New Year Allowance 3,528

Basic salary 211,680

Medical 18,000
Attn/food/Speical allowance 0
PF contribution 21168
Festival 35,280
LFA 0
Honorarium
0
(Gas Allowance)
 National Board of Revenue IT-10GA2016
www.nbr.gov.bd
RETURN OF INCOME
For an Individual Assessee
under section 80(2) of the Income Tax Ordinance, 1984 (XXXVI of 1984)

The following schedules shall be the integral part of this return and must be
annexed to return in the following cases:

Schedule 24A if you have income from Salaries

Schedule 24B if you have income from house property
Schedule 24C if you have income from business or profession
Schedule 24D if you claim tax rebate

PART I
Basic information

Return submitted under section 82BB?

Assessment Year
1 2 (tick one)
2 0 1 9 2 0 Yes No √
Name of the Assessee
3 4
RUBEL Gender M √ F
Twelve-digit TIN Old TIN
5 6
1 2 3 4 5 6 7 8 9 0 1 2
7 Circle 124 (Salary) 8 Zone Tax Zone-4, Chittagonj
9 Resident Status (tick one) Resident √ Non-resident
Tick on the box(es) below if you are:
A gazetted war-wounded
10 10A freedom fighter 10B A person with disability
A parent/legal guardian of a person with
10C Aged 65 years or more 10D
disability
Date of birth (DD-MM-YYYY) Income Year
11 12
0 1 0 1 1 9 9 0 2019 to 9-20
If employed, employer’s name
13

Spouse Name Spouse TIN (if any)

14 15
N/A
Father’s Name Mother’s Name
16 17

Present Address Permanent Address

18 19

Contact Telephone E-mail

20 21
### N/A
National Identification Number Business Identification Numbers
22 23
22 23
12345678901234567 N/A
 111
মাসিক আয় ব্যয়ের হিসাব

500000
500000
500000
500000
500000
500000
500000
500000 4000000
 National Board of Revenue IT-10GA2016
www.nbr.gov.bd
RETURN OF INCOME
For an Individual Assessee
under section 80(2) of the Income Tax Ordinance, 1984 (XXXVI of 1984)

The following schedules shall be the integral part of this return and must be
annexed to return in the following cases:

Schedule 24A if you have income from Salaries

Schedule 24B if you have income from house property
Schedule 24C if you have income from business or profession
Schedule 24D if you claim tax rebate

PART I
Basic information

Return submitted under section 82BB?

Assessment Year
1 2 (tick one)
2 0 1 9 2 0 Yes No √
Name of the Assessee
3 4
Ariful Islam Gender M √ F
Twelve-digit TIN Old TIN
5 6
1 2 3 4 5 6 7 8 9 0 1 2
7 Circle 124 (Salary) 8 Zone Tax Zone-4, Chittagonj
9 Resident Status (tick one) Resident √ Non-resident
Tick on the box(es) below if you are:
A gazetted war-wounded
10 10A freedom fighter 10B A person with disability
A parent/legal guardian of a person with
10C Aged 65 years or more 10D
disability
Date of birth (DD-MM-YYYY) Income Year
11 12
0 1 0 1 1 9 7 8 2019 to 9-20
If employed, employer’s name
13

Spouse Name Spouse TIN (if any)

14 15
N/A
Father’s Name Mother’s Name
16 17

Present Address Permanent Address

18 19

Contact Telephone E-mail

20 21
### N/A
National Identification Number Business Identification Numbers
22 23
22 23
12345678901234567 N/A
 IT-10GA2016

82BB?
 35033

Basic salary 220000 186666

House rent 88,000
Medical 35,200
Attn/food/Speical allowance 22,000
Others 28800
 PART II
Particulars of Income and Tax

TIN 1 2 3 4 5 6 7 8 9 0 1 2

Particulars of Total Income Amount ৳

24 Salaries (annex Schedule 24A) S.21 218000.00

25 Interest on securities S.22 0.00

26 Income from house property (annex Schedule 24B) S.24 0.00

27 Agricultural income S.26 0.00

28 Income from business or profession (annex Schedule 24C) S.28 0.00

29 Capital gains S.31 0.00

30 Income from other sources S.33 0.00

31 Share of income from firm or AOP 0.00

32 Income of minor or spouse under section 43(4) S.43 0.00

33 Foreign income 0.00

34 Total income (aggregate of 24 to 33) 218000.00

Tax Computation and Payment Amount ৳

35 Gross tax before tax rebate 0.00
36 Tax rebate (annex Schedule 24D) 0.00
37 Net tax after tax rebate 0.00
38 Minimum tax 0.00
39 Net wealth surcharge 0.00
40 Interest or any other amount under the Ordinance (if any) 0.00
41 Total amount payable 0.00
42 Tax deducted or collected at source (attach proof) 10000.00
43 Advance tax paid (attach proof) 0.00
44 Adjustment of tax refund [mention assessment year(s) of refund] 0.00
45 Amount paid with return (attach proof) 0.00
46 Total amount paid and adjusted (42+43+44+45) 10000.00
47 Deficit or excess (refundable) (41-46) 10000.00
48 Tax exempted income 2000.00
 PART III
Instruction, Enclosures and Verification
Particulars of Income and Tax

TIN 1 2 3 4 5 6 7 8 9 0 1 2

Instructions
1. Statement of assets, liabilities and expenses (IT-10B2016) and statement of life style expense
(IT-10BB2016) must be furnished with the return unless you are exempted from furnishing such
statement(s) under section 80.
49 2. Proof of payments of tax, including advance tax and withholding tax and the proof of investment
for tax rebate must be provided along with return.
3. Attach account statements and other documents where applicable

If you are a parent of a person with disability, has your spouse

50 availed the extended tax exemption threshold? (tick one) Yes No √

Are you required to submit a statement of assets, liabilities and

51 expenses (IT-10B2016) under section 80(1)? (tick one) Yes √ No

Schedules annexed
52 (tick all that are applicable) 24A √ 24B 24C 24D

Statements annexed
53 (tick all that are applicable) IT-10B2016 √ IT-10BB2016 √

Other statements, documents, etc. attached (list all)

A. Salary Certificate ### ###
54
B. ETIN
C. NID

Verification and signature

Verification
I solemnly declare that to the best of my knowledge and belief the information given in this return and statements and
documents annexed or attached herewith are correct and complete.

Name Signature
RUBEL

Date of Signature (DD-MM-YYYY) Place of Signature

0 7 1 1 2 0 2 0 Dhaka

For official use only

Return Submission Information
of Submission (DD– MM –YYYY) Tax Office Entry Number
 National Board of Revenue Individual
www.nbr.gov.bd
ACKNOWLEDGEMENT RECEIPT OF
RETURN OF INCOME
For an Individual Assessee
under section 80(2) of the Income Tax Ordinance, 1984 (XXXVI of 1984)

Return submitted under section 82BB?

Assessment Year (tick one)

2 0 1 9 2 0 Yes No √

Name of the Assessee

RUBEL

Twelve-digit TIN Old TIN

1 2 3 4 5 6 7 8 9 0 1 2

Circle Zone

###
124 (Salary) Tax Zone-4, Chittagonj

Total income shown (serial 34)

218000.00

Amount payable (serial 41) Amount paid and adjusted (serial 46)

0.00 10000.00

Amount of net wealth shown in IT-10B2016 Amount of net wealth surcharge paid

29253320.00 0.00

Date of Submission (DD– MM –YYYY) Tax Office Entry Number

Signature and seal of the official receiving the return

Date of Signature Contact Number of Tax Office

 0

YES
 SCHEDULE 24A
Particulars of income from Salaries
Annex this Schedule to the return of income if you have income from Salaries

Assessment Year TIN

1 2 0 1 9 2 0 2 1 2 3 4 5 6 7 8 9 0 1 2

Amount Tax exampted Taxable

Particulars
(A) (B) (C=A-B)
3 Basic pay 200,000.00 200,000.00
4 Special pay 0.00 0.00
Arrear pay (if not included in
5 0.00 0.00
taxable income earlier)
6 Dearness allowance 0.00 0.00
7 House rent allowance 1,500.00 1,500.00 0.00
8 Medical allowance 500.00 500.00 0.00
9 Conveyance allowance 0.00 0.00 0.00
10 Festival Allowance 12,000.00 12,000.00
11 Allowance for support staff 0.00 0.00
12 Leave allowance 0.00 0.00 0.00
13 Honorarium/ Reward/Fee 0.00 0.00
14 Overtime allowance 0.00 0.00
15 Bonus / Ex-gratia 0.00 0.00
16 Other allowances 6,000.00 6,000.00
Employer’s contribution to a
17 0.00 0.00
recognized provident fund
Interest accrued on a recognized
18 0.00 0.00 0.00
provident fund
Deemed income for transport
19 0.00
facility

Deemed income for free furnished/

20 0.00
unfurnished accommodation

21 Other, if any (give detail) 0.00 0.00

22 Total ৳ 220,000.00 ৳ 2,000.00 ৳ 218,000.00
All figures of amount are in taka (৳)

Name Signature & Date

RUBEL
 SCHEDULE 24B
Particulars of income from house property
Annex this Schedule to the return of income if you have income from house property

Assessment Year TIN

1 2 0 1 9 2 0 2 1 2 3 4 5 6 7 8 9 0 1 2

For each house property

Description of the house property

Address of the property 03B Total area

03A
03C Share of the asessee (%) 100

Income from house property Amount ৳

4 Annual Value
Deductions (aggregate of 05A to 05G) 0
05A Repair, Collection, etc.
05B Municipal or Local Tax
05C Land Revenue
5
05D Interest on Loan/Mortgage/Capital Charge
05E Insurance Premium
05F Vacancy Allowance
05G Other, if any
6 Income from house property (04-05) 0
7 Incase of partial ownership, the share of income 0

Provide information if income from more than one house property

Aggregate of income of all house properties (1+2+3+- - - )
0
(provide additional papers if necessary)

8 1 (Income from house property 1) 0

2 (Income from house property 2)
3 (Income from house property 3)

Name Signature & Date

RUBEL
<< Input (If any)

<< Input (If any)

<< Input address (If any)

<< Input (If any)

<< Input (If any)

<< Input (If any)
<< Input (If any)
<< Input (If any)
<< Input (If any)
<< Input (If any)
<< Input (If any)
 SCHEDULE 24D
Particulars of tax credit/rebate
To be annexed to return by an assessee claiming investment tax credit
(Attach the proof of claimed investment, contribution, etc.)

Assessment Year TIN

1 2 0 1 9 2 0 2 1 2 3 4 5 6 7 8 9 0 1 2

Particulars of rebatable investment, contribution, etc. Amount ৳

3 Life insurance premium 0.00
4 Contribution to deposit pension scheme (not exceeding allowable limit) 0.00
5 Investment in approved savings certificate 0.00
6 Investment in approved debenture or debenture stock, Stock or Shares 0.00
7 Contribution to provident fund to which Provident Fund Act, 1925 applies 0.00
8 Self contribution and employer’s contribution to Recognized Provident Fund 0.00
9 Contribution to Super Annuation Fund 0.00
10 Contribution to Benevolent Fund and Group Insurance Premium 0.00
11 Contribution to Zakat Fund 0.00
12 Others, if any (Give Details) 0.00
13 Total allowable investment, contribution etc. 0.00
Eligible amount for rebate (the lesser of 14A, 14B or 14C) 0.00
14A Total allowable investment, contribution, etc. (as in 13) 0.00

25% of the total income (excluding any income for

14 which a tax exemption or a reduced rate is applicable
14B under sub-section (4) of section 44 or any income 54,500.00
from any source or sources mentioned in clause (a)
of sub-section (2) of section 82C.)

14C 1.5 crore 15,000,000.00

Amount of tax rebate calculated on eligible amount

15 0.00
(Serial 14) under section 44(2)(b)

Name Signature & Date

RUBEL
84500 41984 2500 10000
84500 41984 2500 10000
 SCHEDULE 24A
Particulars of income from Salaries
Annex this Schedule to the return of income if you have income from Salaries

Assessment Year TIN

1 2 0 1 9 2 0 2 1 2 3 4 5 6 7 8 9 0 1 2

Amount Tax exampted Taxable

Particulars
(A) (B) (C=A-B)
3 Basic pay 384,450.00 384,450.00
4 Special pay 0.00 0.00
Arrear pay (if not included in
5 0.00 0.00
taxable income earlier)
6 Dearness allowance 0.00 0.00
7 House rent allowance 192,225.00 192,225.00 0.00
8 Medical allowance 32,038.00 32,038.00 0.00
9 Conveyance allowance 32,038.00 30,000.00 2,038.00
10 Festival Allowance 71,500.00 71,500.00
11 Allowance for support staff 0.00 0.00
12 Leave allowance 0.00 0.00 0.00
13 Honorarium/ Reward/Fee 0.00 0.00
14 Overtime allowance 0.00 0.00
15 Bonus / Ex-gratia 0.00 0.00
16 Other allowances 0.00 0.00
Employer’s contribution to a
17 0.00 0.00
recognized provident fund
Interest accrued on a recognized
18 0.00 0.00 0.00
provident fund
Deemed income for transport
19 0.00
facility

Deemed income for free furnished/

20 0.00
unfurnished accommodation

21 Other, if any (give detail) 0.00 0.00

22 Total ৳ 712,251.00 ৳ 254,263.00 ৳ 457,988.00
All figures of amount are in taka (৳)

Name Signature & Date

RUBEL
 0

A person with disability

 TAX REFUND 10,000.00 ERROR IN ASSET

National Board of Revenue IT-10B2016

www.nbr.gov.bd

STATEMENT OF ASSETS, LIABILITIES AND EXPENSES

under section 80(1)of the Income Tax Ordinance, 1984 (XXXVI of 1984)
under section 80(2) of the Income Tax Ordinance, 1984 (XXXVI of 1984)

1. Mention the amount of assets and liabilities that you have at the last date of the income year.
All items shall be at cost value include legal, registration and all other related costs;
2. If your spouse or minor children and dependent(s) are not assessee, you have to include their
assets and liabilities in your statement;
3. Schedule 25 is the integral part of this Statement if you have business capital or agriculture or
non-agricultural property. Provide additional papers if necessary.

Assessment Year Statement as on (DD-MM-YYYY)

1 2 0 1 9 2 0 2 3 0 0 6 2 0 1 9
Name of the Assessee TIN
3 RUBEL 4 1 2 3 4 5 6 7 8 9 0 1 2

Particulars Amount ৳
Business capital (05A+05B) 525700.00

5 05A Business capital other than 05B

Director’s shareholdings in limited companies
05B 525700.00
(as in Schedule 25)
06A Non-agricultural property (as in Schedule 25) 13864620.00
6 Advance made for non-agricultural property
06B
(as in Schedule 25)

7 Agricultural property (as in Schedule 25) 6863000.00

Financial assets value (08A+08B+08C+08D+08E) 8000000.00
08A Share, debentures etc.
08B Savings certificate, bonds and other government securities 8000000.00
8
08C Fixed deposit, Term deposits and DPS
08D Loans given to others (mention name and TIN)
08E Other financial assets (give details)
Motor car (s) (use additional papers if more than two cars) 0.00
SL Brand name Engine (CC) Registration No.
9
1
2

10 Gold,diamond, gems and other items(mention quantity)

 11 Furniture, equipment and electronic items

12 Other assets of significant value

Cash and fund outside business (13A+13B+13C+13D) 0
13A Notes and currencies
13 13B Banks, cards and other electronic cash
13C Provident fund and other fund
13D Other deposits, balance and advance (other than 08)
14 Gross wealth (aggregate of 05 to 13) 29253320
Liabilities outside business (15A+15B+15C) 0
15A Borrowings from banks and other financial institutions
15
15B Unsecured loan (mention name and TIN)
15C Other loans or overdrafts
16 Net wealth (14-15) 29253320
17 Net wealth at the last date of the previous income year 10000000
18 Change in net wealth (16-17) 19253320
Other fund outflow during the income year (19A+19B+19C) 10000
19A Annual living expenditure and tax payments (as IT-10BB2016) 10000
19 Loss, deductions, expenses, etc. not mentioned in
19B
IT-10BB2016
19C Gift, donation and contribution (mention name of recipient)
20 Total fund outflow in the income year (18+19) 19263320
Sources of fund (21A+21B+21C) 220000
21A Income shown in the return 218000
21
21B Tax exempted income and allowance 2000
21C Other receipts and sources
22 Shortage of fund, if any (21-20) (19043320)

Verification and signature

Verification Please DECREASE
I solemnly declare that to the best of my knowledge and belief the information given in this statement is
correct and complete.

Name: RUBEL Signature and date:

Please DECREASE O

<< Input (If any)

<< Input (If any)

<< Input (If any)

<< Input (If any)
<< Input (If any)
<< Input (If any)
<< Input (If any)

<< Input Details (If any)

<< Input Details (If any)

<< Input (If any)

<< Input (If any)

<< Input (If any)

<< Input (If any)

<< Input (If any)
<< Input (If any)
<< Input (If any)

<< Input (If any)

<< Input (If any)
<< Input (If any)

<< Input (If any)

<< Input (If any)

<< Input (If any)

<< Input (If any)

 TAX REFUND 10,000.00 ERROR IN ASSET

SCHEDULE 25
To be annexed to the Statement of Assets, Liabilities and Expenses (IT-10B2016)

Assessment Year TIN

1 2 0 1 9 2 0 2 1 2 3 4 5 6 7 8 9 0 1 2

Shareholdings in limited companies as director No. of Shares Value ৳

1 BD Resorts 7.00 700.00
3 2 Lilac 2,250.00 225,000.00
3 3,000.00 300,000.00
Total 5,257.00 525,700.00

increased/
Non-agricultural property at cost value or any advance Value at the start Value at the last date
decreased during
made for such property (description, location and size) of income year ৳ of income year ৳
the income year ৳

1 As before 11,214,620 2,650,000 13,864,620

4
2 0
3 0
4 0
Total 11,214,620 2,650,000 13,864,620

increased/
Agricultural property at cost value (description, Value at the start Value at the last date
decreased during
location and size) of income year ৳ of income year ৳
the income year ৳

1 5,513,000 1,350,000 6,863,000

5
2 0 0
3 0
4 0
Total 5,513,000 1,350,000 6,863,000

(Provide additional paper if necessary)

Name Signature & Date
RUBEL
Please DECREASE O

<< Input Details (If any)

<< Input Details (If any)
<< Input Details (If any)

<< Input Details (If any)

<< Input Details (If any)
<< Input Details (If any)
<< Input Details (If any)

<< Input Details (If any)

<< Input Details (If any)
<< Input Details (If any)
<< Input Details (If any)
 National Board of Revenue IT-10BB2016
www.nbr.gov.bd

STATEMENT OF EXPENSES RELATING TO LIFESTYLE

under section 80(2) of the Income Tax Ordinance, 1984 (XXXVI of 1984)

Assessment Year Statement as on (DD-MM-YYYY)

1 2 0 1 9 2 0 2 3 0 0 6 2 0 1 9
Name of the Assessee TIN
3 RUBEL 4 1 2 3 4 5 6 7 8 9 0 1 2

Particulars Amount ৳ Comments

5 Expenses for food, clothing and other essentials
6 Housing expense
Auto and transportation expenses (07A+07B) 0
7 07A Driver’s salary, fuel and maintenance
07B Other transportation
Household and utility expenses (08A+08B+08C+08D) 0
08A Electricity
8 08B Gas, water, sewer and garbage
08C Phone, internet, TV channels subscription
08D Home-support staff and other expenses
9 Children’s education expense
Special expenses (10A+10B+10C+10D) 0
10A Festival, party, events and gifts
10 10B Domestic and overseas tour, holiday, etc.
10C Donation, philanthropy, etc.
10D Other special expenses 511
11 Any other expenses
Total expense relating to lifestyle
12 0
(05+06+07+08+09+10+11)
Payment of tax, charges, etc. (13A+13B) 10,000
13 10D Payment of tax at source 10,000
10D Payment of tax, surcharge or other amount
14 Total amount of expense and tax (12+13) 10,000

Verification and signature

Verification
I solemnly declare that to the best of my knowledge and belief the information given in this statement is
correct and complete.

Name: RUBEL Signature and date:

<< Input (If any)
<< Input (If any)

<< Input (If any)

<< Input (If any)

<< Input (If any)

<< Input (If any)
<< Input (If any)
<< Input (If any)
<< Input (If any)

<< Input (If any)

<< Input (If any)
<< Input (If any)
<< Input (If any)
<< Input (If any)

<< Input (If any)

xc National Board of Revenue IT-10BB2016
www.nbr.gov.bd

STATEMENT OF EXPENSES RELATING TO LIFESTYLE

under section 80(2) of the Income Tax Ordinance, 1984 (XXXVI of 1984)

Assessment Year Statement as on (DD-MM-YYYY)

1 2 0 1 9 2 0 2 3 0 0 6 2 0 1 9
Name of the Assessee TIN
3 RUBEL 4 1 2 3 4 5 6 7 8 9 0 1 2

Particulars Amount ৳ Comments

5 Expenses for food, clothing and other essentials 460,000
6 Housing expense 5,777
Auto and transportation expenses (07A+07B)
7 07A Driver’s salary, fuel and maintenance yh6778
07B Other transportation
Household and utility expenses (08A+08B+08C+08D) 0
08A Electricity
8 08B Gas, water, sewer and garbage
08C Phone, internet, TV channels subscription
08D Home-support staff and other expenses
9 Children’s education expense
Special expenses (10A+10B+10C+10D) 0
10A Festival, party, events and gifts
10 10B Domestic and overseas tour, holiday, etc.
10C Donation, philanthropy, etc.
10D Other special expenses 511
11 Any other expenses
Total expense relating to lifestyle
12 465,777
(05+06+07+08+09+10+11)
Payment of tax, charges, etc. (13A+13B) 10,000
13 10D Payment of tax at source 10,000
10D Payment of tax, surcharge or other amount
14 Total amount of expense and tax (12+13) 475,777

Verification and signature

Verification
I solemnly declare that to the best of my knowledge and belief the information given in this statement is
correct and complete.

Name: RUBEL Signature and date:

 0

<< Input (If any)

<< Input (If any)

<< Input (If any)

<< Input (If any)

<< Input (If any)

<< Input (If any)
<< Input (If any)
<< Input (If any)
<< Input (If any)

<< Input (If any)

<< Input (If any)
<< Input (If any)
<< Input (If any)
<< Input (If any)

<< Input (If any)

 TAX REFUND 10,000.00 ERROR IN ASSET

Computation of Income & Tax Thereon

For the Income Year Ended June 30, 2019
SL ParicularsInformation
3 Name of the Assessee * Rubel
2 Return submitted under section 82BB? * No
4 Gender (Select one) * Male
8A Location of Assessee (Select one) * Other City Corp.
10 Select if you are (Select Yes/No) * (Select Yes/No) *
A gazetted war-wounded
10A
freedom fighter
No
10B A person with disability No
10C Aged 65 years or more No
10D A parent/legal guardian of a person with disability No
No
50 If you are a parent of a person with disability, has your spouse availed the extended tax exemption threshold? (Yes/No)

Salary Particulars

no. of
per month X month
or Total

→ Basic Salary Tk. 16,500 X or 200000

Monthly Salary 127,500 16,500 X 1
Monthly Salary 17,200
→ House Rent Tk. 102,000 X 12 or 1500
X 6
→ Deemed income for free/decreased No
furnished/unfurnished accommodation
→ Entertainment Tk. - X 6 or 0
Tk. X
→ Utility Allowance Tk. 6,000 X 1 or 6000
Tk. 700 X #REF!
→ Medical Allowance Tk. 3,000 X 12 or 500
X 6

→ Conveyance Allowance Tk. - X 12 or 0

X 6
→ Org. Provided Personal Transport No
Facility/Executive Car Facility
→ Personal pay Tk. X 1 or 0
X 0
→ Special pay Tk. X 1 or 0
Tk. X 0
→ Dearness allowance Tk. X 1 or 0
X 0

→ Allowance for support staff Tk. X 1 or 0

Tk. X 0

→ Arrear pay (if not included in Tk. X 1 or 0

taxable income earlier)
→ Leave allowance Tk. X 1 or

→ Overtime allowance Tk. 0

→ Leave Fare Concession (LFC) Tk. X 1 or 0

X 0

→ Festival Bonus Tk. 12,000 X 2 or 12000

X 1

→ Honorarium/ Reward/Fee 1 0

→ Incentive Bonus Tk. X 1 or

→ Contributory Provident Fund X 6 or 0

X 6
Total Salary Income
→ Other income, if any 0

Pariculars (* Mendetory Field)

Income
25 Interest on securities 0
27 Agricultural income 0
29 Capital gains 0
30 Income from other sources 0
31 Share of income from firm or AOP 0
32 Income of minor or spouse under section 43(4) 0
33 Foreign income 0
40 Interest or any other amount under the Ordinance (if any) 0
42 Tax deducted or collected at source * 10000
44 Adjustment of tax refund [mention assessment year(s) of refund] 0
43 Advance tax paid (attach proof) 0

45 Amount paid with return (Amount to be paid)** 0.00

Schedule 24D: Particulars of tax credit/REBATE

3 Life insurance premium 0
4 Contribution to deposit pension scheme (not exceeding 60000/YEAR) 0
5 Investment in approved savings certificate 0
6 Investment in approved debenture or debenture stock, Stock or Shares 0
7 Contribution to provident fund to which Provident Fund Act, 1925 applies 0
8 Self contribution and employer’s contribution to Recognized Provident Fund -
9 Contribution to Super Annuation Fund 0
10 Contribution to Benevolent Fund and Group Insurance Premium 0
11 Contribution to Zakat Fund 0
12 Others, if any Give Details 0

Basic Information
1 Assessment Year (i.e 201819) * 201920
5 Twelve-digit TIN * Use this Symbol ( ' ) befor number->> 12345678901200
6 Old TIN Use this Symbol ( ' ) befor number->>
7 Circle * 124 (Salary)
8 Zone (Select one) * Tax Zone-4, Chittagonj
9 Resident Status (Select one) * Resident
11 Date of birth (DD-MMM-YYYY) * 01-Jan-1990
12 Income Year (i.e: 20172018) * 2019-20
13 If employed, employer’s name
14 Spouse Name
15 Spouse TIN (if any) Use this Symbol ( ' ) befor number->>
16 Father’s Name *
17 Mother’s Name *
18 Present Address *
19 Permanent Address *
20 Contact Telephone * Use this Symbol ( ' ) befor number->> 1234567890
21 E-mail
22 National Identification Number Use this Symbol ( ' ) befor number->> 12345678901234567
23 Business Identification Numbers Use this Symbol ( ' ) befor number->>
Date of Signature (DD-MMM-YYYY) 07-Nov-2020
Place of Signature Dhaka
53 Statements annexed Please see cell "AF17" on worksheet "IT-10GA2016-3"
54 Attachment List* A. Salary Certificate
B. ETIN
C.
### NID
Please DECREASE Outflow/Expenses or Cash of TK.15043320

PLEASE FILL UP ALL THE YELLOW FIELDS ALONG WITH

*IT-10B2016, *Schedule 25 (For Land Asset),
*IT-10BB2016, *Schedule 24B (For Propertity Income)
for FULL INCOME TAX ASSESMENT !!!

VERSION: 8.1

Taka Taka

200,000
- 200,000
You can fillup either "per
1,500
- 1,500 Month allowance &
-
number of Month" or
- -
"Total" against specific
6,000
- 6,000 field
500
- 500

-
- -

-
- -
-
- -
 -
- -

-
- -

- -

- -

- -

-
- -

12,000
- 12,000
35 Gross tax before tax rebate
- - 36 Tax rebate (annex Schedule 24D)
37 Net tax after tax rebate
- - 38 Minimum tax
39 Net wealth surcharge
- 40 Interest or any other amount under the Ordinance (if any)
- - 41 Total amount payable
220,000 42 Tax deducted or collected at source (attach proof)
- 43 Advance tax paid (attach proof)

- 220,000 45 Amount paid with return (attach proof)

46 Total amount paid and adjusted (42+43+44+45)

47 TAX REFUND
TAX REFUND 10,000.00 ERROR IN ASSET
Printing Instruction Please DECREASE
Outflow/Expenses or Cash
Please Print According order of TK.15043320
1 IT-10GA2016-3 (Page 2-ACK)
2 IT-10GA2016-1

ALL YELLOW 3 IT-10GA2016-2

4 IT-10GA2016-3 (Page 1)
FIELD MUST BE
5 Schedule 24A
FILL UP ALONG 6 IT-10B2016 Please Fill up on specific Tab
WITH form 7 Schedule 25 Please Fill up on specific Tab
*IT-10B2016, 8 IT-10BB2016 Please Fill up on specific Tab
*Schedule 25 (For
Land Asset),
*IT-10BB2016,
 FILL UP ALONG
WITH form
*IT-10B2016,
*Schedule 25 (For
Land Asset),
*IT-10BB2016,
*Schedule 24B (For
1
Propertity Income)
for FULL INCOME
TAX
ASSESMENT !!!

2 0 1 9
1 2 3 4 2 0
5 6 7 8 9 0

Chittagonj

0 1 0 1
2019 - 9-20 1 9 9 0

0 7 1 1
2 0 2 0
 0.00
0.00
0.00
0.00
0.00
0.00
0.00
10,000.00
0.00

0.00

10,000.00

10,000

OR IN ASSET INDICATOR

se DECREASE
w/Expenses or Cash
TK.15043320

Schedule 24A
specific Tab Schedule 24B
specific Tab Schedule 24D
specific Tab IT-10B2016
 Schedule 25

IT-10BB2016

1 2