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Photograph o
(XXXVI OF 1984)
Universal Self/Normal
[Put tick () where applicable]
[to be atte
photo
Assessment Year: 2015-2016
Mr. Alam
3. National ID No:
Date of Birth:
0
1
0
5
Spouses TIN or Name :
0
(a) Circle:
0
(b) Taxes Zone:
Name and address of the employer:
Email:
4.
6.
7.
9.
Serial no.
1
2
3
4
5
6
7
8
9
10
11
12
0
0
Office
Mobile:
3,000.00
-
Verification
I,
Md. X
,
Father:
Md. Abdur Rahim, TIN: 624383329901
solemnly declare
of my knowledge and belief the information given in this return and statements and documents a
is correct and complete.
Place:
Date :
Dhaka
Enclosures:
Signature of th
(Name and sea
Amount in Taka
Basic Salary
100,000.00
House Rent
360,000.00
300,000.00
600,000.00
Whichever is lower
300,000.00
Conveyance Allowance
Medical Allowance
Less: Exempted Max. Tk.120,000.
Leave Encashment
Incentive Bonus
Festival Bonus
30,000.00
120,000.00
400,000.00
Whichever is lower
10%
4,500.00
10%
20,250.00
10%
2,250.00
4
5
10%
Signature of the A
Amount in Taka
120,000.00
120,000.00
60,000.00
100,000.00
Tax Rate
Taxable Income
0%
250,000.00
10%
400,000.00
15%
20%
25%
30%
500,000.00
327,000.00
1,477,000.00
240,000.00
Mr. Alam
0
0
0
Amount in Taka
100,000.00
500,000.00
-
Amount in Taka
750,000.00
110,000.00
-
300,000.00
-
Amount in Taka
1,477,000.00
4
300,000.00
-
I solemnly declare that to the best of my knowledge and belief the information given in this for
complete.
Name & signature of the A
Date:
Assets and liabilities of self, spouse (if she/he is not an assessee), minor children and dependant(s
the above statements.
*Please provide documents and use separate sheet, if needed.
Instructions:
(1) This return of income shall be signed and verified by the individual assessee or person as pre
the Income Tax Ordinance, 1984.
(2) Enclose where applicable:
(i) Salary statement for salary income;
(ii) Deed or rental agreement (if any) for house property income;
(iii) Documents in support of any other income or liabilities shown;
(iv) Documents in support of investments made in any form;
(v) Computation of income according to Income-tax Ordinance, 1984;
(vi) Provide evidence in support of tax payment.
(3) Documents furnished to support the declaration should be signed by the assessee or hi
representative.
(4) Assets and liabilities of self, spouse (if she/he is not an assessee), minor children and dependan
in this form.
(5) If needed, please use separate sheet.
(6) Please visit NBRs website www.nbr-bd.org for further information.
Mr. Alam
0
Assessment Year: 2
0
1,477,000.00
Tax Paid:
5
14,210,000.00
IT-11UMA
ORDINANCE, 1984
Photograph of the Assessee
[to be attested on the
photograph]
Non-resident
on 30/06/2015
Amount in Taka
1,380,000.00
55,000.00
12,000.00
30,000.00
1,477,000.00
180,400.00
36,000.00
144,400.00
4,000.00
3,000.00
-
3,000.00
141,400.00
300,000.00
unt in Taka
Amount in Taka
Pls input yearly basic salary.
100,000.00
360,000.00
1,200,000.00
Input yearly house rent.
300,000.00
600,000.00
300,000.00
60,000.00
30,000.00
120,000.00
120,000.00
400,000.00
-
1,380,000.00
55,000.00
12,000.00
Net Amount
4,500.00
5,000.00
20,250.00
22,500.00
2,250.00
2,500.00
30,000.00
1,477,000.00
8
unt in Taka
120,000.00
120,000.00
60,000.00
100,000.00
Amount in Taka
240,000.00
-
240,000.00
on RPF Less
is lower)
ble Income
250,000.00
407,100.00
15,000,000.00
407,100.00
240,000.00
Tax Liability
-
400,000.00
40,000.00
500,000.00
327,000.00
,477,000.00
240,000.00
75,000.00
65,400.00
180,400.00
36,000.00
144,400.00
144,400.00
4,000.00
144,400.00
500.00
9
2,250.00
250.00
141,400.00
Pls input Tax paid by you through pay order + AIT on car fitness &
tax token fee+ last year Tax Refund.
the Assessee
IT-10BBB
(as on 30/06/2015 )
Amount in Taka
10,000,000.00
800,000.00
unt in Taka
100,000.00
500,000.00
600,000.00
1,200,000.00
400,000.00
200,000.00
150,000.00
unt in Taka
750,000.00
110,000.00
860,000.00
14,210,000.00
300,000.00
300,000.00
13,910,000.00
5,000,000.00
8,910,000.00
1,500,000.00
10,410,000.00
unt in Taka
1,477,000.00
1,777,000.00
10
300,000.00
1,777,000.00
8,633,000.00
..
Return
ladesh
es
3,000.00
11
shown :
13,910,000.00
n Register:
12