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gvwmK g~ 20,100/-
wPwKrmvf vZv 700/-

wZwb mi Kvi x

2013-2014 Rbve wj qvKZ



g~ ,100/- 12 gvm) = 2,41,200/-

2,41,200/-
Ki `vq cwi MYbvt
c_g 2,20,000 UvKvch k~ bnvi
Aewk 21,200 UvKvch 2,120/-
2,120/-

Ki `vZvi Ki gy mxgvi AwZwi Avq _vKvq Ges Ki `vZvXvKvq wmwU
bZg Ki 3,000/- UvKv


50,000/- UvKv| GKRb gwnj vKgKZvev
2,41,200/-


(L) 2013-2014 Rbve AvgRv`

(K) gvwmK g~ = 22,000/- UvKv
(L) ,000 2) = 44,000/- UvKv
14

(M) wPwKrmvf vZv = 700/- UvKv
(N) wk vmnvqK f vZv = 300/- UvKv
(O) evoxf vovf vZv = 11,000/- UvKv


i 2013-14 Ki e Avq I Ki `vq cwi MYbv

(K)
(22,000 12) = 2,64,000/-
= 2,64,000/-

Rbve i 2,64,000/-


Ki nvi
cwi gvY
c_g 2,20,000/- UvKvch
---
k~b k~b
Aewk 44,000/- - 10% 4,400/-
4,400/-

4,400/-


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5,000/- UvKv|
- - UvKv
- UvKv
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5,40,000/-



1,35,000/-
(16,000/- 3/4)* 12,000/-
3| f ~ wg i vR^(500/- 3/4)* 375/-
(20,000/-
3/4)*
15,000/-
*^wbevm- 1/4 Ask, fvovq eeZ-3/4 Ask
1,62,375/-
c 3,77,625/-

3,77,625/-


Avq Ki nvi
cwi gvY
c_g 2,20,000/- UvKvch
---
k~b k~ b
Aewk 1,57,625/- - 10% 15,763/-
15,763/-

15,763/-

17



4| t


g~j 800/-


2 GKi 45 gY evRvi g~j 800/- =72,000/- UvKv|
ev`t Drcv`b eq 60% =43,200/- UvKv|
28,800/- UvKv|

-
(K)
(2,20,000 +50,000) =2,70,000 UvKv|
(L)
(2,50,000 +50,000) =3,00,000 UvKv|


(3,00,000 +50,000) =3,50,000 UvKv|

5| t

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3 Zvwi L ch ,00,000/-
j 6,00,000/-
60,000/-
cwi enb Li P Gi mgw 1,00,000/- UvKv| ZvQvovdvwbPvi q eve` eq
40,000/- UvKv|


12,00,000/-
ev`t Li Pmgn
j -------- 6,00,000/-
-------------------
-
60,000/-
Li P Gi mgw --------------------
-----


1,00,000/-

dvwbPvi q eve` eq 40,000/-|
dvwbPvi g~j abxRvZxq Li P weavq
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7,60,000/-
4,40,000/-


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c_g 2,20,000/- UvKvch k~ b k~b
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22,000/-

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Avq 2,20,000/- 3,15,000/- UvKv| 2013-2014
9,500/- UvKv|


Ki

=
9500 95000
315000
=2,865 UvKv|

9,500-2,865 =6,635 UvKv|

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k~ b k~ b
ci eZx50,000/- UvKvch 10% 5,000/-
2,70,000/- 5,000/-


A_vr 5,000/- UvKvi Ki j abx gybvdv
70,000/- UvKv|


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Dci
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3,00,000/- UvKv|
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3,50,000/- 5,000/-

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50,000/- UvKv|

g~
g~

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Ki nvi
cwi gvY
c_g 2,20,000/- UvKvch
k~ b k~ b
ci eZx3,00,000/- UvKv
Aewk 2,80,000/-
Ges
g~j abxAvq 20,000/-
10%
28,000/
-

2,000/-
ci eZx 20,000/- g~j abx
Dci
15% 3,000/-
5,40,000/- 33,000/
-

22

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,000/- UvKv|

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Ki `vZvi Rb AwMg cwi
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UvKv|

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Dci
k~ b k~ b
ci eZx3,00,000/- 10% 30,000/-
ci eZx4,00,000/- 15% 60,000/-
ci eZx2,80,000/- 20% 56,000/-
12,00,000/- 1,46,000/-


nb

Ki nvi
c_g 2,50,000/-
Dci
k~ b k~ b
ci eZx3,00,000/- UvKvch
Dci
10% 30,000/-
ci eZx4,00,000/- 15% 60,000/-
ci eZx2,50,000/- 20% 50,000/-
12,00,000/- 1,40,000/-
24


3,00,000/- UvKv|



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nvi
3,000/-UvKv
2,000/-UvKv
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GKRb Ki `vZvwb
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f wel 0% A_ev1,50,00,000/- UvKv

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-



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-
- UvKv f
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Ki nvi
c_g 2,20,000/- UvKvch
Dci
k~ b k~ b
ci eZx3,00,000/- i Dci -------- 10% 30,000/-
ci eZx4,00,000/- -------- 15% 60,000/-
ci eZx2,80,000/- -------- 20% 56,000/-
c~eeZxKi `vq = 1,46,000/-



`vb
Avq `uvovq (12,00,000-1,00,000) = 11,00,000/- hvi Dci
3
50,00,000/-



0%
A_ev
0,00,000/- UvKv
A_ev

27

5
Avq ( 12,00,000 - 1,00,000)=
11,00,000 30% =3,30,000/- A_ev
50,00,000/- UvKv
A_ev
- UvKv| Gi
3,30,000/-
A_vr 4,00,000/-
3,30,000/-
3,30,000 15%) =49,500/-
UvKv|
(1,46,000-49,500) =96,500/-
UvKv|

(L) ai vhvK, GKRb evsK my`,
c 3-2014
Ki e D LvZmg~ - UvKv|

- UvKv, Kj vY Znwej I
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-
- UvKv
(wWwcGm) cwZ
- GQvovmswk Ki e
5,000/-

Ki `vZvi -
I Ki `vq cwi MY
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Ki nvi cwi gvY
c_g 2,20,000/-
Dci
k~ b k~ b
ci eZx2,80,000/- -------- 10% 28,000/-
c~eeZxKi `vq = 28,000/-

28


12 gvm) = 24,000/-

(50 +40) UvKv 12 gvm = 1,080/-
40,000/-
(N) Rxeb exgvi wcwgqvg c`vb = 3,000/-
(O) wWwcGmG Rgv(500 12) = 6,000/-
(P) = 5,000/-
79,080/-

30% A_ev1,50,00,000/-
79,080/- UvKv -Gi
M

Ki `vZvi 5,00,000/- Gi 30% `uvovq 1,50,000/-
UvKv hv 1,50,00,000/- UvKvi Kg weavq Zv
Ki `vZvi
79,080/- UvKvhvGB
5%
cwi MYbvKi v 15%) =
11,862/- UvKv| Ki `vZvi ci eZx vY
wb t

= 28,000/-UvKv|
ev` = 11,862/- UvKv|
bxU = 16,138/- UvKv|


16,138/- UvKvAvqKi c~


t
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29


-
(1) GKRb Ki `vZvi bxUm` Uvt 1,90,00,000/-
- Uvt 10,00,000/-
Uvt 1,06,000/-
Uvt k~b|
(2) GKRb Ki `vZvi bxUm` Uvt 2,10,00,000/-
Uvt 1,06,000/-
Uvt 10,600/-
(3) GKRb Ki `vZvi bxUm` Uvt 11,00,00,000/-
- Uvt 10,00,000/-
Uvt 1,06,000/-
Uvt 15,900/-
(4) GKRb Ki `vZvi bxUm` Uvt 12,00,00,000/-
- Uvt 10,00,000/-
Uvt 1,06,000/-
Uvt 20,000/-

AvqKi
Uvt 86,000/-
Uvt 75,000/-
Uvt 11,000/-
- UvKvi
15%
Uvt 12,900/-
ew (individual)


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- 2012-13
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Ki 3-2014 Ki
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perquisite

(L)
(M) g~j abxgybvdvi Ask;
(N) MvPzBwUcvw;
(O)
(P)
(Q)
(R) c

(S) wgDPzqvj dv A_ev BDwbU
(dividend) 25,000/- UvKvch;
(T)

(U) evmxi vi v

(V)
(W)
50,000/- UvKvch;
(X)
(ITES) eemvi Avq
(Y) nvum-gyi Mxi Lvgvi
1,50,000/-

(Z) c
g~j abxgybvdv{GmAvi I bs 269-AvBb/AvqKi /2010 Zvwi Lt
01/07/2010};
(_) n
(`)
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32

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Ki gy Avqmg~










1| miKvixKgKZv/KgPvixi Avq Ges Ki cwiMYbv

(K)


-
wPwKrmvf vZv 700/-

-
wQj 25,500/- UvKv| Kj vY Zn
- I 40/-
UvKv|

33

2013-


g - 12 gvm) = 2,40,000/-

2,40,000/-

Ki `vq cwi MYbvt

2,000/-
2,000/-



12) = 24,000/-
12) = 600/-
12) = 480/-
-


(2,40,000/- 30%) = 72,000/-


15%) = 3,762/-
Ki = (-) 1762/-

Ki `vZvi Ki gy mxgvi

Gj vKvq b~bZg Ki 3,000/- UvKv
- - UvKv


- UvKv

(L)
34

ai vhvK, 2013-2014 Ki e

(K) gvwmK g~ = 25,000/- UvKv
(L) 25,000 2) = 50,000/- UvKv
(M) wPwKrmvf vZv = 700/- UvKv
(N) wk vmnvqK f vZv = 300/- UvKv
(O) evoxf vovf vZv = 12,500/- UvKv

Mvoxe 00/-
nq|

GQvovRbve Kwi g Gi -
10,000/-
1,35,000/- - UvKvGes
-


Rbve
(K)
25,000 12) = 3,00,000/-

(L) 50,000/-
(M) 10,000/-
(N)
(A) j f vsk t
j f vsk cvw 1,35,000/- UvKvhvi
-
25,000/- UvKvi AwZwi AsK
j f vsk Avq (1,35,000-25,000) = 1,10,000/-
(Av) evsK my` = 10,000/-
= 30,000/-
35

= 1,50,000/-
= 5,10,000/-

Rbve 00/-


Ki nvi cwi gvY
c_g 2,20,000/-
-
kb kb
Aewk 2,90,000/- - 10% 29,000/-
29,000/-

Rbve Kwi g - UvKv, Kj vY Znwej I
- UvKvGes 40/-
- UvKvi wZb eQi
Ges Rxeb exgvi wcwgqvg eve` evrmwi K 3,000/-
Rb wZwb 15

12 gvm) = 24,000/- UvKv


(50 +40) UvKv 12 gvm= 1,080/- UvKv
= 40,000/- UvKv
(N) Rxeb exgvi wcwgqvg c`vb = 3,000/- UvKv
- UvKv

-
68,080/-


Rbve 5,10,000/- Gi 30% `uvovq
1.53,000/- UvKv hv 1,50,00,000/- UvKvi Kg weavq Zv Ki
- UvKv| GB
36

-
29,000/-UvKv
ev`t %) = 10,212/- UvKv
= 18,788/- UvKv

ev`
(K) evsK my` 10,000/- Gi 10% = 1,000/-
(L) j f vsk 1,35,000/- Gi 10% =13,500/-
14,500/- UvKv
= 4,288/- UvKv

4,288/-


2|

-2014 Ki e

(K) = 19,300/- UvKv
(L) 2) = 38,600/- UvKv
(M) wPwKrmvf vZv = 500/- UvKv
(N) Avcvqb f vZv = 300/- UvKv
(O) evoxf vovf vZv = 7,720/- UvKv
Puv`v = 24,000/- UvKv

GQvov
- -
- UvKv,
- -
2,10,00,000/- UvKv|


37

(K)
g 12) = 2,31,600/-
2) = 38,600/-
wPwKrmvf vZv=(500 12) = 6,000/-
6,000/-
k~b
Avcvqb f vZv=(300 12) = 3,600/-
evoxf vovf vZv=(7,720 12)=92,640/-
ev` Ki gy f vZvt
evwl K 2,40,000/- evg~
(2,31,600 50%=) 1,15,800/- G
1,15,800/-


cv evoxf vovf vZvKi gy mxgvi

k~ b

hvZvqvZ myweavt
= 17,370/-
24,000/-

3,15,170/-


(L) 50,000/-
(M) 10,000/-
(N)
(A) j f vsk t
j f vsk cvw 1,35,000/- UvKvhvi
-
25,000/- UvKvi AwZwi AsK
j f vsk Avq (1,35,000-25,000) = 1,10,000/-
(Av) evsK my` = 10,000/-
38

= 30,000/-
1,50,000/-
= 5,25,170/-

5,25,170/-


Ki nvi
c_g 2,20,000/-
-
k~ b k~ b
ci eZx3,00,000/-
Dci
10% 30,000/-
ci eZx5,170/- 15% 775/-
30,775/-

Rbve -
- UvKvi wZb eQi
Ges Rxeb exgvi wcwgqvg eve` evrmwi K 3,000/-


12 gvm) 2 =48,000/- UvKv
(L) m =40,000/- UvKv
(M) Rxeb exgvi wcwgqvg c`vb = 3,000/- UvKv
91,000/- UvKv

-
91,000/-


Rbve
Avq (5,25,170/- - 24,000,/-)= 5,01,170/- Gi 30% `uvovq
1,50,351/- UvKv hv 1,50,00,000/- UvKvi Kg weavq Zv Ki
,000/- UvKv| GB

39

vZ Ges
-
= 28,117/-UvKv
ev` ,000 UvKvi 15%) = 13,650/- UvKv
= 14,467/- UvKv

2,10,00,000/-

(14,467/- UvKvi 10%) 1,447/-

(14,467/- + 1,447/-) = 15,914/-UvKv


ev`
(K) evsK my` 10,000/- Gi 10% = 1,000/-
(L) j f vsk 1,35,000/- Gi 10% =13,500/-
14,500/- UvKv
= 1,414/- UvKv


3| GKRb GbwRI KgKZvi Avq Ges Ki cwiMYbv
NGO 2-
2013 A_e
= 20,000/- UvKv
gvwmK evoxf vovf vZv = 12,000/- UvKv
gvwmK wPwKrmvf vZv = 1,000/- UvKv

-
1,90,00,000/- UvKv|

40

2013-2014 Ki



- 12) = 2,40,000/-
evoxf vovf vZv(12,000/- 12) =1,44,000/-
ev` Ki AevnwZ cv t
50% = 1,20,000/- A_ev2,40,000/- Gi
= 1,20,000/-
24,000/-

wPwKrmvf vZv(1,000 12) = 12,000/-
= 12,000/-
k~ b


(2,40,000/- 7.5%) = 18,000/-
= 2,82,000/-
= 2,82,000/-

Ki `vq cwi MYbv
c_g 2,50,000/- k~b
ci eZx32,000/- 3200/-
= 3200/-




Ki `vZvi -
3200/-


41

wkKZv



t
30,000/- UvKv
evoxf vovf vZv 12,750/- UvKv
wPwKrmvf vZv 1,000/- UvKv
- `ywUg~

3,000/-


-
30 Ry b, 2013
cwi gvY wQj 2,30,00,000/- UvKv|

2013-
gZt

t
(30,000 12)
3,60,000/-
evoxf vovf vZv (12,750 12)
1,53,000/-
ev`t 1,80,000/- k~ b

wPwKrmvf vZv(1,000 12)
12,000/-
ev`t 12,000/- k~ b

2)
60,000/-
Puv`v(3,000 12)

36,000/-
4,56,000/-
t
6

42

Rb 4000 12 gvm)
17,28,000/-
21,84,000/-

Ki `vq cwi MYbv
(K) c_g 2,20,000/-
-
k~b
(L) ci eZx3,00,000/-
Dci
10% 30,000/-
(M) ci eZx4,00,000/-
Dci
15% 60,000/-
(N) ci eZx3,00,000/-
Dci
20% 60,000/-
(O) Aewk 9,64,000/- ---- 25% 2,41,000/-
3,91,000/-

t
12) =
72,000/- UvKvi Dci 15% A_vr 10,800/-
-
10,800) =3,80,200/- UvKv|

Ki 3,80,200/-
10%) =38,020/-
AvqKi c` - +38,020/-) =4,18,220/-
UvKv|

5| GKRb wk xi Avq Ges Ki cwiMYbvt
u
-2013 A_ Zuvi Avq I e
i Kgt

43

- 10,00,000/-



t
3 Rb mnwk x----
3 6000 12 gvm
2,16,000/-
wk x---
3 5000 12 gvm
1,80,000/-
2 Rb Zej Px----
2 3000 12 gvm
72,000/-

- UvKvI 2,000/-
UvKv|

2013-2014 Ki e

cvw- 10,00,000/-

ev` eqmgnt

mnwk x-------- 2,16,000/-
-------- 1,80,000/-
Zej Px--------- 72,000/-
4,68,000/-
-- 17,000/-
4,85,000/-
5,15,000/-



Ki `vq cwi MYbv
(K) c_g 2,50,000/- --
k~b
(L) ci eZx2,65,000/- i Dci
--
10% 26,500/-
26,500/-
44


6| t
cavb


t
25,600/- UvKv
evoxf vovf vZv 12,020/- UvKv
wPwKrmvf vZv 500/- UvKv
51,200/- UvKv

- UvKv|
mgcwi gvb b|
-
-
10,00,000/- - UvKvi


- UvKvI
-


2013-2014 Ki e


t
evwl K g~
(25,600/- 12)
3,07,200/-
Drme f vZv(25,600/- 2)
51,200/-
evoxf vovf vZv
(12,020/- 12)
144,240/-
ev` Ki gy g~
50%
144,240/- k~b
45


wPwKrmvf vZv(500 12)
6,000/-
ev` 6,000/- k~b

Puv`v(5000 12gvm)


60,000/-

AwRZ m~`
20,000/-
ev` Ki gy

20,000/- k~b
4,18,400/-



(10Rb 300w`b
500UvKv)
15,00,000/-

(30Rb 300w`b
300UvKv)
27,00,000/-
42,00,000/-
ev` (AvbygvwbK 1/3 Ask) 14,00,000/-
28,00,000/-
32,18,400/-

Ki `vq cwi MYbv
(K) c_g 2,20,000/-
---
k~ b
(L) ci eZx3,00,000/-
--
10% 30,000/-
(M) ci eZx4,00,000/-
--
15% 60,000/-
(N) ci eZx3,00,000/-
--
20% 60,000/-
(O) Aewk 19,98,400/-
Dci ----------
25% 4,99,600/-
6,49,600/-
46

ev`

(5000 12gvm) 2

1,20,000/-

wWwcGm-G evwl K Rgv(6,000
12) =72,000/-
60,000/- UvKv



60,000/-

mqc q ----------------------- 5,00,000/-

10,00,000/-
c 16,80,000/-

(
32,18,400/- - 60,000/-) =
31,58,400/-UvKvi 30% 9,47,520/-

A_ev 1,50,00,000/-
0,000/-

A_vr 9,47,520/-


1,42,128/-
5,07,472/-

7| GKRb eemvqxi Avq Ges Ki cwiMYbvt


weq 1,20,00,000/- UvKv
Mmgybvdv 18,00,000/- UvKv
j vf -
Li P `vex

10,00,000/- UvKv
bxUgybvdv= 8,00,000/- UvKv
47

-
1,20,000/-


2013-2014 Ki Ki `vZvi 8,00,000/-


Ki `vq cwi MYbv
Ki `vZ
2,50,000/-)

(K) c_g 2,50,000/-
---
k~ b
(L) ci eZx3,00,000/-
-
10% 30,000/-
(M) Aewk 2,50,000/-
-
15% 37,500/-
67,500/-

ev`

mqc q 1,20,000/-


2,40,000/-

A_ev1,50,00,000/-
1,20,000/-
-
Dci 15%
-



18,000/-
-
30,000/-
-

48

cg fvMt mc`, `vq I eq weeiYxGes Rxebhv vi gvb mwKZ
Z_ weeiYx

mc`, `vq I eq weei Yx(di g AvBwU-10we, AvBwU-10wewewe I
AvBwU-10wewewewe)
AvBwU-10wet -11MGi

AvBwU-10wewewet Ki `vZv wi Uvbdi g A_vr
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AvBwU-10wewewewe t
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gv

ew Ki `vZvi mc - c qi
weei YxGes Rxeb hv vi gvb mcwKZ Z_ weei Yxc~
- wi Uvb`vwLj
-
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U- 11P
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3-2014 3 Bs
c c
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bvevj K m i hveZxq cwi mc` I `vq, mc


mc c
c eve`
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49

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vi bvg, wVKvbvGes


c
Less:Liabilities


m`, `vq I eq weei Yxc~
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g~
bZzb mc g~j ;
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dig AvBwU-10wewe c~


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wgK bs-1t


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52

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RvZxq cwi Pqc
Qwe ev Abvb KvMRc




GKRb Ki `vZvTIN e-
TIN Registration/Re-
registration


54


l fvMt e-TIN cwZ

e-TIN Registration/Re-
registration c~e K wUAvBGb b
1
y e cewZZ e-
TIN cwZ Ki `vZvMY Re-registration
Ges bZyb Ki `vZvMY Registration Gi
e-TIN cwZ i
www.incometax.gov.bd
Registration/Re-registration Kvhg

e-TIN cwZ Registration/Re-registration
www.incometax.gov.bd Register


Register
55

UserRegistrationForm:

User Id:
character
Password:
character
Retype Password:
56

Security Question:
Security Question
Security Answer: Security Question Gi mwVK Di

Country:
Rb)|
Mobile Number:
e|
Email Address: j Zvi E-mail Address

Verification Letters:
character Try
Again character


Register
SMS
Mobile Activation


57

i e-TIN Activation Code SMS Gi
Activate
Registration/Re-
registration
User Id Ges
Password


TIN Registration/Re-registration cwqvt
Re-
registration
Registration TIN Application

58




Taxpayer Status/ Ki`vZvi aiY (a) t option
Individual->Bangladeshi Resident

(b) t
Individual->Bangladeshi Resident->Major (With NID)
A_ nb

Registration Type/ Re-
registration Registration

Existing (10 digit) TIN / eZgvb wUAvBGbt
Ki `vZv UvBc
General
Information

59



Main Source of income/

Location of main source of income t
Ki `vZvi


Type of Employer/Service Locationt
cavb DrmService

Business (Individual/Firm)t
ai Y
60

Location eemvi wVKvbv

Otherst
Location
|
Go to Next



Taxpayers Name/Ki `vZvi bvg:

Gender/ Male
Female
61

Taxpayers National ID Number/

Date of Birth (DoB)/RbZvwi Lt RvZxq cwi Pqc AbyhvqxRb

Fathers Name/wcZvi bvg:

Mothers Name/gvZvi bvg:

Name of Spouse/^vgxev xi bvg: ^ vgxev xi

Mobile Number/ :

Facsimile/dv :

Email/ :

Current Address: GL UvBc
District Ges Thana

Permanent Address:
District Ges Thana

Other Address: i Abvb wVKvbv
dvi xBZvw`)
District Ges Thana
Go to Next

62




I Hereby affirm that all
information given above is correct & complete Ges bZzb
I Hereby affirm that all information given
above is correct & complete
Submit Application Back
to Previous
Submit Application



63



View Certificate
View Certificate
c`w
64



Print Certificate
Save
Certificate
65

Email Certificate
Zvi ci Send
we www.incometax.gov.bd

===0 ===










66






























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67




































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76



FORM OF RETURN OF INCOME UNDER THE INCOME TAX
ORDINANCE, 1984 (XXXVI OF 1984)







Put the tick ( ) mark wherever applicable



1. Name of the Assessee: ............................................................

2. National ID No (if any): ............................................................

3. UTIN (if any):
- -

4. TIN:
- -

5. (a) Circle: .................. (b) Taxes Zone: ...............................

6. Assessment Year: ............ 7. Residential Status: Resident /Non-resident

8. Status: Individual Firm Association of Persons Hindu Undivided Family

9. Name of the employer/business (where applicable): ...........................
10. Wife/Husband's Name (if assessee, please mention TIN): .............................................

11. Father's Name: .....................................................................................

12. Mothers Name: ...............................................................................

13. Date of Birth (in case of individual)
Day Month Year

14. Address (a) Present: ...................................................
....................................................................

(b) Permanent: ..................................................
...............................................................
...............................................................


15. Telephone: Office/Business ................................... Resident: ....................

16. VAT Registration Number (if any): ..............................................................


Be a Respectable Taxpayers
Submit return in due time
Avoid penalty
IT-11GA
Self Universal Self

Photograph of the
Assessee
(to be attested on
the photograph)

Normal
FOR INDIVIDUAL AND OTHER TAXPAYERS
(OTHER THAN COMPANY)
77

Statement of income of the Assessee

Statement of income during the income year ended on ........................................

Serial
no.
Heads of Income Amount in
Taka
1 Salaries : u/s 21 (as per schedule 1)
2 Interest on Securities : u/s 22
3 Income from house property : u/s 24 (as per schedule 2)
4 Agricultural income : u/s 26
5 Income from business or profession : u/s 28
6 Share of profit in a firm :
7 Income of the spouse or minor child as applicable : u/s 43(4)
8 Capital Gains : u/s 31
9 Income from other source : u/s 33
10 Total (serial no. 1 to 9)
11 Foreign Income:
12 Total income (serial no. 10 and 11)
13 Tax leviable on total income
14 Tax rebate: u/s 44(2)(b)(as per schedule 3)
15 Tax payable (difference between serial no. 13 and 14)
16 Tax Payments:
(a) Tax deducted/collected at source
(Please attach supporting documents/statement) Tk .......
(b) Advance tax u/s 64/68 (Please attach challan ) Tk .......
(c) Tax paid on the basis of this return (u/s 74)
(Please attach challan/pay order/bank draft/cheque) Tk .......
(d) Adjustment of Tax Refund (if any) Tk .......
Total of (a), (b), (c) and (d)
Tk. ............
17 Difference between serial no. 15 and 16 (if any)
18 Tax exempted and Tax free income Tk. ............
19 Income tax paid in the last assessment year Tk. ............

*If needed, please use separate sheet.

Verification

I ................................................ father/husband ........................................... UTIN/TIN:
........................................................ solemnly declare that to the best of my knowledge and belief
the information given in this return and statements and documents annexed herewith is correct
and complete.

Place: .................................
Date : ................................

Signature

(Name in block letters)

Designation and
Seal (for other than individual)

78

SCHEDULES SHOWING DETAILS OF INCOME

Name of the Assessee: .................... TIN - -

Schedule-1 (Salaries)

Pay
&
Allowance
Amount of
Income
(Tk.)
Amount of
exempted
income (Tk.)
Net taxable
income
(Tk.)
Basic pay
Special pay
Dearness allowance
Conveyance allowance
House rent allowance
Medical allowance
Servant allowance
Leave allowance
Honorarium / Reward/ Fee
Overtime allowance
Bonus / Ex-gratia
Other allowances
Employers contribution to
Recognized Provident Fund

Interest accrued on Recognized
Provident Fund

Deemed income for transport facility
Deemed income for free furnished/
unfurnished accommodation

Other, if any (give detail)
Net taxable income from salary

Schedule-2 (House Property income)

Location and
description
of property
Particulars Tk. Tk.
1. Annual rental income
2. Claimed Expenses :
Repair, Collection, etc.
Municipal or Local Tax
Land Revenue
Interest on Loan/Mortgage/Capital
Charge

Insurance Premium
Vacancy Allowance
Other, if any
Total =
3. Net income ( difference between item 1 and 2)



79

Schedule-3 (Investment tax credit)
(Section 44(2)(b) read with part B of Sixth Schedule)

1. Life insurance premium Tk ...................
2. Contribution to deferred annuity Tk ...................
3. Contribution to Provident Fund to which Provident Fund
Act, 1925 applies
Tk ...................
4. Self contribution and employers contribution to
Recognized Provident Fund
Tk ...................
5. Contribution to Super Annuation Fund Tk ...................
6. Investment in approved debenture or debenture stock,
Stock or Shares
Tk ...................
7. Contribution to deposit pension scheme Tk ...................
8. Contribution to Benevolent Fund and Group Insurance
premium
Tk ...................
9. Contribution to Zakat Fund Tk ...................
10. Others, if any ( give details ) Tk ...................
Total Tk ...................

*Please attach certificates/documents of investment.

List of documents furnished

1.



6.
2.



7.
3.



8.
4.



9.
5.



10.

*I ncomplete return is not acceptable

80

Statement of assets and liabilities (as on ----------)

Name of the Assessee: ................... TIN - -

1. (a) Business Capital (Closing balance) Tk. .....
(b) Directors Shareholdings in Limited Companies (at cost) Tk. ........
Name of Companies Number of shares

2. Non-Agricultural Property (at cost with legal expenses ) : Tk. .........
Land/House property (Description and location of property)

3. Agricultural Property (at cost with legal expenses ) : Tk..........
Land (Total land and location of land property)

4. Investments:
(a) Shares/Debentures Tk. ...........
(b) Saving Certificate/Unit Certificate/Bond Tk. ...........
(c) Prize bond/Savings Scheme Tk. ...........
(d) Loans given Tk. ...........
(e) Other Investment Tk. ...........
Total = Tk...........


5. Motor Vehicles (at cost) : Tk...........
Type of motor vehicle and Registration number

6. Jewellery (quantity and cost) : Tk...........

7. Furniture (at cost) : Tk...........

8. Electronic Equipment (at cost) : Tk..........

9. Cash Asset Outside Business:
(a) Cash in hand Tk. ...........
(b) Cash at bank Tk. ...........
(c) Other deposits Tk. ...........
Total = Tk...........


I T-10B
81

B/F = Tk...........

10. Any other assets Tk. .........
(With details)

Total Assets Tk. .........

11. Less Liabilities:
(a) Mortgages secured on property or land Tk. ...........
(b) Unsecured loans Tk. ...........
(c) Bank loan Tk. ...........
(d) Others Tk. ...........

Total Liabilities Tk..........
12. Net wealth as on last date of this income year
(Difference between total assets and total liabilities) Tk..........

13. Net wealth as on last date of previous income year Tk..........

14. Accretion in wealth (Difference between serial no. 12 and 13) Tk..........

15. (a) Family Expenditure: (Total expenditure as per Form IT 10 BB) Tk. .......
(b) Number of dependant children of the family:

Adult Child

16. Total Accretion of wealth (Total of serial 14 and 15) Tk..........

17. Sources of Fund :
(i) Shown Return Income Tk. ...........
(ii) Tax exempted/Tax free Income Tk. ...........
(iii) Other receipts Tk. ...........

Total source of Fund = Tk..........

18. Difference (Between serial 16 and 17) Tk..........

I solemnly declare that to the best of my knowledge and belief the information
given in the IT-10B is correct and complete.

Name & signature of the Assessee
Date ....................

* Assets and liabilities of self, spouse (if she/he is not an assessee), minor children
and dependant(s) to be shown in the above statements.
* If needed, please use separate sheet.
82

FORM

Statement under section 75(2)(d)(i) and section 80 of the Income tax Ordinance,
1984 (XXXVI of 1984) regarding particulars of life style

Name of the Assessee: ................. TIN - -

Serial
No.
Particulars ofExpenditure Amount of Tk. Comments
1 Personal and fooding expenses Tk.
2 Tax paid including deduction at
source of the last financial year
Tk.
3 Accommodation expenses Tk.
4 Transport expenses Tk.
5 Electricity Bill for residence Tk.
6 Wasa Bill for residence Tk.
7 Gas Bill for residence Tk.
8 Telephone Bill for residence Tk.
9 Education expenses for children Tk.
10 Personal expenses for Foreign travel Tk.
11 Festival and other special expenses,
if any
Tk.
Total Expenditure Tk.

I solemnly declare that to the best of my knowledge and belief the information
given in the IT-10BB is correct and complete.

Name and signature
of the Assessee
Date .................
*If needed, please use separate sheet.

.......................................................................................................................................................

Acknowledgement Receipt of Income Statement


Name of the Assessee: ........................ Assessment Year: .............

UTIN/TIN: - - Circle: .... Taxes Zone ...
Form No. I T-10BB
83

Instructions to fill up the Return Form

Instructions:
(1) This return of income shall be signed and verified by the individual assessee or person
as prescribed u/s 75 of the Income Tax Ordinance, 1984.
(2) Enclose where applicable:
(a) Salary statement for salary income; Bank statement for interest; Certificate for
interest on savings instruments; Rent agreement, receipts of municipal tax and
land revenue, statement of house property loan interest, insurance premium for
house property income; Statement of professional income as per IT Rule-8; Copy
of assessment/ income statement and balance sheet for partnership income;
Documents of capital gain; Dividend warrant for dividend income; Statement of
other income; Documents in support of investments in savings certificates, LIP,
DPS, Zakat, stock/share etc.
(b) Statement of income and expenditure; Manufacturing A/C, Trading and Profit &
Loss A/C and Balance sheet;
(c) Depreciation chart claiming depreciation as per THIRD SCHEDULE of the
Income Tax Ordinance, 1984;
(d) Computation of income according to Income tax Law;
(3) Enclose separate statement for:
(a) Any income of the spouse of the assessee (if she/he is not an assessee), minor
children and dependant;
(b) Tax exempted / tax free income.
(4) Fulfillment of the conditions laid down in rule-38 is mandatory for submission of a
return under "Self Assessment".
(5) Documents furnished to support the declaration should be signed by the assessee or
his/her authorized representative.
(6) The assesse shall submit his/her photograph with return after every five year.
(7) Furnish the following information:
(a) Name, address and TIN of the partners if the assessee is a firm;
(b) Name of firm, address and TIN if the assessee is a partner;
(c) Name of the company, address and TIN if the assessee is a director.
(8) Assets and liabilities of self, spouse (if she/he is not an assessee), minor children and
dependant(s) to be shown in the IT-10B.
(9) Signature is mandatory for all the assessee or his/her authorized representative. For
individual, signature is also mandatory in I.T-10B and I.T-10BB.
(10) If needed, please use separate sheet.

..........................................................................................................

Total income shown in Return: Tk ....................... Tax paid: Tk .....................
Net Wealth of Assessee : Tk .................................
Date of receipt of return: .................... Serial No. in return register ..................

Nature of Return : Self Universal Self Normal

Signature of Receiving
officer with seal]



84

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Form of return of income under the Income-tax
Ordinance, 1984 (Ord. XXXVI OF 1984)
(Return under section 82D)

1. Name of the Assessee: .................................................................................. .....

2. Present Address: ...........................................................................................
..............................................................................................
..............................................................................................

3. Father's/husband's Name: ............................ 4. Mothers Name: ........................

5. Date of Birth: ........... 6. Mobile/Telephone:................. 7. e-mail (if any) ...........

8. National ID No. .............................. 9. Nature of Business/Profession ...........

10. TIN/UTIN:

11. (a) Circle: .................................. (b) Taxes Zone: ............................ ....

12. Assessment Year: ................... 13. Status: Individual/Firm/AOP (please tick)
.
14. Total income : Tk.
15. Net tax payable : Tk.
16. Tax paid on the basis of this return : (a) Amount (in figure) :
(b) Pay order/challan No:
(c) Date:

Verification

I, ....................................... , father/husband .........................................
UTIN/TIN: .................................................................................... solemnly declare that
to the best of my knowledge and belief the information given in this return is correct
and complete.

Place: .............................
Date : ............................ Signature of the Assessee

N.B Please see the brief instructions overleaf before filling up the return.
..............................................................................................................................




IT-11GAGA
85

Brief Instructions for calculating income of an individual assessee.

If required, please get help from Income-tax Ordinance, 1984 (Ord. XXXVI of 1984),
and Income Tax Rules, 1984.



Sl
No
.
Head of Income and Description Amount
in Tk.
1. Income from business/profession:
(a) Total sale/receipts/commission (As per section 28):
(b) Total expenses of business or profession (As per
manufacturing/trading/profit-loss accounts) (section 29):

(c) Net profit/income [(a)-(b)]:
2. Net tax payable:
3. Rate of tax
In case of business:

Initial capital to
be shown
Rate of
Tax(Tk)
Applicability
Upto Tk 6 lakh 1,000/- For the assessee not located under any
city corporation or paurashava of
district headquarters;
Upto Tk 7 lakh 2,000/- For the assessee located at Paurashava
in district headquarters and other area
excluding city corporation;
Upto Tk 8 lakh 3,000/- For assessee of any area;
Upto Tk 10
lakh
5,000/- For assessee of any area;
Upto Tk 15
lakh
10,000/- For assessee of any area;

In case of profession:

Length of
profession
Rate of
Tax (Tk)
Applicability
Upto 3 years 1,000/- For the assessee not located under
any city corporation or paurashava
of district headquarters;
Upto 4 years 2,000/- For the assessee located at
Paurashava in district headquarters
and other area excluding city
corporation;
Upto 5 years 3,000/- For assessee of any area;
Upto 10 years 5,000/- For assessee of any area;
86


.........................................................................................................................
Acknowledgement Receipt

Serial No. in return register: .......... Date of submission of Return: ..........

Received income tax return from Mr./Mrs. ............. UTIN/TIN ..............
for the Assessment Year: ............ Income shown in the return Tk. .........
and tax paid Tk. ..............................................................................




Seal
Signature of the Deputy
Commissioner of Taxes/Officer in
Charge

Circle.................., Taxes Zone...........



87


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FORM OF RETURN OF INCOME UNDER THE INCOME-tax
ORDINANCE, 1984 (XXXVI OF 1984)







Assessment Year: 20 -20





























IT-11UMA
ONLY FOR THE SALARIED INDIVIDUAL

Universal Self/Normal

[Put tick () where applicable]

Photograph of the
Assessee


[to be attested on the
photograph]
1. Name of the Assessee:................................................
...............................................
2. TIN:

3. National ID No:

4. Date of Birth: D D M M YY E A E R 5. Email: ...................
6. Spouses TIN or Name :..............................................................................
7. (a) Circle: ......... (b) Taxes Zone: ..........8. Residential Status: Resident
/Non-resident
9. Name and address of the employer: .........................................................
....................................................................................................................
10. Present Address: .....................................................................................
.........................................................................................................................
11. Telephone: Office .............................. Mobile: ....................................



88

Statement of income during the income year ended on ......./......./20...

Serial
no.
Heads of Income Amount in
Taka
1 Salaries : u/s 21
2 Income from house property: u/s 24
3 Agricultural income: u/s 26
4 Income from other sources: u/s 33
5 Total income
6 Tax leviable on total income
7 Tax rebate: u/s 44(2)(b)
8
Tax payable (difference between serial no.6 and
7)

9 Tax Payments:
(a) Tax deducted or paid in advance/with
return Tk...............
(b) Adjustment of Tax Refund (if any)
Tk ..............


Tk..............
10 Difference between serial no. 8 and 9 (if any)
11 Tax exempted and Tax free income Tk. ...........

(Please attach supporting documents/statements, if needed)

Verification

I,............................................., father/husband:..............................., TIN:
........................................................ solemnly declare that to the best of my knowledge
and belief the information given in this return and statements and documents annexed
herewith is correct and complete.

Place: .................................

Date : ................................

Enclosures:
Signature of the assessee
(Name and seal)






89

IT-10BBB

Statement of assets and liabilities for Salaried person (as on ----/----/20 )

Name of the Assessee: ......................... TIN

1. Non-Agricultural Property (at cost with legal expenses ) : Tk. ...................
Land/House property (Description and location of property)

2. Agricultural Property (at cost with legal expenses) : Tk...................
Land (Total land and location of land property)
3. Investments:
(a) Shares/Debentures Tk. ...........
(b) Saving Certificate/Unit Certificate/Bond Tk. ...........
(c) Prize bond/Savings Scheme/FDR Tk. ...........
(d) Loans given Tk. ...........
(e) Other Investment Tk. ...........
Total = Tk...................
4. Motor Vehicles (at cost) : Tk..................
Type of motor vehicle and Registration number
5. Jewellery (quantity and cost) : Tk...................
6. Furniture (at cost) : Tk....................
7. Electronic Equipment (at cost) : Tk...................

8. Cash Asset :
(a) Cash in hand Tk. ...........
(b) Cash at bank Tk. ...........
(c) Other deposits Tk. ...........
Total = Tk........... ......
9. Any other assets (With details) Tk...................
Total Assets Tk. ................
10. Less Liabilities:
(a) Mortgages secured on property or land Tk. ...........
(b) Unsecured loans Tk. ...........
(c) Bank loan Tk. ...........
(d) Others Tk. ...........
Total Liabilities Tk.....................
11. Net wealth as on last date of the income year
(Difference between total assets and total liabilities) Tk....................
12. Net wealth as on last date of previous income year Tk....................
13. Accretion in wealth (Difference between serial no. 11 and 12) Tk...................
14. Personal & Family Expenditure: Tk. .................
15. Total Accretion of wealth (Total of serial 13 and 14) Tk...................
16. Sources of Fund :
(i) Shown Return Income Tk. ...........
(ii) Tax exempted/Tax free Income Tk. ...........
(iii) Other receipts(please specify) Tk. ...........
Total source of Fund = Tk.....................
90

17. Difference (Between serial 15 and 16) Tk........................

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


Name & signature of the Assessee

Date ....................

Assets and liabilities of self, spouse (if she/he is not an assessee), minor children
and dependant(s) to be shown in the above statements.
*Please provide documents and use separate sheet, if needed.



Instructions to fill up the Return Form

Instructions:
(1) This return of income shall be signed and verified by the individual assessee or
person as prescribed u/s 75 of the Income Tax Ordinance, 1984.

(2) Enclose where applicable:
(i) Salary statement for salary income;
(ii) Deed or rental agreement (if any) for house property income;
(iii) Documents in support of any other income or liabilities shown;
(iv) Documents in support of investments made in any form;
(v) Computation of income according to Income-tax Ordinance, 1984;
(vi) Provide evidence in support of tax payment.


(3) Documents furnished to support the declaration should be signed by the assessee or
his/her authorized representative.

(4) Assets and liabilities of self, spouse (if she/he is not an assessee), minor children
and dependant(s) to be shown in this form.

(5) If needed, please use separate sheet.

(6) Please visit NBRs website www.nbr-bd.org for further information.










91

...................................................................................................................................


Acknowledgement Receipt of Income Tax Return

Government of the Peoples Republic of Bangladesh
Office of the Deputy Commissioner of Taxes
Taxes Circle-----------, Taxes Zone------------

Name of the Assessee: .........................................Assessment Year: 20 -20

TIN:

Total income shown in Return: Tk ............. Tax paid: Tk .........................

Gross Wealth shown: Tk. .................. Net Wealth shown : Tk ....................

Date of receipt of return: ......................Serial No. in Return Register.............

Return submitted under section 82BB/Normal

Signature of Receiving Officer with seal.



92

cwiwk N



FORM OF RETURN OF INCOME UNDER The Income-tax Ordinance, 1984 (Ord.
No. XXXVI OF 1984)










Assessment Year: 20 -20






























Universal Self/Normal
[Put tick () where applicable]

ONLY FOR THE INCOME FROM BUSINESS OR
PROFESSION UPTO THREE LAKH TAKA
IT-11CHA
1. Name of the Assessee:................................................
...............................................
2. TIN:

3. National ID No:

4. Date of Birth: D D M M YY E A E R 5. Email: ...................
6. Spouses TIN or Name :..............................................................................
7. (a) Circle: ......... (b) Taxes Zone: ..........8. Residential Status: Resident
/Non-resident
9. Name and address of the employer: .........................................................
....................................................................................................................
10. Present Address: .....................................................................................
.........................................................................................................................
11. Telephone: Office .............................. Mobile: ....................................



Photograph of the
Assessee


[to be attested on the
photograph]
93

Statement of income during the income year ended on ......./......./20...

Serial
no.
Heads of Income Amount in
Taka
1. Salaries : u/s 21

2. Interest on Securities: u/s 22

3. Income from house property: u/s 24

4. Agricultural income: u/s 26

5. Income from business or profession: u/s 28

6. Capital gains: u/s 31

7. Income from other sources: u/s 33

8. Total income

9. Tax leviable on total income
10. Tax rebate: u/s 44(2)(b)
11. Tax payable (difference between serial no.9 and 10)
12. Tax Payments:
(a) Tax deducted or paid in advance/with return
Tk...............
(d) (b) Adjustment of Tax Refund (if any) Tk
..............


Tk.............
13. Difference between serial no. 11 and 12 (if any)

14. Tax exempted and Tax free income Tk. .........w

(Please attach supporting documents/statements, if needed)

Verification

I,.......................................,father/husband:............................................, TIN:
........................................................ solemnly declare that to the best of my knowledge
and belief the information given in this return and statements and documents annexed
herewith is correct and complete.

Place: .................................
Date : ................................
Enclosures:
Signature of the assessee
(Name and seal) ;





94


IT-10BBBB

Statement of assets and liabilities for individual having income not exceeding taka
three lakh from business or profession (as on ----/----/20 )
Name of the Assessee: ..................... TIN

1. (a) Business Capital (Closing balance) Tk. ..........................
(b) Directors Shareholdings in Limited Companies ( at cost) Tk. ................
Name of Companies Number of shares
2. Non-Agricultural Property (at cost with legal expenses ) : Tk. .................
Land/House property (Description and location of property)

3. Agricultural Property (at cost with legal expenses ) : Tk....................
Land (Total land and location of land property)
4. Investments:
(a) Shares/Debentures Tk. ...........
(b) Saving Certificate/Unit Certificate/Bond Tk. ...........
(c) Prize bond/Savings Scheme/FDR Tk. ...........
(d) Loans given Tk. ...........
(e) Other Investment Tk. ...........
Total = Tk..................
5. Motor Vehicles (at cost) Tk..................
Type of motor vehicle and Registration number
6. Jewellery (quantity and cost) : Tk..................
7. Furniture (at cost) : Tk..................
8. Electronic Equipment (at cost) : Tk..................
9. Cash Asset :
(a) Cash in hand Tk. ...........
(b) Cash at bank Tk. ...........
(c) Other deposits Tk. ...........
Total = Tk..................
10. Any other assets (With details) Tk. ...............
Total Assets Tk. ..............
11. Less Liabilities:
(a) Mortgages secured on property or land Tk. ...........
(b) Unsecured loans Tk. ...........
(c) Bank loan Tk. ...........
(d) Others Tk. ...........
Total Liabilities Tk.....................
12. Net wealth as on last date of the income year
(Difference between total assets and total liabilities) Tk..........
13. Net wealth as on last date of previous income year Tk..........
14. Accretion in wealth (Difference between serial no. 12 and 13)Tk..........
15. Personal & Family Expenditure: Tk. ...................

95

16. Total Accretion of wealth (Total of serial 14 and 15) Tk.....................
17. Sources of Fund :
(i) Shown Return Income Tk. ...........
(ii) Tax exempted/Tax free Income Tk. ...........
(iii) Other receipts (please specify) Tk. ...........
Total source of Fund = Tk.....................
18. Difference (Between serial 16 and 17) Tk....................

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

Name & signature of the Assessee
Date ....................

Assets and liabilities of self, spouse (if she/he is not an assessee), minor children
and dependant(s) to be shown in the above statements.
*Please provide documents and use separate sheet, if needed.


Instructions to fill up the Return Form

Instructions:
(1) This return of income shall be signed and verified by the individual assessee or
person as prescribed u/s 75 of the Income Tax Ordinance, 1984.

(2) Enclose where applicable:
(i) Salary or remuneration statement for salary income;
(ii) Deed or rental agreement (if any) for house property income;
(iii) Statement of accounts for business income;
(iv) Documents in support of any other income or liabilities shown;
(v) Documents in support of investments made in any form;
(vi) Computation of income according to Income-tax Ordinance, 1984;
(vii) Provide evidence in support of tax payment.

(3) Documents furnished to support the declaration should be signed by the assessee or
his/her authorized representative.
(4) Assets and liabilities of self, spouse (if she/he is not an assessee), minor children
and dependant(s) to be shown in this form.
(5) If needed, please use separate sheet.
(6) Please visit NBRs website www.nbr-bd.org for further information.







96


.........................................................................................................................
Acknowledgement Receipt of Income Tax Return

Government of the Peoples Republic of Bangladesh
Office of the Deputy Commissioner of Taxes
Taxes Circle-----------, Taxes Zone------------

Name of the Assessee: ...................Assessment Year: 20 -20

TIN:

Total income shown in Return:Tk ............. Tax paid:Tk .................

Gross Wealth shown:Tk. ...............Net Wealth shown:Tk .................

Date of receipt of return: ..............Serial No. in Return Register.........

Return submitted under section 82BB/Normal

Signature of Receiving
Officer with seal ;



97

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Application form for Taxpayers Identification Number
Instructions:
(1) Use capital letters. Write one letter in each box. Keep an empty box in
between two words. Avoid abbreviations.
(2) Incomplete and incorrect application shall not be qualified for Taxpayers
Identification Number.
(3) National Board of Revenue (NBR) will verify the information furnished
below as may be required.


(To be filled in by the assessee)
1. Name of the assessee:




2.(a) Father's Name (In case of individual) :



(b) Mother's Name (In case of individual) :



(c) Date of birth (In case of individual) :

Day Month Year

(d) Name of the spouse (Wherever applicable, In case of individual) :



3. Name and TIN of the-
(a) Business (in case of sole proprietorship, only name and address shall be given)
(b) Partners (in case of a firm)
(c) Sponsor Directors (in case of a company)
(Wherever applicable, if needed separate sheet may be attached)


sl Name TIN
a
b
c
d
e
f
g
passport size
photograph
of the assessee
98



4. Incorporation No./Registration No. (Wherever applicable):




5. Incorporation/Registration Date (Wherever applicable):

Day Month Year

6(a). Current address:





District: Post Code

(b). Telephone/Mobile Phone Number: Fax Number:



E-mail Address:


(c). Permanent address:





District: Post Code
(d). Other address (Business/Factory/Professional):





District: Post Code

7. National ID/Passport Number (mandatory for individual)




I hereby affirm that all information given above is correct and complete and I
have not taken any Tax payers Identification Number.

_____________________
Signature of the assessee
99

cwiwk P
Ki Aj wf wK



Ki Aj AvqKi - cvbx
mg~n
AvqKi - cvbx
eZxZ
Abvbwd mg~n
Ki Aj -1, XvKv 1-1141-0001-0101 1-1141-0001-0111 1-1141-0001-1876
Ki Aj -2, XvKv 1-1141-0005-0101 1-1141-0005-0111 1-1141-0005-1876
Ki Aj -3, XvKv 1-1141-0010-0101 1-1141-0010-0111 1-1141-0010-1876
Ki Aj -4, XvKv 1-1141-0015-0101 1-1141-0015-0111 1-1141-0015-1876
Ki Aj -5, XvKv 1-1141-0020-0101 1-1141-0020-0111 1-1141-0020-1876
Ki Aj -6, XvKv 1-1141-0025-0101 1-1141-0025-0111 1-1141-0025-1876
Ki Aj -7, XvKv 1-1141-0030-0101 1-1141-0030-0111 1-1141-0030-1876
Ki Aj -8, XvKv 1-1141-0035-0101 1-1141-0035-0111 1-1141-0035-1876
Ki Aj -9, XvKv 1-1141-0080-0101 1-1141-0080-0111 1-1141-0080-1876
Ki Aj -10, XvKv 1-1141-0085-0101 1-1141-0085-0111 1-1141-0085-1876
Ki Aj -11, XvKv 1-1141-0090-0101 1-1141-0090-0111 1-1141-0090-1876
Ki Aj -12, XvKv 1-1141-0095-0101 1-1141-0095-0111 1-1141-0095-1876
Ki Aj -13, XvKv 1-1141-0100-0101 1-1141-0100-0111 1-1141-0100-1876
Ki Aj -14, XvKv 1-1141-0105-0101 1-1141-0105-0111 1-1141-0105-1876
Ki Aj -15, XvKv 1-1141-0110-0101 1-1141-0110-0111 1-1141-0110-1876
Ki Aj -1,PUMvg 1-1141-0040-0101 1-1141-0040-0111 1-1141-0040-1876
Ki Aj -2 PUMvg 1-1141-0045-0101 1-1141-0045-0111 1-1141-0045-1876
Ki Aj -3 PUMvg 1-1141-0050-0101 1-1141-0050-0111 1-1141-0050-1876
Ki Aj -4, PUMvg 1-1141-0135-0101 1-1141-0135-0111 1-1141-0135-1876
Ki Aj - Lj bv 1-1141-0055-0101 1-1141-0055-0111 1-1141-0055-1876
Ki Aj - i vRkvnx 1-1141-0060-0101 1-1141-0060-0111 1-1141-0060-1876
Ki Aj - i scyi 1-1141-0065-0101 1-1141-0065-0111 1-1141-0065-1876
Ki Aj - 1-1141-0070-0101 1-1141-0070-0111 1-1141-0070-1876
Ki Aj - ewi kvj 1-1141-0075-0101 1-1141-0075-0111 1-1141-0075-1876
Ki Aj -MvRxcyi 1-1141-0120-0101 1-1141-0120-0111 1-1141-0120-1876
Ki Aj -bvi vqYM 1-1141-0115-0101 1-1141-0115-0111 1-1141-0115-1876
Ki Aj - eov 1-1141-0140-0101 1-1141-0140-0111 1-1141-0140-1876
Ki Aj - Kzwgj v 1-1141-0130-0101 1-1141-0130-0111 1-1141-0130-1876
Ki Aj -
gqgbwmsn
1-1141-0125-0101 1-1141-0125-0111 1-1141-0125-1876
1-1145-0010-0101 1-1145-0010-0111 1-1145-0010-1876
1-1145-0005-0101 1-1145-0005-0111 1-1145-0005-1876

100

cwiwk Q
vb b^i
n
Ki A j i bvg
Ki Aj -1, XvKv 02-9334378
Ki Aj -2, XvKv 02-9331968
Ki Aj -3, XvKv 02-9330552
Ki Aj -4, XvKv 02-9330865
Ki Aj -5, XvKv 02-9333145
Ki Aj -6, XvKv 02-8314025
Ki Aj -7, XvKv 02-8322040
Ki Aj -8, XvKv 02-9332351
Ki Aj -9, XvKv 02-7913772
Ki Aj -10, XvKv 02-8391208
Ki Aj -11, XvKv 02-9514832
Ki Aj -12, XvKv 02-7119884
Ki Aj -13, XvKv 02-9351973
Ki Aj -14, XvKv 02-9513260
Ki Aj -15, XvKv 02-8331678
Ki Aj -1,PUMvg 031-715190
Ki Aj -2 PUMvg 031-2515572
Ki Aj -3 PUMvg 031-728326
Ki Aj -4, PUMvg 031-726466
Ki Aj - Lj bv 041-761983
Ki Aj - i vRkvnx 0721-775797
Ki Aj - i scyi 0521-61773
Ki Aj - 0821-725432
Ki Aj - ewi kvj 0431-72204
Ki Aj -MvRxcyi 02-9261804
Ki Aj -bvi vqYM 02-7646262
Ki Aj -eov 051-61758
Ki Aj -Kzwgj v 081-72670
Ki Aj -gqgbwmsn 091-66175
02-9332010 G -106
02-717225