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Instructions
Before preparing Income Tax Calculation Memo, Please fill up first, "First Information" & then "Details Salary" by
1 doing this all forms will be prepared automatically

First make a file by Save As a Employee's Name whose data is you are going to be fill up & then please fill up only
2 those cells whose colour is blue or blue ' 0 ' in Fist Information & Detail Salary by making different files of
employees will be helpful for Form No. 16 & Form No. Naya Saral as future reference.

If there is any mistake in Details Salary / Income Tax Calculation Memo / From No. 16 / From No. Naya
Saral please contact to Kirit Patel mrkiritpatel@gmail.com /, DILIP BARIA dpbaria@gmail.com,
Leena Malani leena_7_m@yahoo.com or Imran Bagwan imu20593@gmail.com / adr-ddo-
3
dan@gujarat.gov.in
File is available on http://sct.sanjeevanidangs.org or GSWan Availeble http://10.138.4.99/ & also
Ftp://10.138.4.60 User : it Pass : it

I Click here for fill up FIRST INFORMATION V Click here to VIEW AND PRINT Form No. 16's 1st Page

Challan-280
II Click here for fill up SALARY VIEW AND PRINT VI Click here to VIEW AND PRINT Form No. 16's 2nd Page

III Click here to VIEW AND PRINT Income-Tax Calculation Statement


VIII Click here to VIEW & PRINT Acknowledgement

Please do First Setup the Page in which IX Click here to VIEW AND PRINT ITR-1 Form
you want to take print out X Click here to VIEW AND PRINT ITR-2 Form

VI Click here to VIEW AND PRINT ITR-2 C K Sonawane 94273 63791


Aslam Khan 94261 47853
Proposed Calculation
Kirit Patel 94268 94422
BACK Dilip Baria 94268 44723
Imran Bagwan 94278 70846
BACK2 Leena Malani 94263 72895
Chetan Patil 94268 63556
Financial Year 2009 2010 Assessment Year 2010 2011 ,

Make Your Computer System Date DD/MM/YYYY All information fill up Here

SHRI K J PATEL Name e.g. Shri K J Patel Shri K J Patel


KIRITCHANDRA JAYANTILAL PATEL
Full Name e.g. Kiritchandra Jayantilal Patel Kiritchandra Jayantilal Patel
JAYANTILAL RATILAL PATEL
Father's full Name e.g. Jayantilal Ratilal Patel Jayantilal Ratilal Patel
Flat/Door/Block No. e.g. A / 82 8/111
Name Of Premises/Building/Village e.g. Nandanvan Apartment Part II Various Colony
Road/Street/Post Office e.g. Jodhapurgram Road Sunset Point Road
Area /Locality e.g. Ambavadi Near SBI Staff Qtr
Town/City/District e.g. Ahwa Dist. Dangs Ahwa-Dangs
State e.g. GUJARAT GUJARAT
Pin code e.g. 394710 394710
Date of Birth e.g. 1/29/1961 29/01/1961
SENIOR CLERK Designation e.g. Senior Clerk Senior Clerk
ACFPP3047F Pan No. e.g. ACFPP3047F ACFPP3047F
M VALSAD TDS Circle: e.g. Valsad Valsad
MALE 3 Male or Female ? . Male Male
ADD. DIRECTOR ANIMAL HUSAMADRY
TAN No. e.g. BRDROO841B BRDROO841B
DANGS DISTRICT PANCHAYAT TDS Circle: e.g. Valsad Valsad
DANGS DISTRICT PANCHAYAT,
Name of Deptt/Office
AHWA e.g. DANGS DISTRICT PANCHAYAT, AHWA DANGS DISTRICT PANCHAYAT, AHWA
For Stamp Design. of Drawing Officer e.g. Dist.Primary Education Officer Add. Director Animal Husamadry
of
Drawing
Deptt's Name e.g. Dangs Dist.Pan. Education Comm., Ahwa Dangs District Panchayat
Officer AHWA Place : e.g. Ahwa or Gandhingar Ahwa
Drawing Officer Name e.g. DEVENDRABHAI RAYUBHAI MAHLA DEVENDRABHAI RAYUBHAI MAHLA
RAYUBHAI of Drawing Officer Father Name e.g. RAYUBHAI MAHLA
Design.MAHLA RAYUBHAI MAHLA
DEVENDRABHAI RAYUBHAIDetails
MAHLA of Bank Account
STATE BANK OF INDIA Name of Bank e.g. State Bank of India State Bank of India
Acctt. No. e.g. 1190003164 or DJ / 29161 000010936167655
mrkiritpatel@gmail.com / imu20593@gmail.com / dpbaria@gmail.com

STATEMENT SHOWING THE TOTAL SALARY DURING FINANCIAL YEAR 2009 2010
Name : SHRI K J PATEL
Designation SENIOR CLERK
Deduction

Month of Profes- Repay-


Salary Gross Tran. Washing Income
sional GPF Govt. Ins. LIC ment of P. T. A. PLI
Salary Allow. All. Tax
Tax HBA

Mar/2009 13466 200 75 3000 100 0 0 0 0 0 0


Apr/2009 13466 200 75 3000 100 0 0 0 0 0 0
May/2009 19129 200 200 3000 100 0 0 0 0 0 0
Jun/2009 20089 200 200 3000 100 0 0 0 0 0 0
Jul/2009 20674 200 200 4000 100 0 0 0 0 0 0
Aug/2009 20674 200 200 4000 100 0 0 0 0 0 0
Sep/2009 20674 200 200 4000 100 0 0 0 0 0 0
Oct/2009 21498 200 200 6500 100 0 0 0 0 0 0
Nov/2009 21498 200 200 6500 100 0 0 0 0 0 0
Dec/2009 21498 200 200 6500 100 0 0 0 0 0 0
Jan/2010 21498 200 200 6500 100 0 0 0 0 0 0
Feb/2010 21498 200 200 6500 100 0 0 0 0 0 1296
DA Diff 0 0 0 0 0 0 0 0 0 0 0
DA Diff 0 0 0 0 0 0 0 0 0 0 0
Pay Diff. 5663 0 0 0 0 0 0 0 0 0 0
Charge 0 0 0 0 0 0 0 0 0 0
Allow.
Leave En. 0 0 0 0 0 0 0 0 0 0
Bonus 0 0 0 0 0 0 0 0 0 0
Other 0 0 0 0 0 0 0 0 0 0 0
Deduction
20% of the 35800 0 0 35800 0 0 0 0 0 0 0
Arrears
Total 277125 2400 2150 92300 1200 0 0 0 0 0 1296

Specify Percentage for Proposed Calculation 2010-2011 e.g. 10 % 0%


Less House rent allowance exempt U/s 10[13A] 0
[a] Actual amount of HRA received [Yearly] 0
[b] Expenditure on rent in excess of 10@ of salary [including D.A.] as personal 0
D.A. is including for retirement benefits

[a] actual amount paid House rent 0


[b] 10% of Pay & DA [Yearly] 0
[c] 50% of salary [including D.A.] 0
[d] [a], [b], [c] & [d] which ever is less 0

Detail of investment made / to be made during financial year 2009-2010 which is classed as
qualifying u/s 80 C Income Tax Act (Xerox Copy enclosed)

Sr No. Nature of Date Amount R. No. Details of Bank/post


Investment

1
2

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3
4
5
Note : Detail of investment not shown above [in r/o investment to be made] shall be furnished to
the A.O. of Bill Budget branch on of before 31/03/2010

Place : . AHWA Signature


Date : . 3/6/2010 Name SHRI K J PATEL
Designation SENIOR CLERK

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It's must to write a year if you have taken a loan of HBA


Have you drawn Loan for HBA before 1:4:1999? or after, Write year 11/27/2009
If you have taken Loan, Pl. write amount of Interest else write 0 0
Deduction under Chapter VI-A
1 Entertainment allowance 0
2 Honorarium 0
3 Bank Interest 0
4 NSC Interest 0
5 House Rent Income 0
6 Other Sources [ if any ] 0
7 Jivan Suraksha premium u/s 80-ccc [Max.Rs.10,000] 0
8 U/S 80-D Mediclame Paid by Cheque Only Mac. Rs. 15000 0
10 U/S 80-DD (Max. Medical Treatment Charge Mac. Rs. 75000 0
11 Rs. 50,000)
U/S 80-DB Medical Treatment Charge Mac. Rs. 40000 0
12 U/S 80-U 0
13 U/s 80E Education Loan & It's Interest Mac. Rs. 40000 0
9 U/S 80-G Mac. 100% 0
14 U/S 80-GG 0 Mac. 50% 0
15 U/S 80-GGA 0 Mac. 40% 0
16 U/S 80-GGGC 0
17 Others [ if any Bond or Debencher ] 0
18 Others [ if any Bond or Debencher ] 0
Rebate under Chapter VIII Under Section 88
1 Public Provident Fund [ PPF ] 0
2 Deposit in 10 Year, 15 Years 0
3 Account Under
NSC Interest the Post Office Saving Band (CTD)
re-invested 0
4 ULIP 0
5 Equity link Saving fund [ Max. Rs. 15,000/- ] 0
6 Investment in pension fund 0
7 Tuition Frees [For the purpose of full-time education of any 1st Child 17000
two children of the employee.] 2nd Child 0
12 0 Total 17000
00
8 Investment Share/Debenture in infrast..... Power & communication Co Safety Bonds ICICI and
0 IDBI Bonds
9 Others 0
Relief under section 89 [attach details]
1 Where arrears of salary are paid under order of court 0

For "FROM IT-16" After Feb. Without paybill, Tax deposited to Bank
S,NO TDS Surcharge Education Total Tax deposited Rs. Cheque/DD No.(if
Rs. Rs. Cess any)
Rs.
1
2
3
4
5
6
7
8
9
10
11
12

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13
Tax deposited Rs. S,NO BRS Code of Bank branch Date on which tax Transfer voucher challan Identification
0 deposited (dd/mm/yy) No.
1
2
3
4
5
6
7
8
9
10
11
12
13

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DANGS DISTRICT PANCHAYAT, AHWA


Self Assessment Income Tax Calculation Memo for the Accounting Year 2009 2010
And Assessment Year 2010 2011
Name : KIRITCHANDRA JAYANTILAL PATEL
Designation SENIOR CLERK
Residential Address : 8/111,Various Colony ,Sunset Point Road,Near SBI Staff Qtr,Ahwa-Dangs,GUJARAT

PAN NO. ACFPP3047F PSN NO. xxxxxx


No. Particular Rs.
1 Income
[a] Gross Salary Income (Statement enclose] 277125 277125
PAY+DA+D.PAY+HRA+CLA+MA+TA and Other Allowance

[b] Honorarium 0
[c] Bonus 0
[d] Bank Interest 0
[e] NSC Interest 0
[f] House Rent Income 0
[g] Other Sources [ if any ] 0
Total [a] to [g] 277125
2 Less : Deduction Admissible 4550
Deduction Less House rent allowance exempt U/s 10[13A]
(1) a Actual amount of HRA received 0
b 10% of salary [including D.A.] 0
c 50% of salary [including D.A.] 0
HRA Ded. Allowed 0 0
(2) PTA + Washing Allw.U/s 10[14][I] Vide rule 2BB[i] of Rules 0
(3) Transportation Allowance U/S 10(14) 2150
(4) Professional Tax U/S 16(U) 2400
(5) Entertainment allowance 0
3 Balance [1-2] 272575
4 Less : HBA Interest U/S 24(1) (vi)
[i] Up to Rs. 30,000/- can taken before Dt.1/4/99 0 0
[ii] Up to Rs. 1,50,000/- can taken after Dt.1/4/99
5 Total Income (3-4) 272575
6 Deduction : Under Chapter VI-A Gross Qualifying
(a) Med. claim u/s 80-d [Max. Rs. 15,000/-] 0 0
(b) Donation U/S 80-G 0 0 0
(c) Medical Treatment of Handicapped Dependents 0 0
U/S 80-DD (Max. Rs. 50,000)
(d) Medical Treatment on Serious diseases 0 0
U/S 80-DD B (Max. Rs. 40,000)

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(e) Person with Disability U/S 80-U (Max. Rs. 50,000) 0 0


(f) U/s 80E Education Loan & It's InterestMac. Rs. 40000 0 0
(g) Others [ if any Bond or Debencher ] 0 0
(h) Others [ if any Bond or Debencher ] 0 0
7 Total ( a to h ) 0
8 Gross Total Income ( 5 - 7 ) 272575

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9 Less : Deduction U/S 80 C [ Max. Rs. 1,00,000/- Gross Qualifying


(a) GPF Contribution 92300 92300
(b) Group Insurance Scheme / CGEIS 1200 1200
(c) Public Provident Fund [ PPF ] 0 0
(d) LIC Premium 0 0
(e) PLI Premium 0 0
(f) Deposit in 10 Year, 15 Years Account Under the Post 0 0
Office Saving Band (CTD)

(g) NSC Purchase 0 0


(h) NSC Interest re-invested 0 0
(i) ULIP 0 0
(j) Equity link Saving fund [ Max. Rs. 15,000/- ] 0 0
(k) Investment in pension fund 0 0
(l) HBA Repayment of Principal 0 0
(m) Education Expenses [ Tuition Frees Only] [up to 2 17000 17000
children]
(n) Investment Share/Debenture in infrast. Power & 0 0
communication Co Safety Bonds ICICI and IDBI Bonds
(o) Jivan Suraksha premium u/s 80-ccc [Max.Rs.10,000] 0 0
10 Total ( a to o ) Qua. Amt. Max. Rs. 1,00,000/- 110500 100000 100000
11 Net Taxable Total Income [ 8 - 10 ] 172575
12 Net Taxable Total Income rounded to the nearest Multiple of ten Rupees 172580
13 Income Tax Payable on Total Income Calculation of Income Tax on 1258
Male Tax Payee Female Tax Payee
Income Tax up to Tax Income Tax up to Tax
Rs. 1,60,000 Nil 0 Rs. 1,90,000 Nil 0
160000 160000 0 0
Rs. 1,60,001 to Rs. 3,00,000 10% 1258 Rs. 1,90,001 to Rs. 3,00,000 10% 0
12580 12580 0 0
Rs. 3,00,000 to Rs. 5,00,000 20% 0 Rs. 3,00,000 to Rs. 5,00,000 20% 0
-127420 0 0 0
Above Rs. 5,00,000 30% 0 Above Rs. 5,00,000 30% 0
0 0 1258 0 0 0
14 Surcharge thereon if Total Income is above Rs 10,00,000 [Sr.No. 13] 13 0
15 Education Cess 3% on Payable Income Tax Amount 38
16 Total Tax Payable [ 13+14+15 ] 1296
17 Tax Paid up to November 2009 0
Tax to be deducted in December
2009 0
Tax to be deducted in January 2010 0
Tax to be deducted in February2010 1296
Other Any Tax to be deducted 0
18 Total Tax 1296
19 Tax Payable / Refundable [ 16 - 18 ] 0

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Signature
Name SHRI K J PATEL Add. Director Animal Husamadry
Designation SENIOR CLERK Dangs District Panchayat
AHWA
Place
Place: : . AHWA
Date
Date: : . 3/6/2010 Note : Please quote PAN No. Positively

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Name Shri K J Patel Desi SENIOR CLERK


Pay Scale 5000-175-8000 9300-34800(PB2) 4200 Inc_Date July-2009
Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 G_Total
PAY 5900 5900 11790 11790 12270 12270 12270 12270 12270 12270 12270 12270 133540
F.P. 0 0 0 0 0 0 0 0 0 0 0 0
D.P.PAY / Grade Pay 2950 2950 4200 4200 4200 4200 4200 4200 4200 4200 4200 4200 47900
NPA 0 0 0 0 0 0 0 0 0 0 0 0 0
DA. 4160 4160 2558 3518 3623 3623 3623 4447 4447 4447 4447 4447 47500
H.R.A. 0 0 0 0 0 0 0 0 0 0 0 0 0
MEDICAL 100 100 100 100 100 100 100 100 100 100 100 100 1200
P.T.A. 0 0 0 0 0 0 0 0 0 0 0 0 0
T.A. 75 75 200 200 200 200 200 200 200 200 200 200 2150
DANG.ALLO / C.L.A. 281 281 281 281 281 281 281 281 281 281 281 281 3372
WASHING 0 0 0 0 0 0 0 0 0 0 0 0 0
OTHER 0
TOTAL 13466 13466 19129 20089 20674 20674 20674 21498 21498 21498 21498 21498 235662
0
FESTIVL 250 250 0 0 0 0 0 0 0 0 0 0 500
FOOD GRAIN 0 0 0 0 0 0 0 0 0 0 0 0 0
MOTAR CYCLE ADV 500 770 500 500 500 500 500 500 500 500 500 500 6270
H.B.A.LOAN 0 0 0 0 0 0 0 0 0 0 0 0 0
M.CYCLE INT 0 0 0 0 0 0 0 0 0 0 0 0 0
H.B.A.INT 0 0 0 0 0 0 0 0 0 0 0 0 0
H. R. A. 0 0 0 0 0 0 0 0 0 0 0 0 0
SOCAYATI 2692 2693 2675 2767 2867 2858 2850 2842 2833 2825 3400 3390 34692
G.P.F. 3000 3000 3000 3000 4000 4000 4000 4000 4000 4000 4000 4000 44000
G.P.F.ADV 0 0 0 2500 2500 2500 2500 2500 12500
GPF DA 959 988 988 988 1812 1812 1812 1812 1812 12983
PRO.TAX 200 200 200 200 200 200 200 200 200 200 200 200 2400
GROUP INSURANCE 100 100 100 100 100 100 100 100 100 100 100 100 1200
C.T.D / PLI 0 0 0 0 0 0 0 0 0 0 0 0 0
L.I.C 0 0 0 0 0 0 0 0 0 0 0 0 0
Income Tax 0 0 0 0 0 0 0 0 0 0 0 0 0
Other Deduction 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL 6742 7013 6475 7526 8655 8646 8638 11954 11945 11937 12512 12502 114545
Net Pay 6724 6453 12654 12563 12019 12028 12036 9544 9553 9561 8986 8996 121117
BONUS 0 0 0 0 0 0 0 0 0 0 0 0 0
D.A.DIFF. 0 0 0 0 0 0 0 0 0 0 0 0
V.No. Date 120 - 15 / 4 / 07 1159-1-7-09 120 - 15 / 4 / 08 120 - 15 / 4 / 07 120 - 15 / 4 / 07 120 - 15 / 4 / 07 120 - 15 / 4 / 07 1159-1-7-09 120 - 15 / 4 / 07 120 - 15 / 4 / 07 120 - 15 / 4 / 07 120 - 15 / 4 / 07

D.A.DIFF. 0 0 0 0 0 0 0 0 0 0 0 0 0
V.No. Date 120 - 15 / 4 / 07 120 - 15 / 4 / 07 120 - 15 / 4 / 07 120 - 15 / 4 / 07 120 - 15 / 4 / 07 120 - 15 / 4 / 07 120 - 15 / 4 / 07 120 - 15 / 4 / 07 120 - 15 / 4 / 07 120 - 15 / 4 / 07 120 - 15 / 4 / 07 120 - 15 / 4 / 07

Pay DIFF. 0 5663 0 0 0 0 0 0 0 0 0 0 5663


V.No. Date 120 - 15 / 4 / 07 120 - 15 / 4 / 07 120 - 15 / 4 / 07 120 - 15 / 4 / 07 120 - 15 / 4 / 07 120 - 15 / 4 / 07 120 - 15 / 4 / 07 120 - 15 / 4 / 07 120 - 15 / 4 / 07 120 - 15 / 4 / 07 120 - 15 / 4 / 07 120 - 15 / 4 / 07

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FORM NO. 16
[ See third proviso to rule 12(1)(b) and rule 31(1)(a)]
Certificate Under section 203 of the Income-tax Act, 1961 for deducted at source
from income chargeable under the head " Salaries "

Name and Address of the Employer Name and Designation of the Employee

Add. Director Animal Husamadry KIRITCHANDRA JAYANTILAL PATEL

Ahwa Senior Clerk

PAN No. of the Deductor TAN No. of the Deductor PAN/GIR No.

xxxxxx x BRDROO841B ACFPP3047F

Acknowledgement Nos. of all quarterly statement of Period Assessment Year


TDS under sub-section [3] of section 200 as provided
by TIN Facilitation Centre of NSDL web-site

Quarter Acknowledgement No. From To


1ST QUARTER 0 4/1/2009 6/30/2009
2010 2011
2ND QUARTER 0 7/1/2009 9/30/2009
3RE QUARTER 0 10/1/2009 12/31/2009
4TH QUARTER 0 1/1/2010 3/31/2010

DETAILS OF SALARY PAID AND ANY OTHER INCOME AND TAX DEDUCTED

1. Gross Salary
(a) Salary as per provisions contained
in section 17(1) Rs. 277125
(b) Value of perquisites under section
17(2) (as per Form No. 12BA,
wherever applicable) Rs. 0
(c) Profits in lieu of salary under section
17(3) (as per Form No. 12BA, 0
wherever applicable) Rs.

(d) Total Rs. 277125


2. Less: Allowance to the extent exempt under
section 10 P. T. A. Rs. 0
Washing All. Rs. 0
Deduction Less House rent allowance exempt U/s 10 Rs. 0
Transportation Allow. U/s 10 Rs. 2150
[Pl specify] xxxx Rs. 0 Rs. 2150
3. Balance (1-2) Rs. 274975
4. Deductions under section 16.
(a) Standard deduction Rs. 0
(b) Entertainment allowance Rs. 0
(c) Tax on Employment Rs. 2400
(d) Interest payable on loan U/s 24 Rs. 0
5. Aggregate of 4 (a) to (c) 2400 Rs. 2400
6. Income chargeable under the head 'Salaries' 701 Rs. 272575
7. Add. Any other Income reported by the employee
Employee
Family pension Rs. 0

Interest Rs. 0
[c] Total of [a]+[b] above Rs. 0
8. Gross Total Income (6+7] 746 Rs. 272575

9. Deduction under Chapter VI-A

[a] section 80 CCC Rs. 0 235 Rs. 0


[b] section 80 CCD Rs. 0 0
section 80 D + 80DD + 80DDB Rs. 0 0 0 0 236 Rs. 0
[c] section 80 E Rs. 0 239 Rs. 0
[d] section 80 G Rs. 0 242 Rs. 0
[e] Section 80 GG / Section 80 GGA Rs. 0 260 Rs. 0
[f] section 80QQB Rs. 275 Rs. 0
[g] section 80RRB Rs. 0 282 Rs. 0
[h] Others [ if any Bond or Debencher ]U/S 80-U Rs. 0 0 0 0 Rs. 0
10. Aggregate of deductible amounts under Chapter VI-A 747 Rs. 100000
11. Total Income [8-10] 760 Rs. 172580
12. Tax on Total Income 810 Rs. 1258
Conti.. Page no. 2

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Page No. 2

13 Rebate Under Chapter VIII [Under section 88C]

GROSS DEDUCTIBLE
I. Under section 88 Gross Amount [ease specify] AMOUNT AMOUNT

(a) GPF Contribution Rs. 92300 Rs. 92300


(b) Group Insurance Scheme / CGEIS Rs. 1200 Rs. 1200
(c) Public Provident Fund [ PPF ] Rs. 0 Rs. 0
(d) LIC Premium Rs. 0 Rs. 0
(e) PLI Premium Rs. 0 Rs. 0

Rs. (CTD)
(f) Deposit in 10 Year, 15 Years Account Under the Post Office Saving Band 0 Rs. 0
(g) NSC Purchase Rs. 0 Rs. 0
(h) NSC Interest re-invested Rs. 0 Rs. 0
(i) ULIP Rs. 0 Rs. 0
(j) Equity link Saving fund [ Max. Rs. 15,000/- ] Rs. 0 Rs. 0
(k) Investment in pension fund Rs. 0 Rs. 0
(l) HBA Repayment of Principal Rs. 0 Rs. 0
(m) Education Expenses [ Tuition Frees Only] [up to 2 children] Rs. 17000 Rs. 17000

Rs. Bonds ICICI and


(n) Investment Share/Debenture in infrast. Power & communication Co Safety 0 IDBI Bonds Rs. 0
(o) Jivan Suraksha premium u/s 80-ccc [Max.Rs.10,000] Rs. 0 Rs. 0

[p] Total ( a to o ) Qua. Amt. Max. Rs. 1,00,000/- Rs. 110500

II. [a] Under section 88B Rs.

[b] Under section 88C Rs.

14 Aggregate of tax rebates at 13 above [ I [0] + II [a] + II [b] ### Rs. 100000

15. Surcharge(on tax computed at S.No. 12) Rs. 820 0


15. Education Cess @ 2% on (tax at S.No.12 ) 25
15. Secondary and Higher Education Cess @ 1% on (tax at S.No.12 ) 13
15. Tax payable on total income [12 - 14] and 832 1296
16. Relief under section 89 [attach details] 837 0
17. Tax payable [15 - 16] 841 1296
18. Less :

[a] Tax deducted at source under section 192[1] 868 1296


[b] Tax paid by the employer on behalf of the 872 0 873 1296
employee under section 192[1A] on

perquisites under section 17[2]

19. Tax payable / refundable [ 17- 18 ] 891 0

DETAILS OF TAX DEDUCTED AND DEPOSITED INTO CENTRAL GOVERNMENT ACCOUNT

S,NO TDS Surcharge Education Total Tax Cheque/DD No. BRS Code of Date on Transfer voucher
Rs. Rs. Cess deposited (if any) Bank which challan
Rs. Rs. branch tax Identification No.
deposit
1 ed
(dd/mm
2
/yy)
3
4
5
6
7
8
9
10
11
12
13

I DEVENDRABHAI RAYUBHAI MAHLA Son of RAYUBHAI MAHLA


working in the capacity of A D H A DP DANGS ( designation) do hereby certify that a sum of Rupees
Rs. ( 0000 ) [in words] 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 base on the books of account, documents and other available records.
Place : Ahwa
Date : 4/1/2008
Signature of the person responsible
for deduction of tax
Full Name DEVENDRABHAI RAYUBHAI MAHLA
Designation Add. Director Animal Husamadry
Dangs District Panchayat
Ahwa

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Page No. 3 1258


38

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Click here for Back to Main Menu Please fill Manually only in BLUE colour
Page set 8.00 x 13.50 Size ( Portrait ) for Print
Important : Please See notes overleaf before filling up the challan Single Copy (to be sent to the ZAO)

Tax Applicable ( Tick One)* Assessment


CHALLAN (0020) INCOME-TAX ON COMPANIES Year
NO
(Corporation Tax)
ITNS
(0021) INCOME - TAX 2 0 1 0 - 1 1
280
(Other Than COMPANIES)
Permanent Account Number
A C F P P 3 0 4 7 F
Full Name
K I R I T C H A N D R A J A Y A N T I L A L P A T E L
Complete Address With City & State
8 / 1 1 1 , V A R I O U S C O L O N Y , S U N S E T P O I N T R
O A D , N E A R S B I S , A HW A - D A N G S , G U J A R A T
Tel. No. 0 2 6 3 1 2 0 0 0 0 5 Pin 3 9 4 7 1 0
Type Of Payment (Tick One)
Advance Tax (100) Surtax (102)
Self Assessment Tax (300) Tax on Distributed of Domestic Companies (106)
Tax on Regular Assessment (400) Tax on Distributed income to Unit Holder (107)

DETAIL OF PAYMENTS Amount (in Rs. Only)


Income Tax 1 2 5 8 FOR USE IN RECEIVING BANK
Surcharge 0 Debit to A/c Cheque Credited on

Education Cess 3 8 2 5 / 1 2 / 2 0 0 8
Interest D D M M Y Y Y Y
Penalty SPACE FOR BANK SEAL
Others
Total 1 2 9 6
Total (in words)
CRORES LACS THOUSANDS HUNDREDS TENS UNITS
1 2 9 6
Paid in cash/Debit to A/c/Cheque No. Dated 25/12/2008

Drawn on
(Name of the Bank And Branch)

Date : Signature of person making payment RS

Taxpayers Counterfoil (to be filled up by tax payer) SPACE FOR BANK SEAL
PAN A C F P P 3 0 4 7 F
Received From Kiritchandra Jayantilal Patel
Cash/Debit to A/c/Cheque No. For Rs.
Rs.(in words) #VALUE!
Drawn on
(Name of the Bank And Branch)

on account of Companies / Other than Companies Tax


income tax on (Strike out whichever is not applicable)

Type of Payment (To be filled up by person making the payment)

for the Assessment Year 2 0 1 0 - 2 0 1 1

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Government of India

INCOME-TAX DEPARTMENT
ACKNOWLEDGEMENT

Received with thanks from


return of income and/or return of fringe benefits in Form No. ITR - I for assessment year
2010 2011 having the following particulars.
PERSONAL INFORMATION

Name PAN
KIRITCHANDRA JAYANTILAL PATEL A C F P P 3 0 4 7 F
Flat/Door/Block No. Name Of Premises/Building/Village
8/111 Various Colony
Road/Street/Post Office Area /Locality
Sunset Point Road Near SBI Staff Qtr
Town/City/District State
Ahwa-Dangs GUJARAT
1 Gross Total income 1 272575
2 Deductions under Chapter - VI-A 2 100000
3 Total Income 3 172580
COMMUTATION OF INCOME

4 Net tax payable 4 1296


5 Interest payable 5 0
AND TAX THEREON

6 Total tax and interest payable 6 0


7 Taxes paid
a advance Tax 7a 0
b TDS 7b 0
c TCS 7c 0
d self assessment Tax 7d 0
e Total Taxes Paid (7a + 7b +7c + 7d) 7e 0
8 Tax Payable (6 - 7d) 8 0
9 Refund (7e - 6) 9 0
10 Value of fringe Benefits 10 0
BENEFITS AND TAX THEREON

11 Total Fringe benefit tax liability 11 0


COMPUTATION OF FRINGE

12 Total interest payable 12 0


13 Total tax and interest payable 13 0
14 Taxes paid
a advance Tax
b self assessment Tax
c Total Taxes Paid (14a + 14b) 14c 0
15 Tax Payable (13 - 14c) 15 0
16 Refund (14c - 13) 16 0
Receipt No. Seal and Signature of receiving official

Date :

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INDIAN INCOME TAX RETURN


[For Individuals having Income from Salary / Pension / family pension) & Interest] Assessment Year
FROM
( Please see Rule 12 of the Income-tax Rules, 1962)
ITR-1 ( Also see attached instruction ) 2 0 1 0 - 1 1

First Name Middle Name Last Name PAN


PERSONAL INFORMATION

K I R I T C H A N D R A J A Y A N T I L A L P A T E L A C F P P 3 0 4 7 F

Flat/Door/Block No Name Of Premises/Building/Village Date of Birth [ DD/MM/YYYY]


8/111 Various Colony 2 9 / 0 1 / 1 9 6 1

Road/Street/Post Office Area / Locality Employer Category(Tick) √


Sunset Point Road Near SBI Staff Qtr Govt PSU Other

Town/City/District State Pin code Sex (Tick) √


Ahwa-Dangs GUJARAT 3 9 4 7 1 0 √ Male Female

Email Address mrkiritpatel@gmail.com (STD Code)- Phone Number 02631 220829

Designation of Assessing Officer (Ward/Circle) Valsad Return filed under Section -


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

Whether original or Revised return ? √ Original Revised

If revise, enter Receipt No and Date of filing original


return (DD/ MM/ YYYY )

Residential Status √ Resident Non - Resident Resident but Not Ordinarily Resident

1 Income chargeable under the Head 'Salaries'(Salary/Pension) 1 272575

2 Income Chargeable under the Head 'Other Sources'

a Family Pension 2a 0

b Interest 2b 0

c Total ( 2a + 2b ) 2c 0

3 Gross Total Income ( 1 + 2c ) 3 272575


FILING STATUS

4 Deductions under chapter VI A (Section)

a 80 C 110500 e 80 DD 0 i 80 GG 0

b 80 CCC 0 f 80 DDB 0 j 80 GGA 0

c 80 CCD 0 g 80 E 0 k 80 GGC 0

d 80 D 0 h 80 G 0 l 80 U 0

m Deduction ( Total a to l ) 4m 100000

5 Total Income ( 3 - 4m) 5 172575

6 Net Agricultural Income ( Enter only if greater than Rs. 5,000) 6 0

7 Aggregate Income' (5+6) 7 172575

8 a Tax Payable on 'Aggregate Income' 8a 1258

b Rebate in respect of Net Agricultural income 8a 0

9 a Tax Payable on Total Income ( 8a - 8b ) 9a 1258


FILING STATUS

b surcharge on 9a 9b 0

c Education Cess on (9a+9b)and H S Edu. Cess on (9a+9b) 9c 38

d Total Tax, Surcharge & Education Cess and H S Edu. Cess Payable (9a+9b+9c) 9d 1296

10 Relief under Section 89 10 0

11 Relief under section 90 / 91 11 0

12 Balance Tax Payable ( 9d - 10 - 11 ) 12 1296

Do not write or stamp in this area ( Space for bar code) 13 a Interest Payable U/s 234A 13a 0

b Interest Payable U/s 234B 13b 0

c Interest Payable U/s 234C 13c 0

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Total Interest Payable


d 13d 0
(13a+13b+13c)

Total Tax and Interest Payable


14 14 1296
(12 + 13d)

For Office Use Only Seal and Signature of receiving Official

Receipt No

Date

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15 Tax paid

a Advance Tax (from item 23) 9b 0


TAXES PAID

b TDS (column 7 of item 21 +column 7 of item 22) 9c 1296

c Self Assessment Tax (from item 23) 9c 0

d Total Taxes Paid ( 15a + 15b + 15c ) 15d 1296

16 Tax Payable ( 14 - 15d ) (Ender if 14 is greater than 15d, else leave bank) 16 1296

17 Refund (15d - 14) (Ender if 15d greater than 14, also give Bank Account details below) 17 0
REFUND

18 Enter your Bank accounts number ( mandatory in case of refund ) 1 0 9 3 6 1 6 7 6 5 5

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 ( trick as applicable √ ) √ Saving Current

21 Details of Tax Deducted at Source on Interest [As per From 16 issued by Deductor (s)]

sr Tax Deduction Account Name and address of the Income Deduction Tax payable Total tax Tax
. Number (TAN) of the Employment chargeable under Chapter (incl.surch.and deposited
Employer under the VI-A edn.cess)
no head Salaries
TDS ON SALARY

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


A D D . D I R E C
i 272575 100000 1296 1296 0
B R D R O O 8 4 1 B T O R A N I M A L
H U S A M A D R Y
ii

iii

22 Details of Tax Deducted at Source on Interest [As per From 16 A issued by Deductor (s)]

Tax Deduction Accent Name and address of the Amount paid Date of Payment Total tax A mount out of
sr Number (TAN) of the Deductor /Credited /Credit deposited (6) Claimed for
. Deductor this year
no
TDSNO INTEREST

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

ii

iii

Note Enter the total of column (7) of 21 and columm (7) of 22 in sl No. 15b of TAXES PAID

23 Details of Advance Tax and self Assessment Tax Payments


sr
Name of Bank & Branch BSR Code Date of Deposit Serial Number of Amount (Rs)
. Challan
n (DD/MM/YYY)
TDSNO INTEREST

o
i
ii
iii
iv
v
Note Enter the total of column (7) of 21 and columm (7) of 22 in sl No. 15b of TAXES PAID

24 Other Information (transactions reported through Annual Information Return) (Please see instruction number-9(ii) for code)

Amount(Rs) Amount(Rs) Amount(Rs)


SL Code SL Code SL Code

a 001 d 004 g 007


b 002 e 005 h 008
c 003 f 006

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### Tax-exempt interest income ( for reporting purpose only ) 25

26 E-Filling Acknowledgement Number Date(DD/MM/YYYY)

I KIRITCHANDRA JAYANTILAL PATEL Son of JAYANTILAL RATILAL PATEL 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 Year 2008 - 09.

Place : Ahwa Date : 3/6/2010 Sign here →

27 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 form the Government, amount thereof ( to be filled by TRP ) 28

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Government of India

INCOME-TAX DEPARTMENT
ACKNOWLEDGEMENT
1 2 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41
3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

Received with thanks from KIRITCHANDRA JAYANTILAL PATEL


return of income and/or return of fringe benefits in Form No. ITR - 2 for assessment year 2010-11,
having the following particulars.
Name PAN
PERSONAL INFORMATION

KIRITCHANDRA JAYANTILAL PATEL A C F P P 3 0 4 7 F


Flat/Door/Block No. Name Of Premises/Building/Village
8/111 Various Colony
Road/Street/Post Office Area /Locality
Sunset Point Road Near SBI Staff Qtr
Town/City/District State
Ahwa-Dangs GUJARAT

1 Gross Total income 1 0


2 Deductions under Chapter - VI-A 2 0
3 Total Income 3 0
4 Net tax payable 4 0
COMUTATION OF INCOME

5 Interest payable 5 0
AND TAX THEREON

6 Total tax and interest payable 6 0


7 Taxes paid
a advance Tax 7a 0
b TDS 7b 0
c TCS 7c 0
d self assessment Tax 7d 0
e Total Taxes Paid (7a + 7b +7c + 7d) 7e 0
8 Tax Payable (6 - 7e) 8 0
9 Refund (7e - 6) 9 0
10 Value of fringe Benefits 10 0
11 Total Fringe benifit tax liability 11 0
BENEFITS AND TAX THEREON
COMPUTATION OF FRINGE

12 Total interest payable 12 0


13 Total tax and interest payable 13 0
14 Taxes paid
a advance Tax 14a 0
b self assessment Tax 14b 0
c Total Taxes Paid (14a + 14b) 14c 0
15 Tax Payable (13 - 14c) 15 0

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BENEF
COM
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16 Refund (14c - 13) 16 0


Seal and Signature of receiving official
Receipt No.

Date :

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INDIAN INCOME TAX RETURN


FORM

Assessment Year
[For Individuals and HUFs not having Income from Business or Profession]
ITR-2 (Please see Rule 12 of the Income Tax-Rules,1962)
2 0 1 0 - 1 1
(Also see attached Instructions)

Part A - GEN GENERAL


First Name Middle Name Last Name PAN
KIRITCHANDRA JAYANTILAL PATEL A C F P P 3 0 4 7 F
PERSONAL INFORMATION

Flat / Door / Block No Name of Premises / Building / Village Status (Tick) √


8/111 Various Colony P Individual Huf
Road / Street / Post Office Area / Locality Date of birth (DD/MM/YYYY)
Sunset Point Road Near SBI Staff Qtr 2 9 / 0 1 / 1 9 6 1
Town/City/District State Pin Code Sex (Select) √
Ahwa-Dangs GUJARAT 3 9 4 7 1 0 0Male 0 Female
Email id (Std code) Phone No Employer Category(Tick) √
()- 0 P Govt PSU Other

Designation of Assessing Officer 0 Return filed under section


(Ward / Circle) [Pl see instruction no 9(i)]

Whether original or revised return? O-Original Revised


If revised, enter Receipt no and Date of filing Date (DD/MM/YYYY)
FILING STATUS

original return (DD/MM/YYYY)

Residential Status (Tick)√ Resident Non-Resident Resident but not Ordinarily Resident

Whether this return is being filed by a representative assessee? (Tick)


√ Yes No
If yes, please furnish following information
a Name of the representative
b Address of the representative
c Permanent Account Number (PAN) of the representative

PART- B
Part B - TI Computation of total income
1 Salaries (6 of Schedule S) 1 0

2 Income from house property (3C of Schedule-HP) (enter nil if loss) 2 0

3 Capital gains
TOTAL INCOME

a Short term

i Short-term (under section 111A) (A5 of Schedule3ai


- CG) 0

ii Short-term (others) (A6 of Schedule-CG) 3aii 0

iii Total short-term (3ai + 3aii)(enter nil if loss)


3aiii 0

b Long-term (B5 of Schedule-CG) 3b 0

c Total capital gains (3aiii + 3b) 3c 0


Do not write or stamp in this area (Space for bar code) For Office Use Only

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Receipt No

Date :

Seal and Signature of receiving official

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4 Income from other sources


a from sources other than from owning race horses (3 of Schedule OS) 4a 0
b from owning race horses (4c of Schedule OS) 4b 0
c Total (a + b) 4c 0
5 Total (1 + 2 + 3 c+ 4c) 5 0
6 Losses of current year set off against 5 (total of 2vi and 3vi of Schedule CYLA)
6 0
7 Balance after set off current year losses (5-6) (also total of column 4 of Schedule
7 CYLA) 0
8 Brought forward losses set off against 7 (2vi of Schedule BFLA) 8 0
9 Gross Total income (7-8) (also 3vii of Schedule BFLA) 9 0
10 Deductions under Chapter VI-A (n of Schedule VIA) 10 0
11 Total income (9 - 10) 11 0
12 Net agricultural income/ any other income for rate purpose (4 of Schedule EI)
12 0
13 ‘Aggregate income’ (11 + 12) 13 0
14 Losses of current year to be carried forward (total of xi of Schedule CFL) 14 0

Part B - TTI Computation of tax liability on total income


1 Tax payable on total income
a Tax at normal rates 1a 0
b Tax at special rates (11 of Schedule-SI) 1b 0
c Tax Payable on Total Income (1a + 1b) 1c 0
COMPUTATION OF TAX LIABILITY

2 Surcharge on 1c 2 0
3 Education Cess on (1c +2) 3 0
4 Gross tax liability (1c+ 2 + 3) 4 0
5 Tax relief
a Section 89 5a 0
b Section 90 5b 0
c Section 91 5c 0
d Total (5a + 5b + 5c) 5d 0
6 Net tax liability (4 – 5d) 6 0
7 Interest payable
a For default in furnishing the return (section 234A)7a 0
b For default in payment of advance tax (section 234B)
7b 0
c For deferment of advance tax (section 234C) 7c 0
d Total Interest Payable (7a+7b+7c) 7d 0
8 Aggregate liability (6 + 7d) 8 0
9 Taxes Paid
a Advance Tax (from Schedule-IT) 9a 0
TAXES PAID

b TDS (total of column 7 of Schedule-TDS1 and column


9b 7
0
of Schedule-TDS2)
c Self Assessment Tax (from Schedule-IT) 9c 0
d Total Taxes Paid (9a+9b+9c) 9d 0
10 Amount payable (Enter if 8 is greater than 9d, else enter 0) 10 0
11 Refund (If 9d is greater than 8, also give Bank Account details below) 11 0
12 Enter your bank account number (mandatory in case of refund)
REFUND

13 Do you want refund by Cheque or P deposited directly into your bank account
(tick as
? applicable) √
14 In case
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Page account
26 of 31 give additional details

MICR Code Type of Account (Select)√ P Saving Current


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DANGS DISTRICT PANCHAYAT, AHWA


Self Assessment Income Tax Calculation Memo for the Accounting Year 2010 2011
Calculation_Prapose And Assessment Year 2011 2012
Name : KIRITCHANDRA JAYANTILAL PATEL
Designation SENIOR CLERK
Residential Address : 8/111,Various Colony ,Sunset Point Road,Near SBI Staff Qtr,Ahwa-Dangs,GUJARAT

PAN NO. ACFPP3047F PSN NO. xxxxxx


No. Particular Rs.
1 Income
[a] Gross Salary Income (Statement enclose] 277125 277125
PAY+DA+D.PAY+HRA+CLA+MA+TA and Other Allowance

[b] Honorarium 0
[c] Bonus 0
[d] Bank Interest 0
[e] NSC Interest 0
[f] House Rent Income 0
[g] Other Sources [ if any ] 0
Total [a] to [g] 277125
2 Less : Deduction Admissible 4550
Deduction Less House rent allowance exempt U/s 10[13A]
(1) a Actual amount of HRA received 0
b 10% of salary [including D.A.] 0
c 50% of salary [including D.A.] 0
HRA Ded. Allowed 0 0
(2) PTA + Washing Allw.U/s 10[14][I] Vide rule 2BB[i] of Rules 0
(3) Transportation Allowance U/S 10(14) 2150
(4) Professional Tax U/S 16(U) 2400
(5) Entertainment allowance 0
3 Balance [1-2] 272575
4 Less : HBA Interest U/S 24(1) (vi)
[i] Up to Rs. 30,000/- can taken before Dt.1/4/99 0 0
[ii] Up to Rs. 1,50,000/- can taken after Dt.1/4/99
5 Total Income (3-4) 272575
6 Deduction : Under Chapter VI-A Gross Qualifying
(a) Med. claim u/s 80-d [Max. Rs. 15,000/-] 0 0
(b) Donation U/S 80-G 0 0
(c) Medical Treatment of Handicapped Dependents 0 0
U/S 80-DD (Max. Rs. 50,000)
(d) Medical Treatment on Serious diseases 0 0
U/S 80-DD B (Max. Rs. 40,000)

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(e) Person with Disability U/S 80-U (Max. Rs. 50,000) 0 0


(f) Others [ if any Bond or Debencher ] 0 0
(g) Others [ if any Bond or Debencher ] 0 0
7 Total ( a to g ) 0
8 Gross Total Income ( 5 - 7 ) 272575

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9 Less : Deduction U/S 80 C [ Max. Rs. 1,00,000/- Gross Qualifying


(a) GPF Contribution 92300 92300
(b) Group Insurance Scheme / CGEIS 1200 1200
(c) Public Provident Fund [ PPF ] 0 0
(d) LIC Premium 0 0
(e) PLI Premium 0 0
(f) Deposit in 10 Year, 15 Years Account Under the Post 0 0
Office Saving Band (CTD)

(g) NSC Purchase 0 0


(h) NSC Interest re-invested 0 0
(i) ULIP 0 0
(j) Equity link Saving fund [ Max. Rs. 15,000/- ] 0 0
(k) Investment in pension fund 0 0
(l) HBA Repayment of Principal 0 0
(m) Education Expenses [ Tuition Frees Only] [upto 2 17000 17000
children]
(n) Investment Share/Debenture in infrast. Power & 0 0
communication Co Safety Bonds ICICI and IDBI Bonds
(o) Jivan Suraksha premium u/s 80-ccc [Max.Rs.10,000] 0 0
10 Total ( a to o ) Qua. Amt. Max. Rs. 1,00,000/- 110500 110500 110500
11 Net Taxable Total Income [ 8 - 10 ] 162075
12 Net Taxable Total Income rounded to the nearest Multiple of ten Rupees 162080
13 Income Tax Payable on Total Income Calculation of Income Tax on 208
Male Tax Payee Female Tax Payee
Income Tax up to Tax Income Tax up to Tax
Rs. 1,60,000 Nil 0 Rs. 1,90,000 Nil 0
160000 160000 0 0
Rs. 1,60,001 to Rs. 5,00,000 10% 208 Rs. 1,90,001 to Rs. 5,00,000 10% 0
2080 2080 0 0
Rs. 5,00,001 to Rs. 8,00,000 20% 0 Rs. 5,00,001 to Rs. 8,00,000 20% 0
-337920 0 0 0
Above Rs. 8,00,000 30% 0 Above Rs. 8,00,000 30% 0
0 0 208 0 0 0
14 Surcharge thereon if Total Income is above Rs 10,00,000 [Sr.No. 13] 2 0
15 Education Cess 3% on Payable Income Tax Amount 6
16 Total Tax Payable [ 13+14+15 ] 214
17 Tax Paid up to November 2010 0
2010
Tax to be deducted in December 0
Tax to be deducted in January 2011 0
Tax to be deducted in February 2011 1296
Other Any Tax to be deducted 0
18 Total Tax 1296
19 Tax Payable / Refundable [ 15 - 17 ] Refundable -1082

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Signature
Name SHRI K J PATEL Add. Director Animal Husamadry
Designation SENIOR CLERK Dangs District Panchayat
AHWA
Place
Place: : . AHWA
Date
Date: : . 3/6/2010 Note : Please quote PAN No. Positively

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