEPENDING
ON YOUR COMPUTER'S DATE SETTING
PAY DRAWN
TOTAL
RECOVERIES
Salary for the month
GRADE
OTHERS (IT
SP
OTHERS
Pay
D.A
HRA
CCA
MA
OA
GPF/CPF
FBF
SPF
CF
HF
ADV IT
PT
PAY

Mar-14
April
May
June
July
August
September
October
November
December
Jan-15
Feb-15
DA Arrears 1
DA Arrears 2
Bonus/Pongal gift

17530
17530
17530
17530
17530
17530
17530
17530
17530
17530
17530
17530

5400
5400
5400
5400
5400
5400
5400
5400
5400
5400
5400
5400

CESS)

20637
22930
22930
22930
22930
22930
22930
24535
24535
24535
24535
24535
6879
4815

1400
1400
1400
1400
1400
1400
1400
1400
1400
1400
1400
1400

360
360
360
360
360
360
360
360
360
360
360
360

300
300
300
300
300
300
300
300
300
300
300
300

100
100
100
100
100
100
100
100
100
100
100
100

300
300
300
300
300
300
300
300
300
300
300
300

1000

PAY REVISION ARREAR

PAY ARREAR
Surrender leave salary
INCREMENT ARREAR
Duty Allowance
Over Coat Allowance
CMHIS
Total
GROSS SALARY
HRA(exclu. surrender)

PT Paid
GPF

210360
598266
16800
2636
0

USE THESE BLANK CELLS

IF NEEDED

FBF
SPF
HF

64800
360
0
1800

292586

16800

4320

ADV IT
MEDICLAIM

3600

1200
11000

3600

1000

46027
48320
48320
48320
48320
48320
48320
49925
49925
49925
49925
49925
6879
4815
1000
0
0
0
0
0
0
0
598266

0
0
0
0
0
0
0
0
0
0
0
0

30
30
30
30
30
30
30
30
30
30
30
30

0
0
0
0
0
0
0
0
0
0
0
0

10
10
10
10
10
10
10
10
10
10
10
10

150
150
150
150
150
150
150
150
150
150
150
150

1000
1000
1000
1000
1000
1000
1000
1000
1000
1000
1000

1318

1318

30
30
30
30
30
30
30
30
30
30
30

360

120

1800

11000

2636

330

TOTAL
TOT
1220
1220
1220
1220
1220
2538
1220
1220
1220
1220
2538
190
0
0
0
0
0
0
0
0
0
0
16246

LIC PREMIUMS PAID

INFRA STRUCTURE BOND

IT Cess Deducted

330
SIGNATURE OF THE EMPLOYEE

Counter signed

HEAD OF OFFICE
NOTES: The HRA drawn for surrender leave salary should not be taken in to account for the purpose of claiming rebate (i.e.) exemption under HRA. kindly fill up Date of Birth, Pan No, Bank A/c, Residential Address

44807
47100
47100
47100
47100
45782
47100
48705
48705
48705
47387
49735
6879
4815
1000
0
0
0
0
0
0
0
582020