FORM OF RETURN OF INCOME UNDER THE INCOME TAX IT-11UMA | ORDINANCE 1984 (XXXVI OF 1984) ON Photograph of the Assessee {to be attested on the photograph] Assessment year: 2016-2017 1. Name of Assessee: Md. Noor A Alam Siddique TIN 7[3 [3 ol4]3]3]2]°]8]9 3. National ID No: 2[é[il7[*¢|3]5|/4]5]2]*]1]8 4. Date of Binh OTT ToT [1] 9] 71] 8] 5 kmait:siddiquestsegmaitcom 6. Spouse's TIN or Name: Masuda Akhter 7. (a)Circle: 127 (b) Taxes Zone: 8 Residential Status: Resident ["V_] Non-resident 9, Name and address ofthe employer: Jamuna Bank Limited, Head Office, Hadi Mansion 2 Dilkusha c/a, Motijheel, Dhaka-1000, 10. Present address: Jamuna Bank Limited, Head Office, Hadi Mansion 2 Dilkusha c/a, Motijheel, Dhaka-1000. 11. ‘Telephone: Otfice:02-9570912 (Ext-155) Mobile: 01713329315 Statement of income during the income year ended on 30/06/2015 on Heads of Income Amount in Taka 1 [Sataries su/s2i 1106;000 2 [income from house property: w/s 24 = 3. [Agricultural income: u/s26 = 4 [income from other source : w/s.33 = 3 [Total income 106,000 6 [Tax leviable on total income 108,400 7 [fax rebate: u/s 442)(0) 20,680 8 [Tax payable (difference between serial no. 6and 7) C70 9 fax payments: a) Tax dectucted or paisd in advance/ with return Tk 7,720 lb) Adjusted of tax Refund (if any) Tk. : 67720 10 [Difference between serial no. 8 and 9 (ang) Refundable/ Adjustable = T1 [Tax exempted and tax free income 334,000 (Please atfach supporting documents/statements. If needed) Verification 1 Md, Noor A Alam Siddique, father: Md. Mokhlesur Rahman TIN: 753504332089 solemny declare that tothe best of my Knowledge and belie the information given inthis return and statements and documents annexed herewith s correct and complete Place: Dhaka Date : November 28, 2016 Signature of the Assessee Enclosures: Md. Noor A Alam SiddiqueIT- 10 BBB Statement of Assets and Liabilities for salaried person (as on 306.2016 ) Name of the Assessee: Md. Noor A Alam Siddique Tn [7]5]3]5]o[4]3[3]2[0[8]9 1. Non-Agricultural Property (at cost with legal expenses): Tk, - Land House property (Description and Location of Property) 2, Agricultural Property (at cost with legal expenses): Tk. - Land (Total land and location of land property) 3. Investment: (@) Share/Debenture Tk. 730,000 (b) Saving Certificate/ Unit Certificate/Bond Tk. - (9. Prize bond/Saving Scheme Tk 769,711 (@) Loans given Tk - (e) Other Investment Tk. 1,800,000 Total= Tk. 3,299,711 4. Motor Vehicles (at cost): Tk 3 Type of Motor vehicle and Registration number 5. Jewellery (quantity and cost): 14Vori As Before ‘Tk. 650,000 6. Furniture (at cost): As Before Tk. 400,000 7, Electronic Equipment (at cost) (10000+970000) Tk. 407,000 8. Cash Asset Outside Business (a) Cash in hand Tk 96835 (b) Cash at bank Tk 14498 (6) Other deposit Tk : Tk. 111,333 9 Any other assets (With details) PF Tk___ 212,608 Total assets 10, Less: Liabil (2) Mortgage secured on property or land Tk. : (b) Unsecured loans Tk. : (©). Bank oan Tk. : (a) Others Tk. - 11, Net wealth as on last date of the income year Tk. 5,080,652 (Difference between total assets and total liabilities) 32. Net wealth 2s on last date of previous income year Tk 4,493,760 113. Accretion in wealth (Difference between serial no.11 and 12) Tk 586,892 14, Personal & family expenditure Tk 903,108, 15. Total accretion of wealth (Total of serial no.13 and 13) Tk. 1,490,000 16. Sources of Fund: (Shown Return Income ‘Tk. 1,106,000 (i) Tax exempted/Tax free Income Tk. 384,000 (ii) Other receipts (Please specify) Tk. 2 Total source of Fund Tk. 1,490,000 17, Difference (Between serial 15 and 16) Tk . 1 solemnly declare that to the best of my knowledge and belief the information given in this form is correct and complete. Name & signature of the Assessee Date : November 28, 2016 Md. Noor A Alam SiddiqueInstructions to fill up the Return Form b ions: () this return of income shall be signed and verified by the individual assessee or person as prescribed u/s 75 of the Income Tax Ordinance, 1984. (2) Enclose where applicable: (i) Salary statement for salary income; (ii) Deed of 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) Document furnished to support the declaration should be signed by the assessee or his/her authorized representative. (4) Assets and liabilities of self, spouse (if she/he is not an assessee), minor children and dependant(s) to be shown in this form (5) Ifneed, Please use separate sheet. Acknowledgement Receipts of Income Tax Return Government of the People’s Republic of Bangladesh Office of the Deputy Commissioner of Taxes ‘Taxes Circle -127, Taxes Zon Name of Assessee: Md. Noor A Alam Siddique Assessment Year: 2016-2017 TIN 7Ts13 [51°] 473 [312] ° [81> ‘Total income shown in Return: Tk, 1,106,000 Tax paid : Tk. 67,720 Gross wealth shown: Tk. 5,080,652 ‘Net wealth shown: Tk. 5,080,652 Date of receipt of return: Serial no. in Return Register Return submitted under section 828B/Normal Signature of Receiving Officer with sealComputation of Individual Income Tax for the Assessment Year 2016-2017 Income Year 2045-2016 Name of Assessed: Md. Noor A Alam Siddique TIN NO. 753604332089 Contact Address: — Modhumoti Bank Limited A. INCOME FROM SALARY 1 a 3 T 8 9 Basic Pay Bonus House Rent Allowance Less : Exemption Tk, Tk. (60% of Basic Pay or 3,00,000/- which is lower) Conveyance Allowance Less : Exemption Medical Less : Exemption Leave Fare Assistance Less : Exemption Other Allowance Service Benefit Less : Exemption Tk, Tk. Tk. Tk. Tk. Tk. Tk. Provident Fund ( Employers Contribution) B, INCOME FROM HOUSE PROPERTY 1 Annual Rent C, INCOME FROM BANK INTEREST Computation of Ta Tax on 1st Tax @ 10% on Tax @ 15% on Tax @ 20% on Tax @ 25% on Tax @ 30% on rest TOTAL TAX LIABILITY Less : Rebate on the Investment Allowance of of total Income whichever is lower. Rebate up to 250000 @ 15% Rebate for next 500000 @ 12% Rebate for Rest Amount @ 10% TOTAL TAXABLE INCOME Tk. __1,106,000.00 250,000.00 0% Nil 400,000.00 10% 40,000.00 456,000.00 15% 68,400.00 = 20% is = 25% - = 30% = 7,106,000.00 708,400.00 Tk.1,50,00,000/-or 25% 276,500.00 37,500.00 3,180.00 - Tk. 40,680.00, TAX PAYABLE 67,720.00 Tax deducted at sourc Tk. 36,000.00 INVESTMENT TK. Designation: FAVP Tk Tk. 294,000.00 294,000.00 Tk. 60,000.00 30,000.00 (000.00 60,000.00 Tk. Teas Tk. Tk, Tk. 660,000.00 215,600.00 30,000.00 134,400.00 66,000.00 7,106,000.00 TAXTOBEPAID Tk. Provident Fund (Self + Bank) Cont Tk. 132,000.00 Deposit Pension Scheme Tk. 60,000.00 Laptop Tk. 97,000.00 Prime Minister Relif Fund Tk. - Govt. Bond/Share Tk. = Social Security Superannuation Fund Tk. = Total Tk. 289,000.00 31,720.00