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(Assessment Year 2019-20)
[To be furnished by the employees/officers whose income exceeds ₹2,50,000/-]
Gross Salary Income includes Salary, DA, HRA, CCA, Interim Relief, OT Salary from Salary/Pension/
1 a
Allowance, Deputation Allowance, Medical Allowance etc.) KRNNIVSA Others
Total: - -
Standard Deduction 40,000
b Leave Surrender
c Festival Allowance/Bonus/Ex-gratia and Incentive
d Pay Revision Arrears
e Medical reimbursement availed
f Total Salary Income (a+b+c+d+e) -40,000
Deduct: HRA in the case of persons who actually incur expenditure by way of
i) Actual HRA received during the year -
ii) Actual rent paid in excess of 1/10th of the salary -
iii) 40% of the salary -
(i) to (iii) whichever is least is exempted -
3 Balance (1-2) -40,000
4 Deduction u/s 10:
a Entertainment Allowance -
b Profession Tax Paid
5 Net Salary Income (3-4) -40,000
Deduct Interest/Accrued Interest on HBA u/s 24B (maximum admissible
amount is ₹30000/-. If the property is acquired or constructed on or after 1-4-
6 99 and such acquisition or construction is completed within three years of from
the end of the financial year in which capital is borrowed deductible amount is
₹2.00 Lakh):
Any other income (Business, Capital Gain or Other Sources) / Rent Paid
7 -
8 Gross Total Income (5-6+7) -40,000
9 Deduct: -

Mediclaim u/s 80D (maximum of ₹25000/-taken on the health of the tax payer,
a spouse, dependent children and if it is taken on parents additional Rs.25000/-. -
Policy taken on the health of a senior citizen additional ₹5000/-)

Expenditure on medical treatment of mentally or physically handicapped

b dependents u/s 80DD (including the amount deposited in their name) (max. -
Rs.75000/-, in case of sever disability over 80% max. ₹125000/-)
Expenditure incurred on medical treatment of the employee or spouse or
children or parents, brothers and sisters for specified deceases or ailment like
c -
cancer, AIDS etc. u/s 80DDB [max. ₹40000/-in case of treatment is made to a
person who is senior citizen ₹60000/-]
Amount of interest repaid on loan taken for higher education of self or relative
d -
u/s 80E
Donation to various charitable and other funds including PM's National Relief
e -
Fund, Chief Minister's Distress Relief Fund etc. u/s 80G
f Contribution made to political party/electoral trust -
Deduction for persons with disability [₹50000/-, in case of severe disability
g -
over 80% ₹1 Lakh]
10 Deduction under Section 80C [max ₹150000/-] -
a Life Insurance premium of self, spouse & children
b Purchase of NSC VIII issue
c Contribution to GPF/EPF
d Contribution to SLI, GIS, FBS

e Term deposit with scheduled bank for a fixed period of not less than 5 years

Contribution towards Unit Linked Insurance Plan of UTI or LIC (of self, spouse
& children)
g Payment under a contract of annuity plan of the LIC or any other insurer
h Purchase of tax saving units of Mutual Fund or UTI
Contribution to any Deposit Scheme or pension fund set up by National
Housing Bank
Tuition Fees [paid to university, college school or educational institution
situated within India for full-time education to any 2 children]
Housing Loan Repayment (Principal) & stamp duty paid for purchase of
l Subscription to equity shares or debentures of an eligible issue
m Subscription to eligible units of Mutual Fund
n Contribution to PPF account of self, Spouse & Children
o Subscription to Infrastructure Bonds of NABARD
p Deposit under Senior Citizens Savings Scheme
q Five year Time Deposit in Post Office
11 Subscription to Long term infrastructure bonds u/s 80CCF [max ₹20000/-]
12 Total Income rounded off to nearest multiple of ten rupees (8-9-10-11) -40,000
13 Tax on Total Income
Total Income upto ₹2.50 Lakh - Nil; Total Income above ₹2.50 Lakh upto
₹5.00 Lakh -5% of total income in excess of ₹2.50 Lakh; Total Income above
₹5.00 Lakh upto ₹10.00 Lakhs - ₹12500/- plus 20% of total income in excess -
of ₹5.00 Lakhs; Total income exceeds ₹10.00 Lakhs - ₹112500/- plus 30% of
the total income in excess of ₹10.00 Lakhs
Less: Rebate as per Section 87A (for those having total income less than ₹3.5
Lakh, ₹2500/- or amount of tax payable whichever is less)
15 Total Tax Payable (13-14) -
Education Cess and Secondary (2%), Higher Education Cess (1%) and health
16 -
cess (1%) @ 4% of (15)
17 Amount of tax already deducted from Salary
18 Balance Income Tax to be paid -
Name, Designation & Office: