p) Fixed Deposits in Bank More Than (5) years. h) EWF and SWF 40
q) LIC Pension fund U/S 80 CCC (Max. Rs. 10000) i) Others if any
r) Contribution to any Pension Scheme U/S 80 CCD (Max. 10% of salary) 0 Prepared by: G. ASHOK ,SA(M)
ZPHS DURSHED, Mdl&Dt: KARIMNAGAR, A.P.
s) Infrastructure Bonds (ICICI/IDBI etc)U/s 80CCF (Up to Rs.20000)
505001
Note: Savings (a) to(r) Max.Rs 1,00,000 and (s) Rs.20,000 Total Rs.1,20,000 Mail: aputfknr@gmail.com; Ph: 9490300725
INSTRUCTIONS: 1.Fill up the data in the light pink colour only. 3. Send your valuable suggesions and modifications.
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with best compliments from APUTFKNR Copy available at www.utfknr.9f.com Signature of the Assessee
STATEMENT OF INCOME TAX for the Financial Year 2011-12
G. ASHOK
1 Name of the Government Servant & Address
ZPHS DURSHED
2 Permanent Account Number AQTPP2949L
3 Whether living in Own / Rented house (Address) Rented House at Karimnagar
4 Gross Pay & Allowences as indicated in the Statement enclosed Rs 341,790
5 Deductions towards H.R.A. U/s 10 (13-A) (Least of the following exempted) Rs 48,581
a) Actual H.R.A. received 48,581
b) Actual rent paid minus 10% of salary(PAY+DA) Rs 6,500 X 12 -- 10%S 48,917
c) 40% of salary (Salary means Basic Pay+DA) 116,334
6 Total Salary (4-5) Rs 293,209
7 Deductions from Salary Income Rs 2,400
a) Exemption from Conveyance Allowance U/s. 10(14) (i) 0
b) Profession Tax U/s 16 (3) B 2,400
8 Income from Salary(6-7) Rs 290,809
9 Income from Capital Gains ----
10 Other sources of income if any ----
11 Income OR Loss from house Property (U/s.24L(vi)) ----
12 Gross Total Income (8+9+10+11) Rs 290,809
13 Deductions Under Chapter VI A., U/s. 80C, 80CCC, 80CCD
a 1 GPF A/C No. 6968 31,428
2 APGLI No. ---- 0
3 Group Insurance 720
4 Lic Policies Premium ----
5 Subscription to NSC VIII Issue ----
6 Tution Fee for 2 Children ----
7 Repayment of HBA instalments Rs ----
8 UTI Retirement Benefit Pension Fund. ----
9 ULIP ----
10 PLI ----
11 Public Provident Fund ----
12 Subscriptions made to Equity shares/Debentures. ----
13 Subscriptions made to any Mutual Fund (ELSS) ----
14 Subscription to Deposit Scheme of National Housing Bank ----
15 Fixed Deposites in Banks for morethan 5 years ----
16 LIC Annuity Plan (Jeevan Dhara etc.) ----
b 17 LIC Pension fund U/s. 80CCC (Max. Rs. 10,000), LIC Annuity Plans ----
c 18 Contribution to any Pension Scheme U/s. 80 CCD (Max. 10% of Salary) ----
d 19 Infraustructure Bonds (ICICI/IDBI etc)U/s 80CCF 0
TOTAL QUALIFYING AMOUNT (upto Rs. 1,20,000/-) U/Sec. 80C, 80CCC & 80CCD Rs 32,148
UNDERTAKING CERTIFICATE
Certify that I have paid an amount of Rs. 78000 (Rupees seventy-eight thousands Only )
towards House Rent for the year 2010-11 @ Rs.6500.
Rs 258,620
Nil
Rs 9,862
----
----
Rs 9,862
Rs 197
Rs 99
Rs 10,158
Rs 0
Rs 10,158
DERTAKING CERTIFICATE
SIGNATURE OF ASSESSEE
DETAILS OF SALARY PAID AND ANY OTHER INCOME AND TAX DEDUCTED
1 Gross Salary
a) Salary as per provisions contained in Section 17(1) 341790.00 341790.00
b) Value of perquisites under section 17(2) (as per Form No. 12 BA, wherever
applicable)
c) Profit in lieu of Salary under section 17(3) (as per Form No. 12 BA, wherever
applicable)
d) TOTAL 341790.00 341790.00
2 Less: Allowance to the extent exempted under section 10 48581.00 48581.00
3 BALANCE (1-2) 293209.00 293209.00
4 DEDUCTIONS
a) Exemption conveyance allowance 0.00
a) Entertainment allowance:
b) Tax on Employment: 2400.00 2400.00
5 Aggregate of 4 (a&b) 2400.00 2400.00
INCOME CHARGEABLE UNDER THE
6 290809.00
HEAD SALARIES (3-5)
7 Add: Any other income reported by the employee. 0.00 0.00
8 GROSS TOTAL INCOME (6+7) 290809.00
9 Deductions under Chapter VI A
A, (a) Under 80C 32148.00
Gross Amount Qualifying Amount Deductible Amount
1 GPF A/C No. 6,968 31,428.00 31,428.00 31,428.00
2 APGLI No. ---- - - -
3 Group Insurance 720.00 720.00 720.00
4 Lic Policies Premium ---- ---- ----
5 Subscription to NSC VIII Issue ---- ---- ----
6 Tution Fee for 2 Children ---- ---- ----
7 Repayment of HBA instalments Rs ---- ---- ----
8 UTI Retirement Benefit Pension Fund. ---- ---- ----
9 ULIP ---- ---- ----
10 PLI ---- ---- ----
11 Public Provident Fund ---- ---- ----
12 Subscriptions made to Equity shares/Debentures. ---- ---- ----
13 Subscriptions made to any Mutual Fund (ELSS) ---- ---- ----
14 Subscription to Deposit Scheme of National Housing Bank ---- ---- ----
15 Fixed Deposites in Banks for morethan 5 years ---- ---- ----
16 LIC Annuity Plan (Jeevan Dhara etc.) ---- ---- ----
b 17LIC Pension fund U/s. 80CCC (Max. Rs. 10,000), LIC Annuity Plans ---- ---- ----
c 18Contribution to any Pension Scheme U/s. 80 CCD (Max. 10% of Salary) ---- ---- ----
Secendory &
Total Tax Date on which tax
Education Higher Cheque/DD BSR Code of Bank
Sl.No TDS No. Deposited deposited
Cess Rs. Education No. (if any) Branch
Rs. (DD/MM/YY)
Cess Rs.
I J.GOPAL RAO working in the capacity of HEAD MASTER do here by certify that a sum of Rs 10158 of IT (in words
Rupees ten thousands, one hundred fifty-eight Only ) has been deducted at source and paid to the credit of the central
Government. I further certify that the information given above is true and correct based on the books of accounts, documents
and other available records)
258621.00
9,862
197
99
10,158
10,158
10158
ount
Transfer
Voucher/
Challan
Identification
No.
sponsible for
ENTER THE DETAILS OF ADVANCE TAX
PAID MONTH WISE
Sl No. Month Amount
1 Mar-10
2 Apr-10
3 May-10
4 Jun-10
5 Jul-10
6 Aug-10
7 Sep-10
8 Oct-10
9 Nov-10
10 Dec-10
11 Jan-11
12 Feb-11
ANNEXURE
Name of the Employee :
Designation :
Office/Branch :
a) Amount of H.R.A. :
b) Actual Rent paid Less 1/10th of Salary :
c) 40% of Salary :
Least of above (a),(b) and ( c ) i.e. :
( Rupees ten thousands, one hundred fifty-eight Only only)
I here by conform that I have actually incurred expenditure/Amount incurring expenditure as paymen
of rent in respect of the residential accommodation occupied by me and the amount of HRA exempted from
tax as above is calculated as per the relevant provisions of the income tax Act.
(1) For purpose of the above deductions "Salaries" means only basic pay, personal allowance and special
allowance ranking for the purpose of RP deductions, if any.
(2) Attachment receipt if HRA exceeds Rs. 3000/- per month
ANNEXURE
G. ASHOK
SA (M)
ZPHS DURSHED
H.NO. 10-2-6,
Vidya Nagar,
Karimnagar
48581.00
48917.00
116334.00
48581.00
ousands, one hundred fifty-eight Only only)
Signature