SALARY STATEMENT OF Mr.

FOR THE YEAR 2011 -- 2012

PAN No. SEX MALE DATE OF BIRTH DATE OF RETIREMENT
PAY MONTH PAY INCRE- GRADE BP DA RA HRA MA ALL OTHER
ALLOWNCES
GROSS GPF GIS HBA I TAX ALL OTHER TOTAL NET PAY
& YEAR MENT PAY (6% on (Old (FIX) PAY DEDUCTION DEDUCTIONS
BP+DP+IR)) S

MAR 2011 20840 0 4400 25240 6815 567 2524 500 0 35646 6000 30 0 1810 0 7840 27806
APR 2011 20840 0 4400 25240 6815 567 2524 500 0 35646 6000 30 0 1810 0 7840 27806
MAY 2011 20840 0 4400 25240 6815 567 2524 500 0 35646 6000 30 0 1810 0 7840 27806
JUN 2011 20840 0 4400 25240 8834 567 2524 500 0 37665 6000 30 0 1810 0 7840 29825
JUL 2011 20840 0 4400 25240 8834 567 2524 500 0 37665 6000 30 0 1810 0 7840 29825
AUG 2011 20840 0 4400 25240 8834 567 2524 500 0 37665 6000 30 0 1810 0 7840 29825
SEP 2011 20840 0 4400 25240 8834 567 2524 500 0 37665 8000 30 0 1810 0 9840 27825
OCT 2011 20840 0 4400 25240 11358 567 2524 500 0 40189 8000 30 0 1810 0 9840 30349
NOV 2011 20840 0 4400 25240 11358 567 2524 500 0 40189 8000 30 0 1810 0 9840 30349
DEC 2011 20840 0 4400 25240 11358 567 2524 500 0 40189 8000 30 0 1810 0 9840 30349
JAN 2012 20840 0 4400 25240 11358 567 2524 500 0 40189 8000 30 0 1810 0 9840 30349
FEB 2012 20840 0 4400 25240 11358 567 2524 500 0 40189 8000 30 0 1810 0 9840 30349
DA1 10095 10095 10095 10095 0
DA2 7572 7572 7572 7572 0
DA3 0 0 0 0 0
DA4 0 0 0 0 0
AR. 0 0 0 0
TOTAL 302880 130238 6804 30288 6000 0 476210 101667 360 0 21720 0 123747 352463
TOTAL TAX 21,682.00
SHORTFALL -38.00 other Income if any 0

Savings LIC-1 6300 Rent Paid Bonds 0 Other2 HBA Total Paid 0
(Total up to
Rs.120000/- only) LIC-2 5460 Tution F 0 PPF 0 Other3 HBA Principal Amount 0
23760 LIC-3 Donation PLI 0 Other4 12000 HBA Interest Paid 0

FF0000+9198148-65636,
FF0000PREPARED BY: 01+000 FF0000ASHOK KUMAR, MALOUT 3131F7aks1296@gmail.com
+9198729-72636.
Name : AKS
FATHER'S NAME
D.O.B
ADDRESS
NATURE OF BUSINESS SALARY
ACCOUNTING YEAR 2010-2011
ASSESSMENT YEAR 2011-2012
SEX M
PAN
COMPUTATION CHART OF TOTAL INCOME
AMOUNT Rs
Income from Salary 294,869
OTHERS -
Mip MID - -
Total 294,869 294,869
Less deductions u/s 10
(OTHER THAN HRA) - -
H.R.A deduction
HRA PAID 36,000 36,000
HRA RECEIVED 19,285 19,285
HRA PAID-10% BASIC 16,715 16,715
40% BASIC 77,140 77,140
HRA EXEMPTED (16,715)
interst paid on HB loans - -
GROSS TAXABLE INCOME 278,154
DEDUCTIONS under CH VI
DEDUCTION U/S 80 G donation
(Deductible amount) -
DEDUCTION U/S 80CCCA pension -
DEDUCTION U/S 80C
GPF 40,402 40,402
G.I.S. 360 360
P.P.F -
HOME LOAN PRINCIPAL - -
NSC INT - -
ULIP - -
N.S.C - -
L.I.C 16,569 16,569
Others -
TOTAL 57,331 57,331
BONDS 25,000 20,000
G_TOTAL 77,331
Taxable Income 200,823
R.OFF 200,820
Income Tax 4,082
I.TAX PAYABLE 4,082
surcharge
cess 122
TDS 4,204

PER MONTH TAX 360

 PROFORMA FOR CALCULATING INCOME TAX
For Financial Year 2011 --2012 Assesment Year 2012 --2013
Name of the official CATEGORY MALE
Father's Name Sh./S. EFGH Designation ETT TEACHER
Permanent Account No. 0 Date of Birth 30/Dec/1899
School/ Inst. Name GPS NOPQ BLOCK RSTU

Residential Address H.NO.418, ST.NO.4, SEC. 21, S.A.S. NAGAR, MALOUT-152107,

MUKTSAR, PUNJAB
1. Salary Income (Including all allowances and perks etc.) Rs. 476,210.00
(-) H.R.A. Exampteble Rs. 5,712.00
(-) Transport Allowance Rs. -
(-) Interest on House Loan Rs. -
2. Net Salary Income Rs. 470,498.00
3. Income from property & other sources (+) Rs. -
UTI Dividend interest on FDRs, S.F. Account, NSCs, Kisan Vikas Patras,
Loans, Deposits, Monthly Income Schemes- UTI/P.O. etc.
4. Total Income (2+3) Rs. 470,498.00
5. Releif Admissible (u/s 80-c to 80-u)
Other, if any (as GPF 101,667 House Loan PrPAL -
permissible)
GIS 360 Tution Fee -
Bonds - LIC 11,760 Donation -
PPF - OTHERS 12,000 Rent Paid - Rs. 100,000.00
Total Rebate Under Section 80CCE Rs. 100,000.00
6. Net Taxable income (4-5) 370,498.00 Taxable Amt. Rs. 370,500.00
7. Income Tax upto Rs. 160000 …………………………..Nil 160000 Rs. -
210500 …………………………10% 210500 Rs. 21,050.00
- ……….....……………20% - Rs. -
- ………………………..30% - Rs. -
Total Tax Rs. 21,050.00
8. Income Tax Payable Rs. 21,050.00
9. + Surcharge on the Net Income @ 10% of tax,
If total income exceeds Rs. 10,00,000 Rs. -
9(A) 2% Education tax + 1% Higher Education tax Rs. 632.00
10. Total Income Tax Payable + Surcharge + Education Tax @ 2% of Income Tax Rs. 21,682.00
11. Income Tax alredy Paid upto January --2012 Rs. 21,720.00
12. REFUND DUE --2012 Rs. 38.00
* ( TWENTY ONE THOUSAND SIX HUNDRED EIGHTY TWO ONLY)
DECLARATION
I undertake to supply the documentry proof in support of deduction claimed above. I shall be
personally responsible to file return with the Income Tax Department as required under the law and shall also be
liable to face consiquences for the wrong information, supplied and income concealed, if any.

(Signature)

Prepared by ASHOK K SINGLA 12/08/2021 0066FFaks1296@gmail.com Page 3

 Name……………………………………………………..
Dated………………………………….. Deptt./Office………………………………………….

Prepared by ASHOK K SINGLA 12/08/2021 0066FFaks1296@gmail.com Page 4

SALARY STATEMENT OF MR AKS FOR THE YEAR '2010-11' M
ALL
PAY GRADE OTHER GROSS ALL OTHER TOTAL NET
PAY INC B.P DA RA HRA MA GPF HBA GIS I.TAX
MONTH PAY ALLOWA PAY DEDUCTIONS DED. PAY
NCES

MAR 12440 0 3200 15640 4223 567 1564 500 0 22494 2500 0 30 360 300 3190 19304

APR 12440 470 3200 16110 4350 586 1611 500 0 23157 2500 0 30 360 300 3190 19967

MAY 12910 0 3200 16110 4350 586 1611 500 0 23157 2500 0 30 360 300 3190 19967

JUN 12910 0 3200 16110 4350 586 1611 500 0 23157 2500 0 30 360 300 3190 19967

JUL 12910 0 3200 16110 4350 586 1611 500 0 23157 2500 0 30 360 300 3190 19967

AUG 12910 0 3200 16110 5155 586 1611 500 0 23962 2500 0 30 360 300 3190 20772

SEP 12910 0 3200 16110 5155 586 1611 500 0 23962 2500 0 30 360 300 3190 20772

OCT 12910 0 3200 16110 5155 586 1611 500 0 23962 2500 0 30 360 300 3190 20772

NOV 12910 0 3200 16110 5155 586 1611 500 0 23962 2500 0 30 360 300 3190 20772

DEC 12910 0 3200 16110 5155 586 1611 500 0 23962 2500 0 30 360 300 3190 20772

JAN 12910 0 3200 16110 5961 586 1611 500 0 24768 2500 0 30 360 300 3190 21578

FEB 12910 0 3200 16110 5961 586 1611 500 0 24768 2500 0 30 360 300 3190 21578

DA1 5566 5566 5566 5566 0

DA2 4836 4836 4836 4836 0

AR. 0 0 0 0 0

TOTAL 192850 69722 7012 19285 6000 0 294869 40402 0 360 4320 3600 48682 246187

TOTAL TAX 4204.00

SHORTFALL -116.00

PREPARED BY :
 NEW FORM No.16
[See Rule 31[1](a)] of the Income Tax Rules 1962

Certificate under Section 203 of the Income Tax Act, 1961 for Tax deducted at source from income chargeable under the
Head " Salaries".
Name and Address of The Employer Name and Designation of the Employee

ETT TEACHER
GPS NOPQ

PAN/GIR No. TAN PAN No. 0

Period from 1-4- 2011 To 31-3 --2012 Assessment Year 2012 - 2013
DETAILS OF SALARY PAID , ANY OTHER INCOME & TAX DEDUCTED
1. Gross Salary
a.) Salary as per provisions contained in sec. 17(1) Rs. 476,210
b.) Value of prequisties u/s 17(2)
(as per Form No.12 BA, wherever applicable) Rs. -
c.) Profits in lieu of salary u/s 17(3)
(as per Form No.12 BA, wherever applicable) Rs. -
d.) Total Rs. 476,210
2. Less: Allowance to the extent exempt under Section10 Rs. 5,712
3. Balance (1-2) Rs. 470,498
4. Deductions:
a) Entertainment Allowance Rs. -
b) Tax on Employeement Rs. -
5. Aggregate of 4 (a) & (b) Rs. -
6. Income chargeable under the head 'Salaries' (3-5) Rs. 470,498
7. Add any other income reported by the employee
Rs. -
Rs. - Total of item '7' Rs. -
8. Gross total income (6+7) Rs. 470,498
9. Deductions under saction VI A
(A) Section 80C, 80CCC and 80CCD
Gross Amt. Deductible Amnt.

(a) Section 80C

(i) GPF Rs. 101,667
(ii) PPF Rs. -
(iii) LIC Rs. 11,760
(iv) GIS Rs. 360
(v) Others Rs. - Rs. 100,000
(b) Section 80CC Rs. -
(c) Section 80CCD Rs. -
(d) Section 80CCF Bonds Rs. -
Total Rs. 100,000

file:///conversion/tmp/scratch/50066900.xlsForm-16 0066FFaks1296@gmail.com
(B) Other Section (for e.g., 80E, 80G etc.)
under chapter VI A Gross Amt. Qualifying Amt. Deductible Amt.
Rs. - Rs. - Rs. -
10. Aggregate of Deductible amounts under
Chapter VI-A Rs. 100,000
11. Total Income (8-10) Rs. 370,498 R.O. Rs. 370,500
12. Tax on Total Income Rs. 21,050
13. Surcharge (on tax computed at s.no.12) Rs. -
14. Education Cess (on tax at s.no.12 and surcharge
at s.no.13) Rs. 632
15. Tax payable (12+13+14) Rs. 21,682
16. Relief under Section 89 (attach details) Rs.
17. Tax Payable (15-16) Rs. 21,682
18. Less : a) Tax deducted at source u/s 192(1) Rs. 21,720
b) Tax paid by the employer on behalf of the
employee u/s 192 (1A) on perquisites u/s
17(2) Rs. - Rs. 21,720

19. Income Tax REFUNDABLE (17-18) Rs. 39

DETAILS OF TAX DEDUCTED AND DEPOSITED INTO CENTRAL GOVERNMENT ACCOUNT

I WORKING IN THE
CAPACITY OF HEREBY CERTIFIED THAT THE SUM OF Rs. -
( ONLY) HAS BEEN
DEDUCTED AT SOURCE AND PAID TO THE CREDIT OF CENTRAL GOVT. I FURTHER CERTIFY
THAT THE ABOVE INFORMATION IS TRUE AND CORRECT AS PER RECORDS.

file:///conversion/tmp/scratch/50066900.xlsForm-16 0066FFaks1296@gmail.com
 Date 0
Place Malout SIGNATURE AND DESIGNATION
OF TAX DEDUCTING OFFICER

file:///conversion/tmp/scratch/50066900.xlsForm-16 0066FFaks1296@gmail.com
SR.NO.
INDIAN INCOME TAX RETURN Assessment Year : 2010 -- 2011
ITR-1 [For Individuals having Income from Salary/ Pension/ family pension) & Interest]
FORM
(Please see Rule 12 of the Income-tax Rules,1962)
First name Middle name Last name PAN

TAXES PAID
0
PERONAL INFORMATIO

Flat/Door/Block No Name Of Premises/Building/Village Road/Street/Post Office

418 SEC. 21 4 Date of Birth (DD/MM/YYYY)

Area/Locality Town/City/District/State 30/Dec/1899

S.A.S. NAGAR Employer Category (Tick)
MALOUT, MUKTSAR, PUNJAB Govt.
Email Address (optional) Govt PSU Others

REFUND
Pin code 152107 SEX : M/F Sex (Tick)
MALE
(STD code)-Phone Number ( ) Male Female
Designation of Assessing Officer (Ward/Circle) Return filed under Section -
Whether original or Revised return? (Tick) Original Revised [Please see instruction number-9(i)] 21
If revised, enter Receipt No and Date of filing original return (DD/MM/YYYY)
FILING STATUS

TDS ON SALARY
Residential Status (Tick) Resident Non-Resident Resident but Not Ordinarily Resident

1 Income chargeable under the Head ‘Salaries’(Salary/ Pension) 1 1 Rs. 470498 22

2 Income chargeable under the Head ‘Other Sources’

TDS ON INTEREST
a Family pension 2a -
b Interest 2b -
INCOME & DEDUCTIONS

c Total (2a+2b) 2c Rs. -

3 Gross Total Income (1+2c) 3 Rs. 470498
4 Deductions under chapter VI A (Section) 23

TAX PAYMENTS
a)80 C 100000 e)80DD - i)80GG -
b)80 CCC - f)80DDB - j)80GGA -
c)80CCD - g)80E - k)80GGC -
d)80D - d)80G - l)80U -
m )Deductions (Total of a to l) 80 C +80 CCC =100000 (MAX) 4m Rs. 100000
5 Total Income (3-4m) 5 Rs. 370498 24
6 Net Agricultural Income (Enter only if greater than Rs 5,000) 6 Rs. - Sl.No
7 ‘Aggregate Income’ (5+6) 7 Rs. 370498 a
8 a Tax Payable on ‘Aggregate Income’ 8a Rs. 21050 b
b Rebate in respect of Net Agricultural income 8b Rs. - c
TAX COMPUTATION

9 a Tax Payable on Total Income( 8a-8b) 9a 21050 25

b Surcharge on 9a 9b - 26
c Education Cess on (9a+9b) 9c 632
d Total Tax, Surcharge and Education Cess Payable (9a+9b+9c) 9d Rs. 21682
10 Relief under Section 89 10 Rs. -
11 Relief under Section 90/91 11 Rs. -
12 Balance Tax Payable (9d-10-11) 12 Rs. 21682
Do not write or stamp in this 13 a Interest Payable U/s 234A 13a Rs. -
area (Space for bar code) b Interest Payable U/s 234B 13b Rs. -
c Interest Payable U/s 234C 13c Rs. -
d Total Interest Payable (13a+13b+13c) 13d Rs. -
14 Total Tax and Interest Payable (12+13d) 14 Rs. 21682
For Office Use Only 27
Receiiptt No
Datte
Seall and Siignatture of receiiviing official
0066FFaks1296@gmail.com 9 of 11
15 Taxes Paid
a Advance Tax (from item 23) 15a -
b TDS (column 7 of item 21 +column 7 of item 22) 15b 21720
c Self Assessment Tax (from item 23) 15c -
d Total Taxes Paid (15a+15b+15c) 15d Rs. 21720
16 Tax Payable (14-15d) (Enter if 14 is greater than 15d, else leave blank) 16 Rs.
17 Refund (15d-14) (enter if 15d is greater than 14, also give Bank Account details 17
REFUNDABLE below) Rs. 39
18 Enter your bank account number (mandatory in case of refund)
………………..
19 Do you want your refund by cheque, or deposited directly into your bank account? (tick as applicable )
20 In case of direct deposit to your bank account give additional details
MICR Code …………………………...Type of Account (tick as applicable ) Savings Current
Details of Tax Deducted at Source from Salary [As per Form 16 issued by Employer(s)]
Sl. Account
Tax Deduction
Number
Name and address of the Income Deduction Tax payable (incl. Total tax
TAX REFUNDABLE
No (TAN) of the Employer chargeable under Chapter surch. and edn. deposited
under the head VI-A cess)
Employer
Salaries

1 2 3 4 5 6 7 8

0 470498 100000 21682 21720 39

Details of Tax Deducted at Source on Interest [As per Form 16 A issued by Deductor(s)]
Sl. Tax Deduction Name and address of the Amount paid// Date of Total tax Amount out
Account
No Number Deductor Credit Payment/ deposited of 6 claimed
(TAN) Credit for this year
of the
Deductor
1 2 3 4 5 6 7
1 - - - - - -
2 - - - - - -
NOTE Enter the total of column (7) of 21 and column (7) of 22 in Sl No. 15b of TAXES PAID
Details of Advance Tax and Self Assessment Tax Payments
Sl.NoName of BankBSR Code Date of DeposSerial Number of Challan Amount (Rs)
1 - - - - -
2 - - - - -
3 - - - - -
NOTE Enter the totals of Advance tax and Self Assessment tax in Sl No. 15 a and 15c of TAXES PAID
Other Information (transactions reported through Annual Information Return)
Cod Amount (Rs) Sl.No Code Amount (Rs) Sl.No Code Amount (Rs)
001 - d 004 - g 007 -
002 - e 005 - h 008 -
003 - f 006 - -
Tax-exempt interest income (for reporting purposes only) 25
E-filing Acknowledgement Number Date(DD/MM/YYYY) / /
VERIFICATION
I, son/ daughter of EFGH
solemnly 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 Y 2010 -- 2011

Place Date Sign here

08/Dec/2021

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

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

INCOME-TAX DEPARTMENT
ACKNOWLEDGEMENT
Received with thanks from _ a return of income and/or return of fringe

benefits in Form No. ITR -I for assessment year 2012--2013, having the following particulars.
Name PAN NO.
PERSONAL INFORMATION

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

418 SEC. 21

Road/Street/Post Office 4 Area/Locality S.A.S. NAGAR

Town/City/District MALOUT, MUKTSAR State PUNJAB

1 Gross Total Income 1 470,498
2 Deductions Under Chapter VI-A 2 100,000
COMPUTATION OF INCOME AND TAX THEREON

3 Net Income 3 370,498

4 Net tax payable 4 21,682
5 Interest payable 5 -
6 Total tax and interest payable 6 21,682
7 Taxes paid
a Advance Tax 7a -
b TDS 7b 21,720
c TCS 7c
d Self Assessment Tax 7d -
e Total Taxes Paid (7a+7b+7c+7d) 7e 21,720
8 Tax Payable (6-7e) 8 -
9 Refund (7e-6) 9 39
10 Value of Fringe Benefits 10 -
COMPUTATION OF FRINGE BENEFITS AND

11 Total fringe benefit tax liability 11 -

12 Total interest payable 12 -
13 Total tax and interest payable 13 -
TAX THEREON

14 Taxes paid
a Advance Tax 14a
b Self Assessment Tax 14b
c Total Taxes Paid (14a+14b) 14c -
15 Tax Payable (13-14c) 15 -

16 Refund (14c-13) 16 -
For Office Use Only Seal and Signature off receiving official
Receipt No
Date

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