34 3TTUT TY7 tàiy q¢ 2020-21

BLOCK-DIGH
DIST- BIIADOHI
PAN NO: ASSPY5688A Mob. No. 9452077679 DOB 05-Jul-92
AMIT KUMAR YADAV
N AME SEX M DESIGNATION: AT
FATHFR'S NAME: RAJ BAIADUR YADAV SCUOOL PS BASGOTI MAVAIYA
NAM
BANA NAME: STATE BANK OF INDIA CHHIVAYA Alc No. 31100682614

Grade Basie
Months Pay DA HRA Oth |Gross Pay NPS GISPMR |Ad. Total Net Pay
Pay Fund 1T Ded
Mar-20 4200 36500 6205 1340 44045 4271 87 1421 5779 38266
Apr-20 4200 365006205 1340 0 87
44045 4271 0 4358 39687
May-20 4200 36500 6205 1340 0 44045 4271 87 4358 39687
Jun-20 4200
36500 6205 340 44045 4271 87 0 4358 39687
Jul-20 1200 36500 62051340 44045 4271 87 0 0 4358 39687
Aug-20 4200 36500 6205 1340
44045 4271 87 0 0 4358 39687
Sep-20 4200 36500 6205 1340 44045 427187 4358
39687
Oct-20 4200 36500 62051340 0 44045 4271 87 0 4358 39687
Nov-20 4200 36500 6205 1340| 0
44045 4271 87 4358 39687
Dec-20 4200 36500 6205 1340 0
44045 4271 870 4358 39687
Jan-21 4200 37600 6392 1340 0
45332 4399 8 7 4486 40846
Feb-21 4200 37600 6392 1340 45332 4399 87 0 04486 40846
TOTAL 440200 74834 16080| 0 531114 51508 1044 1421 53973 477141
BONUS 2019-2020 6908 0 0 0 0 6908
OTHER AREAR 191719
TOTAL 729741
STANDARD DEDUCTION 50000|7-TT (7) H () T 53973
80-C 7 11- (Aa7 À) 679741 8-YIY (5)-(6) 609688
13d 2020 F
31HTd 2021 T
2-(1 J7T f7 16080|9-3A HTAT
2-(3T 4 T o(T) 2.5/3.0T TT 0%
GPF 3-9 T (1-2) 663661 (T) 2.50 T 5.0T T 5% 12500
NPS 1508|4-FYZT 3AT O5.0 10.0MT a 20%
10445-7 T
21938
GIS 663661 () 10.0 f 7 30%
LIC 6-7274
255211.2TRT 87A 4TE
34438
NSC (7) 8TRT 80-C (1,50000 a)
RT TT 5 TE a7 AtahaH 12500
Tut fee ( ) eTT 80-cCD (50,000) 50000|12-tTHT UA HTP Its4TR 4%
1378
PPF |(T) TT 80-D (25,000) |13-5 3T7
35816|
H.Loan |(7)9ITT-DDB (40,000) |14-Rebate U/s 89(10E qAT)
37194|
Other (F) ATRT 80-U(75,000-1,25000)
TOTAL 2552()TRT80-G 1421 15-E IT arTT

A r m d k y o

Sig. of Candidate
Sig. of Sub Div.0ff.(BEO0)
 FORM N0. 10E
See rule 21AA]
Form for furnishing particulars of income under section 192(2A) for the year
ending 31st March,2021 for claiming relief under section 89(1) by a Government
servant or an employee in a company, co-operative society, local authority,
university, institution, association or body

1. Name and address ofthe employee AMIT EUMAR YADAV , SoUTH KoTwA,JAMUMTPUR,, ALLO
2215o5
2. Permanent Account Number or Aadhaar Number AsspPY S688A
3. Residential status
INOVIDUAL
3598 0604-3416
Particulars of income referred to in rule 21A ofthe Income tax Rules, 1962, during the previous year relevant to
assessment year

1 (a) Salary received in arrears or in advance in accordance Rs. 191719

with the provisions of sub-rule (2) of rule 21A
(b) Payment in the nature of gratuity in respect of past services,
extending over a period of not less than 5 ycars in accordance
with the provisions of sub-rule (3)) of rule 21A
(c) in the nature of compensation from the employer or
Payment
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 years in accordance with the provisions of sub-rule (4)
ofrule 21A

(d) Payment in commutation of pension in accordance with the

provisions of sub-rule (5) ofrule 21A
2. Detailed particulars of payments referred to above may be given in
Annexure I, I1, MA, ll or IV, as the case may be

Amto

Signature of the employee

Verification
AMIT KUMAR YADAV
A , do hereby declare that what is stated above is true to the best of my knowledge and belief.
Verified today, the day of
Amwlleyosl

Place BHADoN
Date Signature of the employee

ANNEXUREI
See item 2 of Form No. 10E]
ARREARS OR ADVANCE SALARY

Total income (excluding salary received in arrears or 538022

advance)
2. Salary received in arrTears or advance 9719
3. Total income (as increased by salary recei ved in arrears or 7 2974 1
advance)[Add item 1 and item 2]
. Tax on total income (as per item 3) 35816
5. Tax on total income (as per item
6. Tax on salary received in arrears or advance [Difference of
3s81
 item 4 and item 5]|
7 Tax computed in accordance with Table "A" [Brought from
column 7 of Table "A"
8. Relief under section 89(1) [Indicate the difference between
the amounts mentioned against items 6 and 7]

TABLE "A"
See item 7 of'Anncxure I

Previous Total income of Salary recieved in Tolal income (us Tax on total income Tax on tolal ineome Difference n lak
Vear(s) the relevant arrears or advance increased by salary /as per column(2)/ as per column(4)) Amount under cohumn
prevous year relating to the received in arrears or (6) minus umount under
relevant jprevions
vear as mentioned
advance) ofthe
releant previous yecur
olumn (5

in column(1) menlioned in
coumn(l)/Add
columns (2) and (3))
(RS)_ (K (Rs.) (Rs.)
5
20/9-2024S 128 1917/2 3976 27

Note: In this Table. details of salary received in arrears or advance relating to different previous years may
be furnished.

ANNEXURE I1
See item 2 of Form No. 10E]
GRATUITY
Past services extending over a period of5 years or more but less than 15 years

1 Gratuity received

2 Total income (including gratuity)

3. Tax on total income mentioned against item2

4. Average rate of tax applicable on tolal income [Divide amount

mentioned against item 3 by amount mentioned against item 2]

5. Tax payable on gratuity by applying the average rate of tax

IMultiply average rate of tax mentioned against item 4 with
amount of gratuity mentioned against item 1]

6. Total income of two previous years immediately preceding the

previous year in which gratuity is received

(ii)
1. Add one-half of the gratuity mentioned against item 1 in the
total income of cach of the two preceding previous years
mentioned against item 6
(i)
(ii)
8. Tax on total income of each of the preceding previous years
mentioned against item 7
i)
(1i)