Income Tax Preparation(Quarterly/Annualy) FOR Financial YEAR 2010-11

This Calculation sheet Only for West Bengal Govt. Employees

Prepared by Pranab Banerjee,Kalisthanpara, Jiaganj,Murshidabad,W.B.,
pranab.banerjee83@gmail.com or 9474316768, 8906279547,
FIRST NAME Pranab
New I T R -I ,For Assessment Year 2011-2012,which rec
MIDDLE NAME Kumar
published by the MINISTRY OF FINANCE(Deptt.of
LAST NAME Bandyopadhyay Revenue)Central Board of Taxes,New Delhi. Notification D
Note:-If any discrepency is arise
about calculation of income Tax,I am
23/04/2010 in the Gazette of India Extraordinary,Part-II, Sec
not responsible for that
DESIGNATION Snr.Accounts Clerk (Sub Sec(ii)]
Permanent A/C No.(PAN NO)
Gender ( Male or Female ) Male If Handicapped Employee Pl. put
"Yes" If General put "No" No
DATE OF BIRTH

EMPLOYEE'S RESIDENTIAL ADDRESS

Flat/Door/Block No.
Village
Post Office:
This Auto Income Tax Calculation Software o
Area/Locality: for West Bengal Govt Employees. As the D.A
If you live in Metro City Type Yes ,else Type No No not mached with other State or Central Govt
District: Employees.(In this Software Prepared Salary
Statement+Form-16 + ITR-I + Form 10E)
PIN CODE:
State:
Designation of Assessing Officer ( Ward/Circle)
Date of Submit this RETURN

Office Address
First Fill the Pay Sheet

STATUS- Govt/PSU/Others DIN NO

Name & Address of the Deductor 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
281392 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) 279832 This Cell is Auto filled (The Data comes from Pay Sheet)

Taxable income of financial year 2008-09 (Col-11) of Form No. 16

For Calculation of Arrears Relief U/s 89(1). Put
114183 your Taxable Income of 2008-2009
( For Financial Year 2008-2009) ) For Calculating Form 10E

Deduction under chapter VI-A (LIC,PF,Tuition Fees,H.B.Principal):80C (Maximum Deposit Rs.1,00,000)+20,000/- Flixible Bond
1
2 a) G.P.F. 48000

b) P.P.F 0

3 c) L.I.C. 38000

4 d) N.S.C.
DEDUCTION ONLY U/S 80C, 80CC (MAXIMUM L
5 e) H.B. Loan Principal 12600 NOT EXCCEED RS.1,20,000/- including New T
Savings Bond(Max Rs.20000/-)
6 f) GROUP INSURANCE (G.I.) 480

7 g)New Flexible Tax Savings Bond ( Maximum Rs. 20,000/-) 0

h)Equity linked savings scheme/tax savings bond etc. 0

8 i) Tuition Fees
TOTAL DEDUCTION U/S 80C Max. Rs 1,00,000/- + 20,000 Total Deduction U/S 80C (Max.limit 1,00,000/-) +
Infrustructure Bond, Total Rs.1,20,000/- 99080 20,000/- New declared Infrustructure Bond
9
10 Income from Bank Interest/N.S.C/Others Source

11 Income from House Property

12 80G Donation in Charitable Fund Maximum 100% of donation)
Premium in health insurance of self,spouse,children,dependent,Maxi
13 80D Rs 15000/-

14 80E For Higher Education Loan

15 80DD Medical treatment for self or dependent as Handicapped

16 80DDB 0 Medical Treatment for self or dependent for sever desease

17 80CC Deposit in Pension Fund (Maximum Rs. 1,00,000/-

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

19 House Rent Paid 72000 For Rented House. Must Submit the receipt of House Rent.

20 Conveyance Allowances U/s 10(14)(i) 0 Maximum Rs. 9600 P.A.

Permanent disability including blindnes as handicapped(Max Rs.7500

21 80U
TOTAL DEDUCTION CHAPTER VI-A Rs. 99080 TOTAL DEDUCTION CHAPTER VI-A Rs.

22 Arrear Received if any 15703 Auto Filled Cell [the Data Comes Pay Sheet]

23 Relief under Section 89(1) 1,617 Auto Filled Cell [the Data Comes 10E ]
W.B.,
906279547,

Year 2011-2012,which recent

RY OF FINANCE(Deptt.of
s,New Delhi. Notification Dated
Extraordinary,Part-II, Section 3,
ec(ii)]

lculation Software only

ployees. As the D.A. is
ate or Central Govt
are Prepared Salary
R-I + Form 10E)

heet
 from Pay Sheet)

from Pay Sheet)

264129

Flixible Bond

C, 80CC (MAXIMUM LIMIT

000/- including New Tax
Max Rs.20000/-)

ax.limit 1,00,000/-) +
structure Bond

% of donation)
,children,dependent,Maximum

Handicapped

sever desease
0,000/-

lary)

of House Rent.

handicapped(Max Rs.75000/-)

Rs.

s Pay Sheet]
 N
O
T
Pay Calculation Sheet for -Income Tax Calculation ,for the financial year 2010-2011, Assessment Year 2011-12
Only For West Bengal Govt Employees T
F
U
O
T
R
I
Basic Conv. Put D.A. H.B. O
PAdvance
MONTH Others Spl. Arrears H.B.Int
+Grade Allown. D.A. Rate of H.R.A. M.A. Bonus (ExcludingB G.P.F. P.Tax G.I.S. Loan. N
RIncome
&Year Allwnc Allwnc Received Paid
Pay If any % onus+ Princpl Itax Paid
F
N
E
T
Mar-10 14850 0 0 0 3267 22% 2228 300 1000 15703 20645 4000 130 40 1050 0 .E
0
S
T
Apr-10 14850 0 0 0 4010 27% 2228 300 21388 4000 130 40 1050
0 H
I

Prepared by Pranab Banerjee, Kalisthanpara,Jiaganj,

May-10 14850 0 0 0 4010 27% 2228 300 21388 4000 130 40 1050 S
0
Arrears) S
Jun-10 14850 0 0 0 4010 27% 2228 300 21388 4000 130 40 1050 H
0
E

Murshidabad, West Bengal

Jul-10 15300 0 0 0 4131 27% 2295 300 22026 4000 130 40 1050 E
0 T
Aug-10 15300 0 0 0 4131 27% 2295 300 22026 4000 130 40 1050 I
0
S
Sep-10 15300 0 0 0 4131 27% 2295 300 22026 4000 130 40 1050
0 R
E
Oct-10 15300 0 0 0 4131 27% 2295 300 22026 4000 130 40 1050 Q 121
0
U
Nov-10 15300 0 0 0 4131 27% 2295 300 22026 4000 130 40 1050 I 100
0 A
R
u
E
Dec-10 15300 0 0 0 5355 35% 2295 300 23250 4000 130 40 1050 D 100
0 t
Jan-11 15300 0 0 0 5355 35% 2295 300 23250 4000 130 40 1050
o
O 100
0 N
Feb-11 15300 0 0 0 5355 35% 2295 300 23250 4000 130 40 1050
S
L
2 100
0 Y
a
3
TOTAL 181800 0 52017 27272 3600 1000 15703 264689 48000 1560 480 12600 0 lP 521
7
4
a
A
1
rY
7
y
C
A
S
L
t
C
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 INCOME TAX STATEMENT FOR THE FINANCIAL YEAR 2010-2011
ASSESSMENT YEAR 2011-2012
A. Name & Designation of the Assesses Pranab Kumar Bandyopadhyay Snr.Accounts Clerk
B. Residential Address - - - Pin Code No. -
C. Pan Card No. -
1 a) Salary income with allowance excluding H.R.A.:-…………………………… Rs. 237417
b) House Rent Allowance :-…………………………………………………………… Rs. 27272
c) Bonus :-………………………………………………………………………………… Rs. 1000
d) Arrear,if any :-………………………………………………………………………….. Rs. 15703
2 Any other income as stated by the Assesses :-
a) Income from N.S.C./Bank interest etc:-…………………………………………. Rs. 0
b) Income from House Property:-……………………………………………………. Rs. 0
3 Gross Income(Col.1 + 2 ) :-……………………………………………………………… Rs. 281392
4 Interest paid as H.B.Loan (1.5 Lacks maximum) U/S 24(B):-………………………. Rs. 0
5 Professional Tax U/S 16(iii) :-………………………………………………………… Rs. 1560
6 Exemption of Conveyance Allowances U/s 10(14)(i)[Max.Rs 9600/-P.A. 0
7 Exemption U/S 10(13A) :- ###
a) H.R.A.Received :-………………………………………… Rs. 27272
b) House Rent paid :-…………………………………………………… Rs. 72000 ###
c) Expenditure on rent in excess of
50% of B.Pay In Metropol City ors 40%.............................
72,720 Rs. 72,720
10% of B.Pay ………………………………………………… 53,820 Rs. 53820
e) Amount exempted (Least of a,c):- - Rs. 0 Rs. 0
8 Total Income(Col.3-4-5-6-7) :-………………………………………………………. Rs. 279832
9 Deduction U/S 80 C (Maximum Rs.1,20,000/- including T.Svngs Bond) ###
a) Contribution to G.P.F.:- ……………………………………………. Rs. 48000 ###
b) Contribution to P.P.F…………………………………………………… Rs. 0
b) Group Insurance Savings Scheme :-………….. Rs. 480 ###
c) L.I.C./P.L.I./U.Lip Premiam paid(including Notified Char
(Pension Scheme for maximum Rs.10,000/-:-)………………….. Rs. 38000
d)Purchase of N.S.C. :-………………………………………….. Rs. 0
e) Amount paid as excluisively tuition fees to any
University/College/School for maximum of two
Children( 2 )Maximum Rs.1,00,000/-) Rs. 0
f) Payment of H.B.Loan (Principal) :- Rs. 12600
g) Nes Flexible Bond Max Rs. 20,000/-)………………………………… Rs. 0
g) Equity linked savings scheme/tax savings bond etc.{Max-20000/-) Rs. 0 ###
h) Others, if any as notified :- 80DDB 0 ii)80G 0 ###
80U 0 iii)80DD 0 iv)80D 0 v)80E 0 ###
10 Total Amount Deducted (a to h) :-……………………………………….. Rs. 99080 Rs. 99080
11 Taxable Income (8-10) :-[Rouned to the next 10]……………….. Rs. 180760
12 i) Upto Rs.1,60,000/- Tax Nil, (ii)Rs.1,60,001/-to 5,00,000/-Tax 10%(iii) 500000 -80000
20%, iv)Rs.8,00,001/-to Onwards Tax 30%, For Female Up to 190000/- Tax NIL
13 Total Tax :-……………………………………………………………………… Rs. 2,076
14 3% Educational cess on tax :-…………………………………………………… Rs. 62
15 Tax Payable including educational cess(Col.12+13) :-………………….. Rs. 2,138
16 Relief U/S 89(1)[Arrears Relief from Salary] Rs. 1,617
17 Net Tax Payable ( 13-14) Rs. 521
18 Tax Paid from Salary Anually or Monthwise……………………………………………… 521
19 Balance Tax Payable/Refundable……………….. ………………………………….. Rs. 0
###
Date:- Signature of the employee
Designation
 Salary Statement for the Year 2010-2011
Pranab Kumar Bandyopadhyay Snr.Accounts Clerk
Salary Statement of Sri
Basic Conv. H.B. Advance
MONTH Others Spl.
+Grade Allown. D.A. H.R.A. M.A. G.P.F. P.Tax G.I.S. Loan. H.B.Int Paid Income
&Year Allwnc Allwnc
Pay If any Princpl tax Paid

Mar-10 14850 0 0 0 3267 2228 300 4000 130 40 1050 0 0

Apr-10 14850 0 0 0 4010 2228 300 4000 130 40 1050 0 0

May-10 14850 0 0 0 4010 2228 300 4000 130 40 1050 0 0

Jun-10 14850 0 0 0 4010 2228 300 4000 130 40 1050 0 0

Jul-10 15300 0 0 0 4131 2295 300 4000 130 40 1050 0 0

Aug-10 15300 0 0 0 4131 2295 300 4000 130 40 1050 0 0

Sep-10 15300 0 0 0 4131 2295 300 4000 130 40 1050 0 0

Oct-10 15300 0 0 0 4131 2295 300 4000 130 40 1050 0 121

Nov-10 15300 0 0 0 4131 2295 300 4000 130 40 1050 0 100

Dec-10 15300 0 0 0 5355 2295 300 4000 130 40 1050 0 100

Jan-11 15300 0 0 0 5355 2295 300 4000 130 40 1050 0 100

Feb-11 15300 0 0 0 5355 2295 300 4000 130 40 1050 0 100

TOTAL 181800 0 0 0 52017 27272 3600 48000 1560 480 12600 0 521

Dated:- Signature of Employee

Designation:-
 FORM NO.16
[See rule 31(1)(a)]
PRART A
Certificate under section 203 of the Income-tax Act, 1961 for Tax deducted at source from Salary

Name and address of the Employer Name and designation of the employee
Snr.Accounts
- Pranab Kumar Bandyopadhyay
Clerk
TAN No.of the
PAN NO.of Deductor PAN NO. of the Employee DIN NO
Deductor
- - - -
CIT (TDS) Period
Assessment Year
Address - From To
- 2011 2012 1/4/2010 31/3/2011
City - Pin Code -
Receipt Numbers of original Amount of tax deposited
Amount of tax deducted in respect of
Quarter statements of TDS under sub- remitted in respect of the
the employee
section (3) of section 200 employee
Q1
Q2
Q3
Q4
TOTAL
PART B (Refer Note )
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
(a) in section 17(1) 281392
Value of perquisites under section
(b) 17(2)(as per Form No. 0
12BA,wherever applicable)
Profits in lieu of salary under
(c) section 17(3)(as per Form No. 12BA, 0
wherever applicable)
(d) TOTAL 281392
Less: Allowance to the extent exempt
2
u/s 10
Allowance Rs.
HRA Exempt( U/s
10(13A)
0
Conv.Alw.exempt(U/s
10(14)(i)
0 0
3 Balance(1-2) Rs. 281392
4 Deductions :
H.B.Loan Int.(Max-
(a) 1,50,000/-) u/s 0
24(B)
(b) Tax on employment 1560
5 Aggregate of 4(a) to (b)
Income chargeable under the head
1560
'salaries'
6 279832
(3-5) reported by the
Add: Any other income
7
employee ###
a)Income form N.S.C./Bank int.etc. Rs. 0 ###
8 Gross total income (6+7) Rs. 279832
 9 Deductions under Chapter VIA
U/s 80C (Aggregate amount Gross
A Deductible Amount Rs.
Max.Rs.1,20,000/-) Amount
(a)(i)Sec.80C-G.P.F. Rs. 48000
(ii)P.P.F. Rs. 0
(ii) G.I.S.
(iii) L.I.C.+P,L.I.
Rs. 480
+U.LIP+Tuition
Fees+NSC+Tax Savings
Rs. 38000
Bond
(iv) H.B.L.(Principal) Rs. 12600 99080 99080
Other sections e.g.,80E,80G,etc under chapter Qulfy
B
VI
Gross Amount Deductible Amount Rs.
amount
(a) Section 80 E Rs. 0 0
(b) Section 80 G Rs. 0 0
© 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 80DDB Rs. 0 0
Aggregate of deductible amount under
10
Chap. VIA
99080
11 Total Income (8-10) 180752
12 Tax on total income 2,076
13 Surcharge on col.12 0
14 Education & cess @3% on col.no.12 62
15 Tax payable (12+13+14) 2138
16 Relief U/s 89(1) 1,617
Tax payable/refundable
17
(15-16)
521
18 Less (a) Tax deducted at source 521
Net Tax
19
col.No.17-18)
Refundable Tax payable 0
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
Designatio
Full Name:-
n

Note:-
1 If an assessee is employed under more than one employer during the year, each of the employers shall is
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

Sl.No Book Identification Number (BIN)
of the employee (Rs.

DDO Sequence Number in Date on which

Receipt Numbers of Form
the Book Adjustment Mini tax deposited
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)
Challan Identification Number ( C I N )
Tax Deposited in respect on
Sl.No
of the employee (Rs.) Date on which tax deposited Challan Serial
BSR Code of the Bank Branch
(dd/mm/yy) Number

1 - - -
2 - - -
3 - - -
4 - - -
5 - - -
6 - - -
7 - - -
8 121 28/11/2010 8
9 100 28/12/2010 9
10 100 28/1/2011 10
 11 100 28/2/2010 11
12 100 28/3/2010 12
Total 521

1 In the Column for TDS, give total amount for TDS, Surcharge(if applicable) and education cess
 INDIAN INCOME TAX RETURN Assessment Year
[For Individual having Income from Salary/Pension/income from One
FORM

SARAL-II House Property(Excluding loss brought forward from previous

(ITR-I) years)/Income from Other Sources (Excluding Winning from Lottery and 2 0 1 1 - 1 2
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
Pranab Kumar Bandyopadhyay - -
PERSONAL INFORMATION

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

- - 12/30/1899

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

- - √ Govt. PSU Others
Town/City/District State Pin code Employer Category
- - - √ 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 ORIGINAL
filing original return (DD/MM/YYYY)
Original return(DD/MM/YYYY) -
Residential Status (Tick)√ √ Resident Non-Resident Resident but not ordinarily Reside
1 Income chargeable under the Head 'Salaries',Pension 279832 1
2 Income chargeable under the Head 'House Property'(enter-ve sign in case2of loss,0 if any)
Income chargeable under the Head 'Other Sources' (enter-ve sign in
INCOME & DEDUCTIONS

3 case 0
GrossofTotal
loss,Income
if any) 3
4 (1+2+3) 4 279832
5 Deductions under chapter VIA (Section
a 80C 99080 e 80DD 0 I 80GG
b 80CCC 0 f 80DDB 0 j 80GGA
c 80CCD g 80E 0 k 80GGC
d 80D 0 h 80G 0 l 80U 0
6 Deductions (Total of 5a to5i) 6 99,080
7 Total Income (4-6) 7 180752
8 Tax Payable on 'Aggregate Income' 8 2076 ###
62
TAX COMPUTATION

9 Education Cess on (on 8) 9

### Total Tax, Surcharge and Education cess payable (8+9) ### 2138
### Relief under Section 89 ### 1,617 ###
### Relief under Section 90/91 ### 0
### Balance Tax Payable (10-11-12) ### 521
14 Total interest payable u/s 234A/234B/234C 14 0
### Total Tax and Interest payable (12+13) 15 521
Do not write or stamp in this areas for office Seal and signature of receiving official
use only

Receipt No.

Date

1
1
 16 Taxes Paid
a Advance Tax (from item 25) 16a 0
TAXES PAID

b TDS (column 7 of item23+column 7 of item 24) 16b 521

c Self Assessment Tax (from item 25) 16c 0
17 Total Taxes paid (16a+16b+16c) 17 521
18 Tax payable(15-17)(enter if 15 is greater than 17, else leave blank) 18 0 ###
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 chequnumber (mandatory in case of refund) 0

21 Do you want your refund bye or deposited directly into your bank account? (tick as applicable
√
22 Give additional details of your bank account
MICR Code 0 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
TDS ON SALARY

Tax Deduction Deduction

Name and Income payable -
Sl Account under Total tax
No Number(TAN) of the
address of the chargeable under (incl.
Chapter VI- deposited
Employer the head salaries surch. And Refundabl
Employer A
edn. Cess) e
(1) (2) (3) (4) (5) (6) (7) (8)

- - 279,832 99,080 521 521 0

24 Details of Tax Deducted at Source other than salary

Amount
Tax Deduction Namee and out of
TDS ON INTEREST

Sl Account Amount paid/ Date of Total tax

No Number(TAN) of the address of the (6) claim
credited Payment /Credit deposited
Deductor Deductor for this
year
(1) (2) (3) (4) (5) (6) (7)
- -
-
-
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 Name of Bank & Date of Deposit Serial Number of
No BSR Code Amount (Rs.)
Branch (DD/MM/YYYY) Challan
TAX PAYMENTS

(i)
(ii)
(iii)
(iv)
NOTE Enter the total of Advance tax and Self Assessmen tax in Sl.No.17 of TAXES PAID-
26 Other Information (Transactions reported through Annual Information Return) (Please see instruction number-9(ii)
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

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

2
 Government of India

INCOME TAX DEPARTMENT

ACKNOWLEDGEMENT

Received with thanks form: Pranab Kumar Bandyopadhyay 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

Pranab Kumar Bandyopadhyay - -

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

1 Gross total income 1 279832

2 Deduction under Chapter-VI-A 2 99080
3 Total Income 3 180752
4 Net tax payable 4 521
5 Interest payable 5 0
6 Total tax and interest payable 6 521
7 Taxes paid
a Advance Tax 7a -
b TDS 7b 521
c TCS 7c -
d Self Assessment Tax 7d -
e Total Taxes paid (7a+7b+7c+7d) 7e 521
8 Tax payable (6-7e) 8 - ###
9 Refund (7e-6) 9 - ###
10 Value of Fringe Benefits 10 NA
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 Pranab Bandyopadhyay
2 Permanent account number 0

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. 15703
(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) 165,057
2 Salary received in arrears or advance 15703
Total income (as increased by salary received in arrears or advance)
3
[Add item 1 and item 2] 180,760
4 Tax on total income [as per item 3] 2,138 ###
5 Tax on total income [as per item 1] 521 ###
Tax on salary received in arrears or advance
6
[Difference of item 4 and item 5] 1,617
Tax computed in accordance with Table "A"
7
[Brought from column 7 of Table A] 0
Relief under Section 89(1) [Indicate difference between the amounts mentioned
8
against item 6 and item 7] 1,617

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

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

[ Including
1st & 2nd
Instlmnt of
Arrears
(1) (2)
ROPA-09] (3) (4) (5) (6) (7)

2008-09 114,183 15703 129,886 0 0 0 ###

###

Signature:

Place: Name:

Date: Designation:
Dept: