Prepare Income Tax , With Salary Statement, ITR-I, Form 16, FOR Financial YEAR 2010-11.

This Calculation sheet for All Govt. & Private concern Employees
Prepared by Pranab Banerjee,Kalisthanpara, Jiaganj,Murshidabad,W.B., pranab.banerjee83@gmail.com
For more calculation visit :-www.pranab.jiaganj.com
(This Software is Demo Version) For Full Version(Unlocked Data Filling Cell) you have to pay Rs.525/-

if any discripency is arise FIRST NAME

for calculation of income tax This New I T R - I(SARAL II),For Assessment Year 2011-2012,which
by this software,I am not MIDDLE NAME
recent published by the MINISTRY OF FINANCE(Deptt.of
respoisible for that LAST NAME Revenue)Central Board of Taxes,New Delhi. Notification Dated
23/04/2010 in the Gazette of India Extraordinary,Part-II, Section 3,
pranab banerjee DESIGNATION (Sub Sec(ii)]
Employee's Permanent A/C No.(PAN NO)
Gender ( Male or Female ) Male If Handicapped Employee Pl. put
"Yes" If General put "No" Yes
DATE OF BIRTH

EMPLOYEE'S RESIDENTIAL ADDRESS

Flat/Door/Block No.
CLICK DON'T Village
UPDATE
Post Office: First your Fill the Pay Sheet ,
Area/Locality:
If you live in Metro City Type Yes ,else Type No No
After you fill this Bio Data Sheet
District:
PIN CODE:
State:
Date of Submit this RETURN
For Various Calculation Visit :-
Office Address www.pranab.jiaganj.com

STATUS- Govt/PSU/Others Govt DIN NO

Full Name of Deductor/D.D.O. Pan No. of Deductor
 Name & Address of the Employer Tan No. of Employer

PARTICULARS OF SALARY
Gross Income from Salary (Salary+H.R.A.+Bonus+Arrear if
588995 This Cell is Auto filled( The Data Comes from Pay Sheet)
any+Int.Bank/NSC+House Property)

Total Income from Salary( This Cell Auto filled) 562295 This Cell is Auto filled (The Data comes from Pay Sheet)

Taxable income of previous year (Col-11) Form No. 16 of After Deduction of 80C & Chapter VA(Taxable Income)
139000
PREVIOUS YEAR [ From Previous Year's Form-16]

1 Deduction under chapter VI-A (LIC,PF,Tuition Fees,H.B.Principal):80C (Maximum Deposit Rs.1,00,000)

2 a) G.P.F. 48000

3 b) L.I.C. 25000

4 c) N.S.C. 2000
DEDUCTION ONLY U/S 80C, 80CC (MAXIMUM LIMIT NOT
5 d) H.B. Loan Principal 0 EXCCEED RS.1,20,000/- including New Tax Savings
Bond(Max Rs.20000/-)
6 e) GROUP INSURANCE (G.I.) 0

7 f) Tax Savings Bond ( Maximum Rs. 20,000/-) 20000

8 g) Tuition Fees (Max.Rs.1,00,000) 5000

TOTAL DEDUCTION U/S 80C Max. Rs 1,00,000/- + 20,000 Total Deduction U/S 80C (Max.limit 1,00,000/-) + 20,000/-
Infrustructure Bond, Total Rs.1,20,000/- 100000 New declared Infrustructure Bond
9
Interest given from Bank/N.S.C/Others Fixed Deposited of
10 Income from Bank Interest/N.S.C/Others Source 5000
previous Years & Current Years
11 Income from House Property 40000 Income From House Property if any
12 80G 5000 Donation in Charitable Fund Maximum 100% of donation)
Premium in health insurance of self,spouse,children,dependent,Maximum Rs
13 80D 5000 15000/-
14 80E 5000 For Higher Education Loan Maximum No Limit

15 80DD 5000 Medical treatment for self or dependent as Handicapped

16 80DDB 10000 Medical Treatment for self or dependent for sever desease
17 80CC 2000 Deposit in Pension Fund (Maximum Rs. 1,00,000/-

18 80CCD 2000 New Pension Scheme (Maximum 10% or Salary)

19 House Rent Paid 60000 For Rented House. Must Submit the receipt of House Rent.
20 Transport OR Conveyance Allowances U/s 10(14)(i) 2400 Maximum Rs. 9600 P.A.
21 Children Education Allowances 500 Maximum Rs. 100 P.M. for two Children
22 Children Hostel Allowances 1800 Maximum Rs. 300 P.M.
23 Leave Travel Allowances 20000 For Govt Employees Fully Exempted, For Private Max.Ra.3,00,000/-

24 Intertenment Allowances 2000 Max.Rs.5000/- P.A.

25 80U 50000 Permanent disability including blindnes as handicapped(Max Rs.75000/-)

TOTAL DEDUCTION CHAPTER VI-A Rs. 184000 TOTAL DEDUCTION CHAPTER VI-A Rs.

26 Arrear Received if any 25000 The Data Comes From Pay Sheet

Relief under Section 89(1) 0 The Data Comes From 10E

 mail.com

have to pay Rs.525/-

essment Year 2011-2012,which

TRY OF FINANCE(Deptt.of
New Delhi. Notification Dated
xtraordinary,Part-II, Section 3,
(ii)]

Pay Sheet
10E

eet ,

Bio Data Sheet

ulation Visit :-
aganj.com
om Pay Sheet)

om Pay Sheet)

xable Income)
Form-16]

000)

0CC (MAXIMUM LIMIT NOT

uding New Tax Savings
.20000/-)

imit 1,00,000/-) + 20,000/-

ond
ers Fixed Deposited of
rent Years

f donation)
hildren,dependent,Maximum Rs

ndicapped

ver desease
00/-

y)

receipt of House Rent.

ate Max.Ra.3,00,000/-

ndicapped(Max Rs.75000/-)

.
Pay Calculation Sheet for -Income Tax Calculation ,for the financial year 2010-2011, Assessment Year 2011-12

Put
Basic Other Hill/Rurl Put Arrear Put
MONTH Hill/Rural D.A. H.R.A.
+Grade Alwnces AGP TA PP DDA CCA Alwn D.A. D.A. if H.R.A. M.A.
&Year Alwance Rate of Rate
Pay if any Rate of % any of %
%
1 2 3 4 5 6 7 8 9 10 11 12 13

Mar-10 28700 0 0 0 0 0 0 0% 0 22% 6314 0 20% 5740 300

Apr-10 28700 0 0 0 0 0 0 0% 0 22% 6314 0 20% 5740 300

May-10 28700 0 0 0 0 0 0 0% 0 22% 6314 0 20% 5740 300

Jun-10 29570 0 0 0 0 0 0 0% 0 22% 6505 0 20% 5914 300

Jul-10 29570 0 0 0 0 0 0 0% 0 27% 7984 0 20% 5914 300

Aug-10 29570 0 0 0 0 0 0 0% 0 27% 7984 0 20% 5914 300

Sep-10 29570 0 0 0 0 0 0 0% 0 27% 7984 0 20% 5914 300

Oct-10 29570 0 0 0 0 0 0 0% 0 27% 7984 0 20% 5914 300

Nov-10 29570 0 0 0 0 0 0 0% 0 27% 7984 0 20% 5914 300

Dec-10 29570 0 0 0 0 0 0 0% 0 27% 7984 0 20% 5914 300

Jan-11 29570 0 0 0 0 0 0 0% 0 27% 7984 0 20% 5914 300

Feb-11 29570 0 0 0 0 0 0 0% 0 27% 7984 0 20% 5914 300

TOTAL 352230 0 0 0 0 0 0 0 89319 70446 3600

 TOTAL
(2+3++4+ G.P.F./ G.I.S. H.B. Advance
Convnce Arrear H.B.Int
Bonus +5+6+7+8+9 E.P.F./P. P.Tax or Pr. Income
Allwn. Received Paid
+10+11+12+ F. CGEIS Paid tax Paid
13+14)
14 15 16 TOTAL 16 17 18 19 20 21

200 1000 25000 41254 4000 130 0 0 0 1500

200 41254 4000 130 0 0 1500

0

200 41254 4000 130 0 0 1500

0

200 42489 4000 130 0 0 1500

0

200 43968 4000 130 0 0 1500

0
Contact for
200 43968 4000 130 0 0 1500
preparation of any 0
Accounts
200 Calculation for any 43968 4000 130 0 0 1500
0
Concern with low
200 cost 43968 4000 130 0 0 1500
0

200 43968 4000 130 0 0 1500

0

200 43968 4000 130 0 0 1500

0

200 43968 4000 130 0 0 2500

0

200 43968 4000 130 0 0 3234

0

2400 517995 48000 0 0 0 0 20734

 INCOME TAX STATEMENT FOR THE FINANCIAL YEAR 2010-2011
ASSESSMENT YEAR 2011-2012
A. Name & Designation of the Assesses - - - -
B. Residential Address - - - Pin Code No. -
C. Pan No - Office permanent A/C No.
1 a) Salary income with allowance excluding H.R.A.:-……………………… Rs. 447549
b) House Rent Allowance :-……………………………………………………… Rs. 70446
c) Bonus :-…………………………………………………………………………… Rs. 1000
d) Arrear,if any :-……………………………………………………………………… Rs. 25000
2 Any other income as stated by the Assesses :-
a) Income from N.S.C./Bank interest etc:-…………………………………… Rs. 5000
b) Income from House Property:-……………………………………………… Rs. 40000
3 Gross Income(Col.1 + 2 ) :-…………………………………………………… Rs. 588995
4 Interest paid as H.B.Loan (1.5 Lacks maximum) U/S 24(B):-………… Rs. 0
5 Professional Tax U/S 16(iii) :-(For Handcpd employees are exempt from P.tax) Rs. 0
6 Exemption of Conveyance Allowances U/s 10(14)(i)[Max.Rs 9600/-P.A. 2400
7 Exemption U/S 10(13A) :-
a) H.R.A.Received :- Rs. 70446
b) House Rent paid :- Rs. 60000
c) Expenditure on rent in excess of
50% of B.Pay + D.A. In Metropol City ors 40% ### Rs. 176,620
10% of B.Pay + D.A. 15,845 Rs. 15845
e) Amount exempted (Least of a,c):- - Rs. 0 Rs. 0
8 Children Education Allowances Max.Rs.100 p.m.(Two Children) Rs. 500
9 Children Hostel Allowances Max.Rs.300 p.m.(Two Children) Rs. 1800
10 Intertenment Allowances U/s 16(ii) Max.Rs. 5000/- P.A……………….. 2000
11 Leave Travel Concession For Govt employees Fully Exempt Rs. 20000
12 Total Income(Col.3-4-5-6-7-8-9-10-11)…………………………………. Rs. 562295
13 Deduction U/S 80 C (Maximum Rs.1,20,000/- including T.Svngs Bond)
a) Contribution to G.P.F./E.P.F. ………………………………………. Rs. 48000
b) Contribution to New Flexible Bond……………….. Rs. 0
c) Group Insurance Savings Scheme :-…………………. Rs. 0
d) L.I.C./P.L.I./U.Lip Premiam paid(including Notified
Pension Scheme for maximum Rs.10,000/-:- Rs. 25000
e)Purchase of N.S.C. :-……………………………………. Rs. 2000
f) Amount paid as excluisively tuition fees to any
University/College/School for maximum of two
Children( 2 )Maximum Rs1,00,000/-………………………… Rs. 5000
g) Payment of H.B.Loan (Principal) :-………………………… Rs. 0
h) Equity linked savings scheme/tax savings bond etc.{Max-20000/-) Rs. 0
j) Others, if any as notified :- 80DDB 10000 80G 5000
i) 80U 50000 ii)80DD 5000 iii)80D 5000 80E 5000 Rs. 80000
k) Total Amount Deducted (a to j) :-………………………. Rs. 160000 Rs. 180000
14 Taxable Income (12-13) :-[Rounded off to the next 10]………………… Rs. 382300
15 i)
iii)Upto Rs.1,60,000/-
Rs.5,00,0001/- Tax Nil, Tax(ii)Rs.1,60,001/-to
to 8,00,000/- 5,00,000/-Tax
20%, iv)Rs.8,00,001/-to Onwards 10%
Tax
30%
v) For Women employee upto Rs.1,90,000/- Tax Nil
16 Total Tax :-………………………………………………………………….. Rs. 22,230
17 3% Educational cess on tax :-…………………………………………………… Rs. 667
18 Tax Payable including Education & Cess(Col.12+13) Rs. 22,897
19 Relief U/S 89(1)[Arrears Relief from Salary] Rs. -
20 Net Tax Payable ( 13-14) Rs. 22,897
21 Tax already deducted from source :-…………………………………………. Rs. 20,734
22 Balance Tax : - Payable Rs. 2,163
Bio Data Sheet
 FORM NO.16
[See rule 31(1)(a)]
Certificate under section 203 of the Income-tax Act, 1961 for Tax deducted at source on Salary

PART- A
Name and address of the Employer Name and designation of the employee

- - - - -

PAN NO.of Deductor TAN No.of the Deductor PAN NO. of the Employee
- - -
From To
CIT (TDS) Assessment Year Period

Address…………………………………………………………
………………………………………………….. 2010 2011
City…………………….Pin Code……………………..

Summary of tax deducted at source

01/04/2010 01/03/2011
Receipt Numbers of original statements of Amount of tax deducted in Amount of tax deposited remitted in
Quarter TDS under sub-section (3) of section 200 respect of the employee respect of the employee
Q1 500 4/28/2010 4500 4500
Q2 600 31/9/2010 4500 4500
Q3 700 31/12/2010 4500 4500
Q4 800 31/3/2011 7234 7234
PART- B (Refer Note 1)
Details of Salary paid and any other income and tax deducted
1 Gross Salary IN RUPEES IN RUPEES IN RUPEES
Salary as per provisions contained in
(a) section 17(1) 588995
Value of perquisites under section 17(2)
(b) (as per Form No. 12BA,wherever 0
applicable)
Profits in lieu of salary under section
(c) 17(3)(as per Form No. 12BA, wherever 0
applicable)
(d) TOTAL 588995
2 Less: Allowance to the extent exempt u/s 10 cn
Allowance Rs. ###
2400 2400
3 Balance(1-2) Rs. 586595
4 Deductions :
H.B.Loan Int.(Max-1,50,000/-)
(a) u/s 24(B) 0
(b) Tax on employment 0
5 Aggregate of 4(a) tounder
Income chargeable (b) the head 'salaries' 0
6
(3-
586595
Add: Any other income reported by the
5)
7
employee
a)Income form N.S.C./Bank int.etc. Rs. 5000
8 Gross total income (6+7) Rs. 591595
9 Deductions under Chapter VIA
U/s 80C (Aggregate amount Gross
A
Max.Rs.1,20,000/-) Amount
Deductible Amount Rs.
(a)(i)Sec.80C-G.P.F. Rs. 48000
(ii) G.I.S. Rs. 0
(iii) L.I.C.+P,L.I.+U.LIP+Tuition
Fees+NSC+Tax Savings Bond
Rs. 32000
 (iv) H.B.LOAN(PRINCIPAL) Rs. 0 80000 100000
Qulfy
B Other sections e.g.,80E,80G,etc under chapter VI A Gross Amount
amount
Deductible Amount Rs.
(a) Section 80 E Rs. 5000 5000
(b) Section 80 G Rs. 5000 5000
( c ) Section 80U Rs. 50000 50000
(d) Section 80DD Rs. 5000 5000
(e) Section 80D Rs. 5000 5000
f) Section 80CC Rs. 0 0
G) Section 80DDB Rs. 10000 10000
Aggregate of deductible amount under Chap.
10
VIA
180000
11 Total Income (8-10) 411595
12 Tax on total income 22,230
13 Education & cess @3% on col.no.12 667
14 Tax payable (12+13+14) 22897
Less Relief U/s 89(1)(attach
15
dtls
0
Tax payable/refundable (15-
16
16)
22,897
17 Less (a) Tax deducted at source 20734
Net Tax col.No.17-
18
18)
- Tax payable 2163
Verification
I son/daughter of

working in the capacity of(designation do hereby certify that a sum of Rs [Rs.

(in words)] has been deducted and deposited to the credit of the Central Governement. I further

certifify that the information given about is true, complete and correct and is based on the books of account, documents, TDS

statement ,TDS deposited and other available records.

Place:-

Date:- Signature of person responsible for deduction of tax

Designation :- Full Name:-

###

Note:-
1 If an assessee is employed under more than one employer during the year, each of the employers shall i
of the certificate in Form No. 16 pertaining to the period for which such assessee was employed with each
of the employers. Part B may be issued by each of the employers or the last employer at the option of the
assessee.
2 Government deductors to enclose Annexure-A if tax is paid without production of an income-tax
challan and Annexure-B if tax is paid accomanied by an income-tax challan.

3 Non-Government deducto5rs to enclose Annexure-B

4 The deductor shall furnish the address of the Commissioner of Income-tax(TDS) having jurisdiction
as regards TDS statements of the assesee.

5 This Form shall be applicable only in respect of tax deducted on or after 1st day of April, 2010.
 ANNEXURE-A
DETAILS OF TAX DEDUCTED AND DEPOSITED IN THE CENT5RAL GOVERNMENT ACCOUNT THROUGH BOOK ENTRY
(The Employer to provide payment wise details of tax deducted and deposited with respect to the employee)
Tax Deposited in respefct on of
Sl.No Book Identification Number (BIN)
the employee (Rs.

DDO Sequence Number in the Date on which

Receipt Numbers of
Book Adjustment Mini tax deposited
Form No 24G
Statement (dd/mm/yy)

Note:-
1. In the column for TDS, give total amount for TDS,Surcharge(if applicable) and education cess.

ANNEXURE-B
DETAILS OF TAX DEDUCTED AND DEPOSITED IN THE CENTRAL GOVERNMENT ACCOUNT THROUGH CHALLAN
(The Employer to provide payment wise details of tax deducted and deposited with respect to employee)
Tax Deposited in respect on of
Sl.No Challan Identification Number ( C I N )
the employee (Rs.)
Date on which tax deposited Challan Serial
BSR Code of the Bank Branch
(dd/mm/yy) Number
1 1500 00055 4/28/2010 1
2 1500 00055 5/28/2010 1
3 1500 00055 6/28/2010 1
4 1500 00055 7/28/2010 2
5 1500 00055 8/28/2010 2
6 1500 00055 9/28/2010 2
7 1500 00055 10/31/1910 3
8 1500 00055 31/11/10 3
9 1500 00055 12/31/1910 3
10 1500 00055 1/31/1911 4
11 2500 00055 2/28/1911 4
12 3234 00055 3/31/1911 4

Total 20734

Note:-

1 In the column for TDS,give total amount for TDS, Surcharge(if applicable) and education cess
 INDIAN INCOME TAX RETURN Assessment Year
FORM

SARAL-II [For Individual having Income from Salary/Pension/income from One House
(ITR-I) Property(Excluding loss brought forward from previous years)/Income from Other Sources 2 0 1 1 - 1 2
(Excluding Winning from Lottery and income from Race Horses)]

(Please see Rule 12 of the Income-tax Rules, 1962)(Also see attached instuctions)
First name Middle name Last Name Pan No DIN NO
- - - - -
PERSONAL INFORMATION

Flat /Door/Block No. Name Of Premises/Building/Village Date of Birth

0 - 12/30/1899

Road/Street/Post Office Area/Locality Employer Category √

- - √ Govt PSU Others
Town/City/District State Pin code Employer Category
- - 0 √ male √ -
Email Addrs. (STD Code) - Phone Number
Designation of Assessing Officer (Ward/Circle) Return Filed Under Section- 1 1
FILING STATUS

- [Please see instruction number-9(i)]

Whether original or Revised return? (Tick) √ √ Original Revised
If revised, enter Receipt No and Date of filing ORIGINAL
original return (DD/MM/YYYY) -
Original return(DD/MM/YYYY)
Residential Status (Tick) √ √ Resident Non-Resident Resident but not ordinarily Resident
1 Income chargeable under the Head 'Salaries',Pension 1 562295
2 Income chargeable under the Head 'House Property'(enter-ve sign in case of loss, if any) 2 0
0
INCOME & DEDUCTIONS

3 Income chargeable under the Head 'Other Sources' (enter-ve sign in case of loss, if any) 3
4 Gross Total Income (1+2+3) 4 562295
5 Deductions under chapter VIA (Section
a 80C 100000 e 80DD 5000 I 80GG 0
b 80CCC 0 f 80DDB 10000 j 80GGA 0
c 80CCD 2000 g 80E 5000 k 80GGC 0
d 80D 5000 h 80G 5000 l 80U 50000
6 Deductions (Total of 5a to5i) 6 182,000
7 Total Income (4-6) 7 380295
8 Tax Payable on 'Aggregate Income' 8 22230 ###
9 Education Cess on (on 8) 9 667
TAX COMPUTATION

10 Total Tax, Surcharge and Education cess payable (8+9) 10 22897

11 Relief under Section 89 11 0 ###
12 Relief under Section 90/91 12 0
13 Balance Tax Payable (10-11-12) 13 22897
14 Total interest payable u/s 234A/234B/234C 14 0
15 Total Tax and Interest payable (12+13) 15 22897
Do not write or stamp in this areas for office use only Seal and signature of receiving official

Receipt No.

Date

1
 16 Taxes Paid
a Advance Tax (from item 25) 16a 20734
TAXES PAID

b TDS (column 7 of item23+column 7 of item 24) 16b 0

c Self Assessment Tax (from item 25) 16c 0
17 Total Taxes paid (16a+16b+16c) 17 20734
18 Tax payable(15-17)(enter if 15 is greater than 17, else leave blank) 18 2163
19 Refund (18-17) (enter if 15d is greater than 14, also give Bank account details below) 19 0
REFUND

20 Enter your bank account number (mandatory in case of refund) 501

21 Do you want your refund by cheque or deposited directly into your bank account? (tick as applicable √
22 Give additional details of your bank account
MICR Code 000558 Type of Account (tick as applicable) √ Savings
23 Details of Tax Deducted at Source from Salary [As per Form 16 issued by Employer(s)]
TAX
Tax payable
TDS ON SALARY

Tax Deduction Account Income chargeable Deduction Payble

Sl Name and address of (incl. surch. Total tax
Number(TAN) of the under the head under
No the Employer And edn. deposited
Employer salaries Chapter VI-A Refundable
Cess)

(1) (2) (3) (4) (5) (6) (7) (8)

0 0 562,295 184,000 22,897 22,897 0

24 Details of Tax Deducted at Source other than salary

Amount
Tax Deduction Account
Namee and address Amount paid/ Date of Payment Total tax out of (6)
TDS ON INTEREST

Sl
Number(TAN) of the
No of the Deductor credited /Credit deposited claim for
Deductor
this year

(1) (2) (3) (4) (5) (6) (7)

- 0
0
0
NOTE Enter the total of column (7) of 23and column (7) of 17 of TAXES PAID
25 Details of Advance Tax and Self Assessment Tax Payments
Sl Date of Deposit Serial Number of
No Name of Bank & Branch BSR Code Amount (Rs.)
(DD/MM/YYYY) Challan
TAX PAYMENTS

(i) SBI,Lalbagh 00055 40,296 500 4500

(ii) SBI,Lalbagh 00055 31/9/2010 600 4500
(iii) SBI,Lalbagh 00055 31/12/2010 700 4500
(iv) SBI,Lalbagh 00055 31/3/2011 800 7234
NOTE Enter the total of Advance tax and Self Assessmen tax in Sl.No.17 of TAXES PAID 20734
26 Other Information (Transactions reported through Annual Information Return) (Please see instruction number-9(ii) for code)
Sl. Code Amount (Rs.) Sl. Code Amount (Rs.) Sl. Code Amount (Rs.)
a 001 e 004 h 007
b 002 f 005 i 008
c 003 g 006 j
27 Exempt income only for reporting purposes(from Dividend, Capital gains etc) 27
VERIFICATION
I, son/ daughter of solemnly
declare that to the best of my knwledge 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 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 2010-11
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

2
29 If TRP is entitled for any reimbursement from the Government, amount thereof (to be filled by TRP) 29

2
Bio Data Sheet

Acknowledgement

2
 Government of India

INCOME TAX DEPARTMENT

ACKNOWLEDGEMENT

Received with thanks form: 0 - 0 a return of income &/return

of fringe benefits in Form No ITR - 1 for assessment year 20011-2012, having the following particulars:

Name PAN NO DIN NO

PERSONAL INFORMATION

- - - - -
Flat/Door/Block No: Name of Premises/Building/Village:
- -
Road/Street/Post Office: Area/Locality:
- -
Town/City/District: State: Status(fill the code)
- - Govt 11
Designation of Assessing Officer Original/Revised Original
1 Gross total income 1 562295
COMPUTATION OF INCOME & TAX THEREON

2 Deduction under Chapter-VI-A 2 182000

3 Total Income 3 380295
4 Net tax payable 4 22897
5 Interest payable 5 0
6 Total tax and interest payable 6 22897
7 Taxes paid
a Advance Tax 7a 20,734
b TDS 7b 0
c TCS 7c 0
d Self Assessment Tax 7d 0
e Total Taxes paid (7a+7b+7c+7d) 7e 20734
8 Tax payable (6-7e) 8 2163 ###
9 Refund (7e-6) 9 0 ###
10 Value of Fringe Benefits 10 NA
Fringe Benefits & Tax Thereon
Computation of Income &

11 Total fringe benefit tax liability 11 NA

12 Total interest payable 12 NA
13 Total tax and interest payable 13 NA
14 Taxes paid NA
a Advance Tax 14a
b Self Assessment Tax 14b
c Total Taxes paid (14a+14b) 14c NA
15 Tax payable (13-14c) 15 NA
16 Refund (14c-13) 16 NA
Receipt No. Seal and Signature of receiving official:
Date:
 FORM NO.10 E
[See rule 21AA]

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, instituty
1 Name and address of the employee - -
2 Permanent account number -

3 Residential status PERMANENT RESIDENT

Particulars of income referred to in rule 21A of the Income-tax Rules, 1962,during the previous year relevant to
assessment year 2010-11

1 (a) Salary received in arrears or in advance in accordance with the provisions of sub-rule (2)
of rule 21A. 25,000
(b)
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. Not Applicable

(c)
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 Not Applicable
years or where the unexpired portion of term of employment is also not less than 3 ye

(d) Payment in commutation of pension in accordance with the provisions of sub-rule (5) of
rule 21A Not Applicable
2 Detailed particulars of payments referred to above may be given in Annexure I,II,IIA,III,
or IV as the case may be. ANNEX-I

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

Verification
I, _______,do hereby declare that 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
 ANNEXURE-I
[See item 2 of Form No.10E]
Arrears or advance salary
Sl No. Particulars Amount (Rs.)
1 Total income (excluding salary received in arrears or advance) 357,300
2 Salary received in arrears or advance 25000
Total income (as increased by salary received in arrears or advance)
3
[Add item 1 and item 2] 382,300
4 Tax on total income [as per item 3] 0 ###
5 Tax on total income [as per item 1] 0 ###
Tax on salary received in arrears or advance
6
[Difference of item 4 and item 5] 0
Tax computed in accordance with Table "A"
7
[Brought from column 7 of Table A] 412
Relief under Section 89(1) [Indicate difference between the amounts mentioned
8
against item 6 and item 7] 0

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

Total income Salary Total income (as Tax on total Tax on total Difference in
of the received in increased by income [as per income[as tax [Amount
relevent arrears or salary received in column (2)-After per column under column
previous year advance arrears or Rebate and (4) After (6) minus
(Rs.) relating to the advance) of the including Edn Rebate and amount under
relevent relevent previous Cess and including column (5)]
Previous previous year year mentioned Surcharge] Edn Cess and (Rs.)
year as mentioned in column (1) (Rs.) Surcharge]
in column (1) [add colmn 2 & (Rs.)
(Rs.) 3] (Rs.)

(1) (2) (3) (4) (5) (6) (7)

2009-10 139,000 25000 164,000 0 412 412 ###

###

Signature:

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Date: Designation:
Dept: