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Income Tax Statement for the Financial Year 2010-2011(Assessment Year 2011-2012) In respect of

Name: PAN
Designation : Male(M)/Female(F)?
( To be furnished by Employees / Officers whose income exceeds Rs. 1,60,000/- )
March - 2010 Total Salary (1a) b/f
April Festival Allowance
May Leave Surrender
June Arrears of :-

OTHER BENEFITS
GROSS SALARY

July 1. Increment
August 2. Rural Allowance
1 September 3. PG Allowance
October 4. Hill Tract Allowance
November 5
December 6
January - 2011 Others (if any)
February
1a.Total Salary 0 Deduct Refund if any
Total Salary Income
2 Deductions:
a. Profession Tax Paid u/s 16 (iii)
b. House Rent Allowance (HRA) u/s 10(13A)
c. Transport Allowance (TA) u/s 10 (14)
d. Accrued Interest on Housing Loan u/s 24*
e.
f.
Less:- Total Deductions (a+b+c+d+e+f)
3 Balance after deductions (1 - 2)
4 Add any other income reported by the Employee
5 Deductions:
a. (Sec 80 C) : (Contribution made towards) Amount
b1. GPF ( Subscription + DA - Arrears )
b2. LIC ( SLI + GIS + GPAIS + Premium )
b3. Refund of Housing Loan ( Principal )
b4. NSC / Interest on NSC
b5. Tuition fee of children
b6. Mutual Funds
b7. Pension Fund (80 CCC)
Deduction Total (Rs. 1,00,000/- max.)
6 Other Deductions if any
1. 80 CCF( Infrastructure Bonds approved by Central Govt.- Max. Rs.20,000)
2. 80 D,80 DD,80 DDB
3. 80 G, 80 U
7 Balance Income
8 Taxable Income (Rounded off to nearest Rs. Ten)
9 Tax
10 Education Cess (3%)
11 Total Tax Payable
12 Relief/ Tax already paid
13 Balance Tax Payable
Dated signature of the employee
2011-2012) In respect of

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