National Board of Revenue

www.nbr.gov.bd

RETURN OF INCOME
For an Individual Assessee

The following schedules shall be

the integral part of this return and
must be annexed to return in the
following cases:

Schedule if you have income

24A from Salaries

Schedule if you have income

24B from house property

if you have income

Schedule
from business or Photo
24C
profession

Schedule if you claim tax

24D rebate

PART I
Basic information

1 Assessment Year 2

2 0     -    
 

3 Name of the Assessee 4

5 Twelve-digit TIN 6
 5 Twelve-digit TIN 6

7 Circle 8

   
9 Resident Status (tick one) Resident

Tick on the box(es) below if you are:

A gazetted war-
wounded
10A 10B
10 freedom fighter

Aged 65 years
10C 10D
or more

        2 0  
11 Date of birth (DD-MM-YYYY) 12

13 If employed, employer’s name

14 Spouse Name 15

16 Father’s Name 17

18 Present Address 19

20 Contact Telephone 21

22 National Identification Number 23

PART II
Particulars of Income and Tax
TIN:                    

Particulars
of Total
Income
Salaries (annex
24 S.21 720400
Schedule 24A)

25 Interest on securities S.22

Income from house

26 property (annex S.24
Schedule 24B)

27 Agricultural income S.26

Income from
business or
28 S.28
profession (annex
Schedule 24C)
29 Capital gains S.31
Income from other
30 S.33
sources
Share of income
31
from firm or AOP
Income of minor or
32 spouse under section S.43
43(4)
33 Foreign income
Total income
34 (aggregate of 24 to 720400
33)
 Computati
on and
Payment Amount $

Gross tax before tax

35 45560
rebate
Tax rebate (annex
36 8820
Schedule 24D)
Net tax after tax
37 36740
rebate
38 Minimum tax

39 Net wealth surcharge

Interest or any other

40 amount under the
Ordinance (if any)
Total amount
41 36740
payable
Tax deducted or
42 collected at source
(attach proof)
Advance tax paid
43
(attach proof)
Adjustment of tax
refund [mention
44
assessment year(s)
of refund]

Amount paid with

45
return (attach proof)

Total amount paid

46 and adjusted 0
(42+43+44+45)

Deficit or excess
47 36740
(refundable) (41-46)

Tax exempted
48 50000
income

PART III
Instruction, Enclosures and Verification
 TIN:                    

Instructions

1. Statement of assets, liabilities and expenses (IT-10B2016) and statement of

life style expense (IT-10BB2016) must be furnished with the return unless you
are exempted from furnishing such statement(s) under section 80.

49

2. Proof of payments of tax, including advance tax and withholding tax and the
proof of investment for tax rebate must be provided along with return.

3. Attach account statements and other documents where applicable

   

If you are a parent of a person with

disability, has your spouse availed
50 Yes
the extended tax exemption
threshold? (tick one)
   

Are you required to submit a

statement of assets, liabilities and
51 Yes
expenses (IT-10B2016) under
section 80(1)? (tick one)

Schedules annexed
24A   24B   24C   24D  
52 (tick all that are
applicable)
IT-10B2016   Statements annexed IT-10BB2016  
53 (tick all that are
applicable)

54 Other statements, documents, etc. attached (list all)

Verification and signature

Verification

I solemnly declare that to the best of

my knowledge and belief the
information given in this return and
statements and documents annexed
or attached herewith are correct and
complete.

55

Name Signature

Date of Signature Place of

(DD-MM-YYYY) Signature
 Date of Signature Place of
(DD-MM-YYYY) Signature

        2 0    

For official use only

Return Submission Information

Date of
Submissio Tax Office Entry
n (DD-MM- Number
YYYY)

           

        2 0    

National Board of Revenue

www.nbr.gov.bd

ACKNOWLEDGEMENT RECEIPT OF
RETURN OF INCOME

Return under section 82BB? (tick

Assessmen one)
t Year

    Yes No
2 0     -    
Name of the Assessee

Twelve-
Old TIN
digit TIN

Circle Taxes Zone

Circle Taxes Zone

Total income shown (serial 34)

৳

Amount
Amount paid and adjusted (serial
payable
46)
(serial 41)
৳ ৳

Amount of
net wealth
Amount of net wealth surcharge
shown in
paid
IT10B201
6
৳ ৳

Date of
Submissio Tax Office Entry Number
n (DD-MM-
YYYY)

        2 0    

Signature and seal of the official receiving the

return

Date of
Contact Number of Tax Office
Signature
 IT-11GA2016

Return submitted under

section 82BB? (tick one)

 
 
Yes No

Gender (tick one) M   F  

Old TIN
 Old TIN

Zone

Non-resident

   

A person with disability

A parent/legal  guardian of a  
person
with disability

   
Income Year

  t  
o

Spouse TIN (if any)

Mother’s Name

Permanent Address

E-mail

Business Identification
Number(s)
     

Amount $

Tax Calculation

Income Slab Rate Amount of Tax

350000 0% 0
100000 5% 5000

270400 15% 40560

20% 0

25% 0
0

Total 720400 45560

      

16) and statement of

he return unless you
n 80.

hholding tax and the

ith return.

plicable

No
 No

 
 

Individual
 SCHEDULE 24A
Particulars of income from Salaries
Annex this Schedule to the return of income if you have income from Salaries

1 Assessment Year

2 0    

Particulars

3 Basic pay
4 Special pay
5 Gratuity
6 Dearness allowance
7 House rent allowance
8 Medical allowance
9 Conveyance allowance
10 Festival Allowance
11 Allowance for support staff
12 Leave allowance
13 Honorarium/ Reward/Fee
14 Overtime allowance
15 Bonus / Ex-gratia
16 Other allowances (travel allowance)
Employer’s contribution to a
17
recognized provident fund
Interest accrued on a recognized
18
provident fund

19 Deemed income for transport facility

 Deemed income for free furnished/
20 unfurnished accommodation or rent
free accomodation

21 Other (Wroker Participation Fund)

22 Total
All figures
of amount
are in taka
(৳)

Name Signature & Date

 2 TIN

  -    

Amount Tax exempted Taxable

(A) (B) (C = A-B)
480000 480000
0
0
48000 48000
0
0
0
80000 80000
2400 2400
0
0
0
40000 40000
0

0
60000 60000

60000 50000 10000

770400 50000 720400
 SCHEDULE 24B
Particulars of income from house property
Annex this Schedule to the return of income if you have income from house property

Assessm
1 2 TIN
ent Year

2 0     -    

For each
house
property

Description of the house property

03B
3 Address
03A of the
property 03C

Municipal Value 2097778

Income from house property Amount ৳

Actual Value 1966667
4 Annual Value 2597778
Deductions
(aggregate of 05A 807833
Yearly interest 135000 to 05G)
Repair,
05A Collectio 629333
Monthly interest 11250 n, etc.
Municipa
l or
05B
Local
Tax

5
 Land
05C
Revenue

5 Interest
on
Loan/Mo
05D 178500
rtgage/C
apital
Charge

Insuranc
05E e
Premium
Vacancy
05F Allowan
ce
Other, if
05G
any
Income from house
6 1789945
property (04-05)
In case of partial
7 ownership, the
share of income

Provide
informati
on if
income
from
more
than one
house
property

Aggregate of
income of all house
2198945
properties
(1+2+3+4+5 )

(Income
from
1 house 1789945
property
1)
8
8
(Income
from
2 house 34400
property
2)

(Income
from
3 house 16000
property
3)

(Income
from
4 house 6000
property
4)

(Income
from
5 house 5000
property
5)

(Income
from
6 house 347600
property
5)

Signature
Name
& Date
property
Total
area
Share of
the
asessee
(%)
2nd 3rd 4th
1st bldg Advaced
Building Building Building 1800000*7.5%
59200 26000 12000 8000 488000

24800 10000 6000 3000 140400

14800 6000 3000 2000 140400

4000
 2500

500

10000 1000

34400 16000 6000 5000 347600

 SCHEDULE 24D
Particulars of tax credit/rebate
To be annexed to return by an assessee claiming investment tax credit
(Attach the proof of claimed investment, contribution, etc.)

Assessm
1 2 TIN
ent Year

2 0     -    

Particulars of rebatable investment, contribution,

Amount ৳
etc.

3 Life insurance premium

Contribution to deposit pension scheme

4 6000
(not exceeding allowable limit)

Investment in approved savings

5
certificate

Investment in approved debenture or

6
debenture stock, Stock or Shares
 Contribution to provident fund to which
7 48000
Provident Fund Act, 1925 applies

Self contribution and employer’s

8 contribution to Recognized Provident
Fund

9 Contribution to Super Annuation Fund

Contribution to Benevolent Fund and

10 4800
Group Insurance Premium

11 Contribution to Zakat Fund

12 Others, if any ( laptop )

Total allowable investment,

13 58800
contribution etc.

Eligible amount for rebate (the lesser of

58800
14A, 14B or 14C)

Total allowable investment,

14A
contribution, etc. (as in 13)
58800

.....25... % of the total income

[excluding any income for
14 which a tax exemption or a
reduced rate is applicable under
14B sub-section (4) of section 44 or 180100
any income from any source or
sources mentioned in clause (a)
of sub-section (2) of section
82C.]

14C 1.5 crore

 Amount of tax rebate calculated on
15 eligible amount (Serial14) under 8820
section 44(2)(b)

Signature
Name
& Date
National Board of Revenue IT-10B2016
www.nbr.gov.bd

­
STATEMENT OF ASSETS, LIABILITIES AND EXPENSES
under section 80(1) of the Income Tax Ordinance, 1984 (XXXVI of 1984)

1.     
Mention
the
amount of
assets and
liabilities
that you
have at
the last
date of
the
income
year. All
items
shall be at
cost value
include
legal,
registrati
on and all
other
related
costs;
2.      If
your
spouse or
minor
children
and
dependent
(s) are not
assessee,
you have
to include
their
assets and
liabilities
in your
statement;
3.     
Schedule
25 is the
integral
part of
this
Statement
if you
have
business
capital or
agricultur
e or non-
agricultur
al
property.
Provide
additional
papers if
necessary
.

Assessm
1 2
ent Year

2 0    

Name of
3 the 4
Assessee
Particulars

Business capital (05A+05B)

05A Business capital other than 05
5 Director’s shareholdings
05B limited companies (as
Schedule 25)
Non-agricultural property
06A
in Schedule 25)
6 Advance made for no
06B agricultural property (as
Schedule25)
Agricultural property
7
Schedule25)
Financial assets va
(08A+08B+08C+08D+08E)
08A Share, debentures etc.
Savings certificate, bonds a
08B
other government securities
8 Fixed deposit, Term depo
08C
and DPS
Loans given to others (ment
08D
name and TIN)
Other financial assets (g
08E
details)
Motor car (s) (use additional papers
more than two cars)
Brand
9 Sl. name
1
2
Gold, diamond, gems and other ite
10
(mention quantity)
Furniture, equipment and electro
11
items
12 Other assets of significant value
Cash and fund outside busin
(13A+13B+13C+13D)
13A Notes and currencies
Banks, cards and ot
13 13B
electronic cash
13C Provident fund and other fun
Other deposits, balance a
13D
advance (other than 08)
 14 Gross wealth (aggregate of 05 to 13)
Liabilities outside busin
(15A+15B+15C)
Borrowings from banks a
15A
15 other financial institutions
Unsecured loan (mention na
15B
and TIN)
15C Other loans or overdrafts
16 Net wealth (14-15)
Net wealth at the last date of
17
previous income year
18 Change in net wealth (16-17)
Other fund outflow during the inco
year (19A+19B+19C)

Annual living expenditure a

19A
tax payments (as IT-10BB20
19
Loss, deductions, expenses, e
19B
not mentioned in IT-10BB20

Gift, donation and contribut

19C
(mention name of recipient)
Total fund outflow in the income y
20
(18+19)
Sources of fund (21A+21B+21C)
21A Income shown in the return
21 Tax exempted income a
21B
allowance
21C Other receipts and sources
22 Shortage of fund, if any (21-20)

Verification and signature

Verification

23
 I solemnly declare
that to the best of
my knowledge and
belief the
information given
in this statement
23 and the schedule
annexed herewith
are correct and
complete.

Signature
Name
& date

SCHEDULE 25
to be annexed to the Statement of Assets, Liabilities and Expenses (IT-10B2016)

Assessm
1 2
ent Year

Shareholdings in
limited companies
as director
31
2
3
4

Non-agricultural
property at cost
value or any
advance made for
such property
(description,
location and size)
4
1

2
 4

Agricultural
property at cost
value (description,
location and size)

5
1

(Provide
additiona
l paper if
necessar
y)

Signature
Name
& date
AND EXPENSES
1984 (XXXVI of 1984)
 Statemen
t as on
(DD-MM-
YYYY)

  -    
 -       2 0    

TIN
 Amount ৳

capital (05A+05B)
Business capital other than 05B
Director’s shareholdings in
limited companies (as in
Schedule 25)
Non-agricultural property (as
7500000
in Schedule 25)
Advance made for non-
agricultural property (as in
Schedule25)
ural property (as in
575000
25)
assets value 1170000
B+08C+08D+08E)
Share, debentures etc. 433000
Savings certificate, bonds and
1057000
other government securities
Fixed deposit, Term deposits
55000
and DPS
Loans given to others (mention
name and TIN)
Other financial assets (give
58000
details)
ar (s) (use additional papers if
n two cars)
255000
Engine Registrat
(CC) ion No.

amond, gems and other items

99000
quantity)
, equipment and electronic
85600
ets of significant value
nd fund outside business 182000
B+13C+13D)
Notes and currencies 177200
Banks, cards and other
4800
electronic cash
Provident fund and other fund
Other deposits, balance and
advance (other than 08)
ealth (aggregate of 05 to 13) 9866600
s outside business
278000
B+15C)
Borrowings from banks and
278000
other financial institutions
Unsecured loan (mention name
and TIN)
Other loans or overdrafts
th (14-15) 9588600
lth at the last date of the
income year
n net wealth (16-17)
nd outflow during the income
A+19B+19C)

Annual living expenditure and

tax payments (as IT-10BB2016)

Loss, deductions, expenses, etc.

not mentioned in IT-10BB2016

Gift, donation and contribution

(mention name of recipient)
nd outflow in the income year

of fund (21A+21B+21C) 7284445

Income shown in the return 7252945
Tax exempted income and
31500
allowance
Other receipts and sources
of fund, if any (21-20)
d Expenses (IT-10B2016)

TIN

No. of
Value ৳
shares

280000

increased
Value at / Value at
the start decrease the last
of d during date of
income the income
year৳ income year ৳
year ৳

7500000
 increased
Value at / Value at
the start decrease the last
of d during date of
income the income
year৳ income year ৳
year ৳

575000
National Board of Revenue IT-10BB2016
www.nbr.gov.bd

­
STATEMENT OF EXPENSES RELATING TO LIFESTYLE
under section 80(2) of the Income Tax Ordinance, 1984 (XXXVI of 1984)

2 0    -    
-

Statemen
Assessm t as on
1 2
ent Year (DD-MM-
YYYY)

        2 0    

Name of
3 the 4 TIN
Assessee

Amount Commen
Particulars ৳ t
Expenses for food,
5 clothing and other 78000
essentials
6 Housing expense 2800
Auto and
transportation
6000
expenses
(07A+07B)

7
 Driver’s
7 salary,
07A fuel and
maintenan
ce

Other
07B transporta
tion

Household and
utility expenses 42400
(08A+08B+08C+08
D)

08A Electricity 1600

Gas,
water,
08B 2800
sewer and
garbage
8
Phone,
internet,
TV
08C
channels
subscripti
on

Home-
support
08D staff and 38000
other
expenses

Children’s
9 7800
education expenses
Special expenses
(10A+10B+10C+10 19000
D)
Festival,
party,
10A events 12000
and gifts

10
 Domestic
and
overseas
10 10B tour,
7000
holiday,
etc.

Donation,
10C philanthro
py, etc.

Other
10D special
expenses
Any other
11 26200
expenses
Total expense
12 relating to lifestyle 182200
(05+06+07+08+09+10
+11)

Payment of tax,
charges, etc.
(13A+13B)
Payment
13A of tax at
source
13
Payment
of tax,
13B surcharge
or other
amount

Total amount of
14 expense and tax 182200
(12+13)

Verification and signature

Verification

I solemnly declare
that to the best of
my knowledge and
belief the
information given
15
in this statement is
correct and
complete.
15

Signature
Name
& date