Automated Income Tax , With Salary Statement,ITR-I,Form 16,Form 10E,FOR Financial YEAR 2010-11.

This Calculation sheet for All Govt. & Private concern Employees Prepared by Pranab Banerjee,Kalisthanpara, Jiaganj,Murshidabad,W.B., pranab.banerjee83@gmail.com or 9474316768, 8906279547, For more calculation visit :-www.pranab.jiaganj.com
FIRST NAME MIDDLE NAME LAST NAME DESIGNATION Permanent A/C No.(PAN NO) This New I T R - I(SARAL II),For Assessment Year 20112012,which recent published by the MINISTRY OF FINANCE(Deptt.of Revenue)Central Board of Taxes,New Delhi. Notification Dated 23/04/2010 in the Gazette of India Extraordinary,Part-II, Section 3,(Sub Sec(ii)] Male If Handicapped Employee Pl. put "Yes" If General put "No"

if any discripency is arise in calculation by this software,I am not responcible for that

Gender ( Male or Female )
DATE OF BIRTH

No

EMPLOYEE'S RESIDENTIAL ADDRESS
Flat/Door/Block No. Village Post Office: Area/Locality:
If you live in Metro City Type Yes ,else Type No
JIAGANJ JIAGANJ JIAGANJ No MURSHIDABAD 742123 West Bengal 31/5/2011 B.LLRO,B.golaI,Murshidabad Govt S.D.L.&L.R.O. Clk.Don't UPDATE

District: PIN CODE: State: Date of Submit this RETURN

(In this Software Prepared Salary Statement+Form-16 + ITR-I + Form 10E) Auto Calculation

Office Address STATUS- Govt/PSU/Others Name & Address of the Deductor

For Various Calculation Visit :www.pranab.jiaganj.com

Pan No. of Deductor

AA5544C

Name & Address of the Employer

Amar Kr. Bosu

Tan No. of Employer

pranab Employee's Bank Account No. PARTICULARS OF SALARY

Gross Income from Salary (Salary+H.R.A.+Bonus+Arrear if any+Int.Bank/NSC+House Property) Total Income from Salary( This Cell Auto filled) Taxable income of previous year (Col-9) Form No. 16 of PREVIOUS YEAR

276479

This Cell is Auto filled( The Data Comes from Pay Sheet)

274939

This Cell is Auto filled (The Data comes from Pay Sheet) Auto Calculation for Relief U/S 89(1)

139000 [ Taxable Income for this year after deduc 80 C (Col-9 of Salary statement]

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Deduction under chapter VI-A (LIC,PF,Tuition Fees,H.B.Principal):80C (Maximum Deposit Rs.1,00,000)
a) b) c) d) e)

G.P.F. L.I.C. N.S.C. H.B. Loan Principal
GROUP INSURANCE (G.I.)

36000 41002

12408 480

DEDUCTION ONLY U/S 80C, 80CC (MAXIMUM LIMIT NOT EXCCEED RS.1,20,000/- including New Tax Savings Bond(Max Rs.20000/-)

f) Tax Savings Bond ( Maximum Rs. 20,000/-)
g)

Tuition Fees

TOTAL DEDUCTION U/S 80C Max. Rs 1,00,000/- + 20,000 Infrustructure Bond, Total Rs.1,20,000/-

89890

Total Deduction U/S 80C (Max.limit 1,00,000/-) + 20,000/- New declared Infrustructure Bond

Income from Bank Interest/N.S.C/Others Source

Income from House Property 80G 80D 80E 80DD
Donation in Charitable Fund Maximum 100% of donation) Premium in health insurance of self,spouse,children,dependent,Maximum Rs 15000/For Higher Education Loan Maximum No Limit Medical treatment for self or dependent as Handicapped

9600 P.16 17 18 19 20 21 80DDB 80CC 80CCD House Rent Paid Conveyance Allowances U/s 10(14)(i) 0 Medical Treatment for self or dependent for sever desease Deposit in Pension Fund (Maximum Rs. 22 Arrear Received if any Relief under Section 89(1) Received as Arrear from Salary if any AUTO FILLED CELL (DON'T PUT ANY DATA ) .00. 0 Maximum Rs. 1.A.000/New Pension Scheme (Maximum 10% or Salary) For Rented House. Permanent disability including blindnes as handicapped(Max Rs. 89890 15703 1.617 TOTAL DEDUCTION CHAPTER VI-A Rs.75000/-) 80U TOTAL DEDUCTION CHAPTER VI-A Rs. Must Submit the receipt of House Rent.

New Delhi.shidabad.jiaganj. 2010 in the Gazette of India Section 3.(Sub Sec(ii)] e Prepared Salary ITR-I + Form 10E) Auto ulation lculation Visit :b.com ).For Assessment Year 2011shed by the MINISTRY OF entral Board of Taxes..B.W.jiaganj.com AA5544C . pranab.

80CC (MAXIMUM LIMIT .including New Tax Max Rs.1.000/-) + ustructure Bond 00% of donation) m Rs 15000/- o Limit as Handicapped .000/.mes from Pay Sheet) mes from Pay Sheet) 259236 .000) 0C.20000/-) Max.00.00.limit 1.

00.75000/-) -A Rs.for sever desease 1.000/Salary) eipt of House Rent. ary if any . as handicapped(Max Rs.

B. Pr.S.com or bpranab78@yahoo. D.A.P.F./ Bonus (2+3+5+7+8 Allwn./ TOTAL Conv Arrear E. M.A.banerjee83@ gmail. Paid 16 1034 1034 1034 1034 1034 1034 1034 1034 1034 1034 1034 1034 12408 1 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 TOTAL 2 14410 14410 14410 14850 14850 14850 14850 14850 14850 14850 14850 14850 176880 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 300 300 300 300 300 300 300 300 300 300 300 300 3600 5 3983 2306 2306 2376 2376 2376 2376 2376 3267 3267 3267 3267 33543 7 2000 2000 2000 2000 2000 2000 2000 2000 2000 2000 2000 2000 24000 8 300 300 300 300 350 500 500 500 500 500 500 500 5050 14 110 130 130 130 130 130 130 130 130 130 130 130 1540 15 40 40 40 40 40 40 40 40 40 40 40 40 480 Contact for preparation of any Accounts Calculation for any Concern with low cost For Fully Unlocked this Software please Mail to :pranab./ Tax GISL H./ +9+10+11) ESI 9 0 0 0 0 0 0 0 0 0 0 0 0 0 10 1000 11 15703 12 37696 19316 19316 13 3000 3000 3000 3000 3000 3000 3000 3000 3000 3000 3000 3000 36000 P.c om 19826 19876 20026 20026 20026 20917 20917 20917 20917 259776 . Assessment Year 2011-12 MONTH &Year Basic Pay Other Alwnces if any 3 0 0 0 0 0 0 0 0 0 0 0 0 0 Fuel Alown Food Rural/ /Tel Hill Allown Allown.F.Pay Calculation Sheet for -Income Tax Calculation .A.L.for the financial year 2010-2011. H.R. G. G.F.I. Received P.P.

H.B.L Advance Int Income Paid tax Paid 17 0 0 0 0 0 0 0 0 0 0 0 0 0 18 0 0 0 0 0 0 0 0 0 0 0 963 963 .

24000 b) House Rent paid :Rs./Bank interest etc:-…………………………………………. 36000 b) Contribution to New Flexible Bond……………….000/.169 Rs. 0 j) Others.Received :Rs.A. b) Income from House Property:-……………………………………………………. 2 Any other income as stated by the Assesses :a) Income from N. ……………………………………….12+13) :-…………………. Rs. 0 e) Amount exempted (Least of a. … Rs.P.001/-to 5.8.P.1.90. Rs.75000/Rs.00. 9 Deduction U/S 80 C (Maximum Rs. In Metropol City ors 40% 84. Rs. 89890 185049 Rs. 18 Balance Tax Payable :-…………………………………………………………. 13 3% Educational cess on tax :-…………………………………………………… 14 Tax Payable including educational cess(Col. if any as notified :. Rs.Svngs Bond) a) Contribution to G. 30% v) For Women employee upto Rs.A. Rs. Pan No GIR NO Office permanent A/C No.S. 0 274939 ### ### ### ### Ch ### ### Hn Rs.F. Rs.S.Tax Nil 12 Total Tax :-…………………………………………………………………………. 742.tax) 6 Exemption of Conveyance Allowances U/s 10(14)(i)[Max.000/-:Rs. :.INCOME TAX STATEMENT FOR THE FINANCIAL YEAR 2010-2011 ASSESSMENT YEAR 2011-2012 A.505 75 2.A.1 + 2 ) :-……………………………………………………………… 4 Interest paid as H. 3 Gross Income(Col. Rs.Rs 9600/-P.C. 0 g) Payment of H.to Tax Nil. Rs.B. 480 d) L. 0 c) Expenditure on rent in excess of 50% of B.80DDB 0 80G 0 Rs.000/.R. 11 i) Upto Rs.000/-Tax 10% iii) Rs.1...:-…………………………… b) House Rent Allowance :-…………………………………………………………… c) Bonus :-………………………………………………………………………………… d) Arrear.B.Lip Premiam paid(including Notified Pension Scheme for maximum Rs. 84.F. Rs.A. Rs. Rs.including T.Loan (Principal) :Rs.………………………………….A.I. Rs.c):Rs.………………. 15 Relief U/S 89(1)[Arrears Relief from Salary] 16 Net Tax Payable ( 14-15) 17 Tax already deducted from source :-…………………………………………. … Rs. 0 i) 80U 0 ii)80DD 0 iii)80D 0 80E 0 k) Total Amount Deducted (a to j) :-……………………….Pay + D. 0 f) Amount paid as excluisively tuition fees to any University/College/School for maximum of two Children( 2 )Maximum Rs. Rs. Rs. Rs. Rs.C. 235776 24000 1000 15703 0 0 276479 0 1540 0 ### ### Rs.Loan (1.1.{Max-20000/-) Rs.617 963 963 (0) ### Signature of the employee Designation .C.000/. Residential Address JIAGANJ JIAGANJ MURSHIDABAD Pin Code No.001/-to Onwards Tax (ii)Rs.if any :-………………………………………………………………………….000/. Rs.8. 2.. Rs.60.5 Lacks maximum) U/S 24(B):-……………………….00..1.00.169 10% of B.60./P. 7 Exemption U/S 10(13A) :a) H. Rs.123 - 1 a) Salary income with allowance excluding H.3-4-5-6-7) :-………………………………………………………. 0 8 Total Income(Col.5.I.R./E. Name & Designation of the Assesses B.Tax 20%. 5 Professional Tax U/S 16(iii) :-(For Handcpd employees are exempt from P. 41002 e)Purchase of N.L.Pay + D.580 1.20. C. 89890 10 Taxable Income (7-8) :-……………………………………………………………. 0 c) Group Insurance Savings Scheme :. 12408 h) Equity linked savings scheme/tax savings bond etc. Refundable - Rs.0001/./U. Rs.10. iv)Rs.00.

A./ ESI 3000 110 TAX 130 G.R. Paid Adv.S.P.B.B.Date P.A. Pay Statement for the year 2010-2011(April'10 to March'11) MONTH & Year Basic Pay D.Tax Paid Apr-10 14410 3983 2000 300 0 20693 40 1034 0 0 May-10 14410 2306 2000 300 0 19016 3000 40 1034 0 0 Jun-10 14410 2306 2000 300 0 19016 3000 130 40 1034 0 0 Jul-10 14850 2376 2000 300 0 19526 3000 130 40 1034 0 0 Aug-10 14850 2376 2000 350 0 19576 3000 130 40 1034 0 0 Sep-10 14850 2376 2000 500 0 19726 3000 130 40 1034 0 0 Oct-10 14850 2376 2000 500 0 19726 3000 130 40 1034 0 0 Nov-10 14850 2376 2000 500 0 19726 3000 130 40 1034 0 0 Dec-10 14850 3267 2000 500 0 20617 3000 130 40 1034 0 0 Jan-11 14850 3267 2000 500 0 20617 3000 130 40 1034 0 0 Feb-11 14850 3267 2000 500 0 20617 3000 130 40 1034 0 0 Mar-11 14850 3267 2000 500 0 20617 3000 130 40 1034 0 963 TOTAL 176880 33543 24000 5050 0 239473 36000 1540 480 12408 0 963 If the Employee is a Handicapped Employee the P.P./ P. H.Loan Prnc H.Tax is Exempted Signature of Employee Designation Date . Int./ E.A. Conv.F. M. H. Allown TOTAL G.F.F.I.

80E.LOAN(PRINCIPAL) B (a) (b) © (d) f) Section Section Section Section Section 80 E 80 G 80U 80DD 80D 80CC Other sections e. Rs.. 1961 for Tax deducted at source from Income chargable under the head on Salary Name and address of the Employer Amar Kr.Rs. wherever applicable) Less: Allowance to the extent exempt u/s 2 10 Allowance Rs.16 [See rule 31(1)(a)] Certificate under section 203 of the Income-tax Act. Rs.L.I. Rs. 8 Gross total income (6+7) 9 Deductions under Chapter VIA U/s 80C (Aggregate amount A Max. 12BA.of Deductor AA5544C TAN No.20.80C-G.000/-) u/s 24(B) (b) Tax on employment Rs. of all quarterly statements of TDS under sub-section (3) of section 200 as provided by TIN Facilitation Centre or NSDLWebsite. Rs. Quarter Acknowledgement No 2010-2011 From To Q1 500 31/6/10 2011-2012 Q2 600 31/9/10 Apr-10 Mar-11 Q3 700 31/12/10 Q4 800 31/3/11 DETAILS OF TAX DEDUCTED AND DEPOSITED INTO CERTRAL GOVERNMENT ACCOUNT 1 Gross Salary Salary as per provisions contained in (a) section 17(1) Value of perquisites under section (b) 17(2)(as per Form No.(Max(a) 1. Rs. Rs.000/-) (a)(i)Sec.wherever applicable) Profits in lieu of salary under section (c) 17(3)(as per Form No. 36000 480 41002 12408 Gross Amount (iv) H.+P.S. of the Employee Period Assessment Year Acknowledgement Nos. (ii) G. 0 Rs.Loan Int.C. Gross Amount 5 Aggregate of 4(a) to (b) the head Income chargeable under 'salaries' 6 Add: Any other income reported by the (3-5) 7 employee a)Income form N.FORM NO.S.of the Deductor - PAN NO.I. Bosu Name and designation of the employee - PAN NO.B. Rs.C.+U.etc. (iii) L.I.F.1. Rs.etc under chapter VI Rs.B.80G./Bank int.g. 0 0 0 0 0 0 .P.LIP+Tuition Fees+NSC+Tax Savings Bond 274939 Deductible Amount Rs. (e) Section 0 0 0 0 0 0 Qulfy amount 89890 89890 Deductible Amount Rs. Rs. 12BA. 0 276479 0 1540 1540 274939 Rs.50. IN RUPEES IN RUPEES IN RUPEES 276479 0 0 276479 (d) TOTAL 0 3 Balance(1-2) 4 Deductions : H.

of which tax deposited (dd/mm/yy 1 2 3 4 5 6 7 8 9 10 11 12 13 963 75 April May June July August September October November December January February March I.12 14 Education & cess @3% on col. Dt. 0 0 89890 185049 2. No Rs. Sl.No.617 963 963 Refundable Tax payable 0 DETAILS OF TAX DEDUCTED AND DEPOSITED INTO CERTRAL GOVERNMENT ACCOUNT (The employer is to provide transaction-wise details of tax deducted and deposited) Transfer voucher No/Challan Identification No. I further certify that the information given above is true and correct based on the books of account.G) Section 80DDB Aggregate of deductible amount under 10 Chap. 963 0 0 0 0 0 0 0 0 0 0 0 963 son/daughter of (designation) do hereby certify that a sum of Rs (In words) 000955 000955 000955 000955 000955 000955 000955 000955 000955 000955 000955 000955 31/4/2010 31/5/2010 31/6/2010 31/7/2010 31/8/2010 31/9/2010 31/10/2010 31/11/2010 31/12/2010 31/1/2011 28/2/2011 31/3/2011 1 1 1 2 2 2 3 3 3 4 4 4 working in the capacity of Rupees has been deducted at source and paid to the credit of the Central Government. documents and other available records. Cess Rs. VIA 11 Total Income (8-10) 12 Tax on total income 13 Surcharge on col.505 0 75 2580 1.1718) Rs. Total Tax Cheque No/DD BSR Code of Deposited No (if any) Bank Branch Rs. Surcharge Education TDS Rs.no. Place Signature of the person responsible for deduction of tax Date .12 15 Tax payable (12+13+14) 16 Relief U/s 89(1) Tax payable/refundable (1517 16) 18 Less (a) Tax deducted at source 19 Net Tax col.

Full Name with desitgnation .

Surcharge and Education cess payable (8+9) ### Relief under Section 89 ### Relief under Section 90/91 ### Balance Tax Payable (10-11-12) 14 Total interest payable u/s 234A/234B/234C 185049 2505 8 75 9 ### 2580 7 ### 1.890 TAX COMPUTATION ### Total Tax. 1962)(Also see attached instuctions) First name PERSONAL INFORMATION Middle name Last name Flat /Door/Block No. enter Receipt No and Date of filing original return (DD/MM/YYYY) 31/5/2011 Original return(DD/MM/YYYY) Residential Status (Tick) √ ORIGINAL Non-Resident √ Resident Resident but not ordinarily Reside INCOME & DEDUCTIONS 274939 0 2 Income chargeable under the Head 'House Property'(enter-ve sign in case of loss. PSU Others Employer Category FILING STATUS MURSHIDABAD West Bengal 742123 √ male√ Email Addrs.Phone Number Designation of Assessing Officer (Ward/Circle) Return Filed Under Section1 1 [Please see instruction number-9(i)] Whether original or Revised return? (Tick) Original Revised √ √ If revised. if any) 3 Gross Total Income 274939 4 (1+2+3) 4 1 Income chargeable under the Head 'Salaries'. if any) 2 Income chargeable under the Head 'Other Sources' (enter-ve sign in 0 3 case of loss.INDIAN INCOME TAX RETURN SARAL-II (ITR-I) [For Individual having Income from Salary/Pension/income from One House Property(Excluding loss brought forward from previous years)/Income from Other Sources (Excluding Winning from Lottery and income from Race Horses)] Assessment Year FORM 2 0 1 1 Pan No 1 2 (Please see Rule 12 of the Income-tax Rules.617 ### 0 ### 963 14 15 ### ### 0 963 ### Total Tax and Interest payable (12+13) Do not write or stamp in this areas for office use only Seal and signature of receiving official Receipt No. Date 1 .Pension 1 5 Deductions under chapter VIA (Section a 80C 89890 e 80DD 0 b 80CCC 0 f 80DDB 0 c 80CCD 0 g 80E 0 d 80D 0 h 80G 6 Deductions (Total of 5a to5i) 7 Total Income (4-6) 8 Tax Payable on 'Aggregate Income' 9 Education Cess on (on 8) 0 I j k l 80GG 80GGA 80GGC 80U 0 0 0 0 6 89. (STD Code) . 0 Road/Street/Post Office - Name Of Premises/Building/Village Date of Birth JIAGANJ Area/Locality 12/30/1899 Employer Category √ JIAGANJ Town/City/District State JIAGANJ Pin code √ Govt.

1 .

B.) No Branch (DD/MM/YYYY) Challan 000955 31/6/10 500 0 (i) S.No. Code Amount (Rs.17 of TAXES PAID 963 26 Other Information (Transactions reported through Annual Information Return) (Please see instruction number-9(ii) Sl. 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 in accordance with the provisions of the Income -tax Act.I.B. 1961. Cess) e (2) 0 (3) Amar Kr.I. Chapter VIdeposited the head salaries surch.B. Bosu (4) 274. also give Bank account details below) 19 0 20 Enter your bank account chequ (mandatory in case of refund) number 800lk 21 Do you want your refund bye or deposited directly into your bank account? (tick as applicable √ 22 Give additional details of your bank account MICR Code 500 Type of Account (tick as applicable) √ Current 23 Details of Tax Deducted at Source from Salary [As per Form 16 issued by Employer(s)] REFUND TAXES PAID TDS ON SALARY Tax Deduction Sl Account No Number(TAN) of the Employer (1) Name and address of the Employer TAX Tax Deduction Income payable under Total tax chargeable under (incl.) Sl.16 Taxes Paid a Advance Tax (from item 25) b TDS (column 7 of item23+column 7 of item 24) c Self Assessment Tax (from item 25) 17 Total Taxes paid (16a+16b+16c) 16a 16b 16c 17 963 0 0 963 0 18 Tax payable(15-17)(enter if 15 is greater than 17.I.) Sl. lalbagh NOTE Enter the total of Advance tax and Self Assessmen tax in Sl. Code Amount (Rs.890 (6) 963 (7) 963 (8) 0 24 Details of Tax Deducted at Source other than salary TDS ON INTEREST Tax Deduction Namee and Account Sl address of the No Number(TAN) of the Deductor Deductor (1) Amount paid/ credited (4) Amount out of Date of Total tax (6) claim Payment /Credit deposited for this year (5) (6) (7) 0 0 0 (2) (3) NOTE Enter the total of column (7) of 23and column (7) of 17 of TAXES PAID 25 Details of Advance Tax and Self Assessment Tax Payments Name of Bank & Date of Deposit Serial Number of Sl BSR Code Amount (Rs.) a 001 e 004 h 007 b 002 f 005 i 008 c 003 g 006 j 27 Exempt income only for reporting purposes(from Dividend. lalbagh 000955 31/9/10 600 0 (ii) S. else leave blank) 18 ### 19 Refund (18-17) (enter if 15d is greater than 14. Code Amount (Rs. lalbagh 000955 31/12/10 0 (iii) S. in respect of income chargeable to income-tax for the previous year relevant to the Assessment Year 2010-11 Place Date Sign here 28 If the return has been prepared by a Tax Return Preparer (TRP) give further details as below : 2 .I. Capital gains etc) 27 VERIFICATION I. And Refundabl A edn.939 (5) 89. lalbagh 700 000955 31/3/11 800 963 (iv) S. son/ daughter of TAX PAYMENTS solemnly declare that to the best of my knwledge and belief.B.

amount thereof ### 29 (to be filled by TRP) 2 . of TRP Name of TRP Counter Signature of TRP If TRP is entitled for any reimbursement from the Government.Identification No.

1 for assessment year 20011-2012.Government of India INCOME TAX DEPARTMENT ACKNOWLEDGEMENT Received with thanks form: 0 . Date: 1 Gross total income 1 2 Deduction under Chapter-VI-A 2 3 Total Income 3 4 Net tax payable 4 5 Interest payable 5 6 Total tax and interest payable 6 7 Taxes paid a Advance Tax 7a 963 b TDS 7b 0 c TCS 7c 0 d Self Assessment Tax 7d 0 e Total Taxes paid (7a+7b+7c+7d) 7e 8 Tax payable (6-7e) 8 9 Refund (7e-6) 9 10 Value of Fringe Benefits 10 11 Total fringe benefit tax liability 11 12 Total interest payable 12 13 Total tax and interest payable 13 14 Taxes paid a Advance Tax 14a b Self Assessment Tax 14b c Total Taxes paid (14a+14b) 14c 15 Tax payable (13-14c) 15 16 Refund (14c-13) 16 Seal and Signature of receiving official: 963 0 0 NA NA NA NA NA ### ### NA NA NA . having the following particulars: PERSONAL INFORMATION Name 0 0 Road/Street/Post Office: JIAGANJ Town/City/District: MURSHIDABAD Designation of Assessing Officer Flat/Door/Block No: PAN NO 0 Name of Premises/Building/Village: JIAGANJ Area/Locality: JIAGANJ State: West Bengal Status(fill the code) Govt Original/Revised 11 Original 274939 89890 185049 963 0 963 Computation of Income & Fringe Benefits & Tax Thereon COMPUTATION OF INCOME & TAX THEREON Receipt No.0 a return of income &/return of fringe benefits in Form No ITR .

.

extending over a period of not less than 5 years in accordance with the provisions of sub-rule (3) of rule 21A. Payment in the nature of compensation from the employer or former employer at or in connection with termination of employment after continuous service of not less than 3 years or where the unexpired portion of term of employment is also not less than 3 ye Payment in commutation of pension in accordance with the provisions of sub-rule (5) of rule 21A Detailed particulars of payments referred to above may be given in Annexure I.IIA. 15.FORM NO.III. or IV as the case may be. 1962. Signature of the employee Verification _______. Payment in the nature of gratuity in respect of past services.II. the Day of I.703 Not Applicable (c) Not Applicable (d) 2 Not Applicable ANNEX-I ………………………………………….during the previous year relevant to assessment year 2010-11 1 (a) (b) Salary received in arrears or in advance in accordance with the provisions of sub-rule (2) of rule 21A.10 E [See rule 21AA] Form for furnishing particulars of income under section 192(2A) for the year ending 31 st March.co-operative society..do hereby declare that what is stated above is true to the best of my knowledge and belief. Place: …………………….local authority . Verified today.university. Date:…………………… ……………………………………… Signature of the employee . instituty 1 2 3 Name and address of the employee Permanent account number Residential status PERMANENT RESIDENT - Particulars of income referred to in rule 21A of the Income-tax Rules. 2010 for claiming relief under section 89(1) by a Government servant or an employee in a 2[company.

.

) (Rs.346 15703 185.) Difference in tax [Amount under column (6) minus amount under column (5)] (Rs.) colmn 2 & 3] (Rs.) relevent advance) of the including Edn and including previous year relevent previous Cess and Edn Cess and as mentioned year mentioned in Surcharge] Surcharge] in column (1) column (1) [add (Rs.10E] Arrears or advance salary Sl No.000 15703 154.) Previous year (1) (2) (3) (4) (5) (6) (7) 2009-10 139.049 2.ANNEXURE-I [See item 2 of Form No. 1 2 3 4 5 6 7 8 Particulars Total income (excluding salary received in arrears or advance) Salary received in arrears or advance Total income (as increased by salary received in arrears or advance) [Add item 1 and item 2] Tax on total income [as per item 3] Tax on total income [as per item 1] Tax on salary received in arrears or advance [Difference of item 4 and item 5] Tax computed in accordance with Table "A" [Brought from column 7 of Table A] Relief under Section 89(1) [Indicate difference between the amounts mentioned against item 6 and item 7] Amount (Rs.617 ### TABLE "A" [See item 7 of Annexure 1] Total income Salary received Total income (as Tax on total Tax on total of the in arrears or increased by income [as per income[as per relevent advance salary received in column (2)-After column (4) previous year relating to the arrears or Rebate and After Rebate (Rs.) (Rs.580 ### 963 1.617 0 1.703 0 0 0 ### ### Signature: Place: Date: Name: Designation: Dept: .) 169.