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JIPMER, PUDUCHERRY- 6
PROFORMA FOR DETERMINATION OF INCOME TAX DEDUCTIBLE FROM SALARY FOR
THE YEAR 2017-2018
(Please read the form thoroughly and fill up without omission and correction)
1 (i) Name & Employee No. :
(iii) Date of Birth :
(iv) Sex :
(v) Designation & Section :
(vi) PAN Number :
(vii) Bill No/Contact No.(Mobile/Office No.):
2 Pay, GP, Date of next increment :

3 Residential address and period from


which residing :

4 House owned or rented :


Rent paid (Rent receipt to be produced if
HRA received per month exceeds
Rs. 3,000/- and above)
Computation of Income for 2017-18
Amount chargeable under the Head Salaries from March 2017 to February 2018
1) Gross Pay : Rs.
2) Arrears, if any : Rs.
3) D.A. Arrears (Jan17 to Mar17) : Rs.
4) Expected D.A. Arrears (July17 to Sep17) : Rs.
5) Honorarium, O.T. etc. : Rs.
6) Children Education Allowance : Rs.
7) Bonus : Rs.
8) Leave Encashment (LTC) : Rs.
9) Govt. Contribution to New Pension Scheme : Rs.
10) Others : Rs.
TOTAL : Rs.
Deductions:
Transport Allowance (Exemption upto
Maximum of Rs. 19,200/-) : Rs.
UA : Rs.
AA : Rs.
WA : Rs.
BA : Rs.
Professional Tax Paid : Rs.
TOTAL : Rs.

TOTAL SALARY INCOME : Rs.

LESS: Amount of HRA Exempted (Least of : Rs.


the following)
i) Actual HRA received : Rs.
ii) Actual Expenditure incurred on rent
in excess of 10% of Salary : Rs.
iii) 40% of Salary : Rs.

Income from Salary : Rs.