For Tax Computation 2012 Ver 1.1 Please Log On To WWW - Jitenkumarsahu.blogspot - Com and Purchase at Nominal Price of $1.00

Please read the instructions
1. Please enter the data in the Unprotected areas in the number format where ever it is allowed to enter the data 2008-09
2. Please specify the Assessment Year for which you are calculating the tax Below In the Assessement Year Drop Down Menu
because there are certain provisions which are applicable for 2009 - 10 Assessement year onwards 2009-10
It is Suggested to Enable the macro by seting the macro security level to Medium or Very low it is required to
generate Form 16 2010-11
2011-12
Assessement Year 2011-12 4
In the sheets the data are interlinked with each other there are some hidden files also hence this workbook is entirely protected for
the data and function security purpose. You will get the Taxable Components of Salary in the Taxable sheet.
To Generate The Form 16 Please Go to the "Details" sheet Fill up the particulars and then Click the Buttons (GENERATE
OLD FORM 16 OR GENERATE NEW FORM 16)relating to different format as per your requirement
Or Click the Buttons located in the "Details" Sheet i.e. Generate New Form 16 or Generate Old
Form 16 Buttons
This Spreadsheet Programme has been designed to Enable the employers to make TDS from the Salary every month on actual
basis and not on presumption or imaginary basis.
This spreadsheet Calculated tax every month on cumulative basis hence it is helpful for TDS aspect under section 192 of IT Act 1961
Also Please provide details like the age of the assessee and the gender as well as the status of inability in the sheet
'Details' employee details which takes into consideration the various exemption limit for taxation purpose
Fill the Yellow and Sky Coloured Cells in the Sheets Additional Details, 12BA, New Form 16 Export.
Name of the author: Jiten Kumar Sahu [B.Com, M.Com, CA (Inter)]
Place of Origin: Bhubaneswar (Orissa)
Email: jiten_sahu@yahoo.co.in
Please log on to www.jitenkumarsahu.blogspot.com for revised and updated version
Suggestions and Advices are invited: Please write your advices and revert me back
Due to some Errors in the previous version Improvements
and revisons made in this version.
Further Improvements are needed to be identified by the users.
Type of errors in the previous Versions: Rectification status
HRA Monthly exemption system introduced due to RULE 2A Modified calculation
Rent free or concessional accommodation calculation was erroneous Rectified
Amendmends to the Car perk and other vehicles perk Introduced
Features Introduced
New Form 16 Introduced
DISCLAIMER: The author is not Responsible or Liable For any damage caused due to this program to any
client or organisation due to errors and ommissions in the Program. Though extensive coverage of the
Income Tax Act 1961, Section 192 has been taken care of. It is requested to the users to identify such
mistakes for further correction in the programme.
Please make the following configurations in your MS Excel programme Tools>Options>Calculations>Iteration Check>Ok And
Tools>Options>Security>Macro security>low>Ok
Employee Details Employer details
Employee
Tax Details
CIT
Details
Receipt number to be quoted in Form 16/16A will be generated by T

pertaining to FY 2010-11 and onwards uploaded to TIN. Receipt num
statements pertaining to FY 2010-11 and onwards. Eight digit receip
statement at under Quarterly Statement Status feature available at T
Receipt number provided by TIN is in addition to the provisional rece

Provisional receipt number will be referred as Token no for the statem
Financial Year
PERIOD (dd-mmm-yyyy) e.g. 01-Jan-2001
Name
Address 1
Address 2
Address 3
Pin code
PAN No. of the Deductor
TAN No. of the Deductor
TDS Assessment Range of the Employer :

Tax Deducting person is (Male or Female)
Person responsible for deduction of tax
Father's Name (Son or Daughter of)
Designation :
Name of the employee

Designation of the employee
PAN No. of the Employee
Is the employee a director or a person with

substantial interest in the company
(where the employer is a company)
Is the employee Handicaped?
Gendre of the employee (Male or Female)
What is the Age of the Employee as per
matriculation certificate? (in Years)
Place :
Date :
Quarter
June 2010
September 2010
December 2010
March 2011
Address
City
Pin code
eceipt number to be quoted in Form 16/16A will be generated by TIN. Receipt number will be g
ertaining to FY 2010-11 and onwards uploaded to TIN. Receipt number generated will be of eig
atements pertaining to FY 2010-11 and onwards. Eight digit receipt number can be obtained by
atement at under Quarterly Statement Status feature available at TIN website (www.tin-nsdl.co
eceipt number provided by TIN is in addition to the provisional receipt number provided on acce
rovisional receipt number will be referred as Token no for the statements pertaining to FY 2010
2010 - 11 Assessment Year 2011 - 12
No
No
Male
3
Receipt no. of Original statements
TIN. Receipt number will be generated for the quarterly TDS/TCS statements
mber generated will be of eight digits (alphabets) and will be applicable only for
pt number can be obtained by viewing the status of the quarterly TDS/TCS
TIN website (www.tin-nsdl.com).
eipt number provided on acceptance/upload of quarterly TDS/TCS statement.

ements pertaining to FY 2010-11 and onwards.
2011 - 12
Fill up the
Yellow
highlighted
Areas only
, Son of, Male
Err:502 Female
Err:502
2
1
tatements
DS/TCS statements
be applicable only for
arterly TDS/TCS
DS/TCS statement.
FORM NO.16
[See rule 31 (1) (a)]
PART A
Certificate under section 203 of the Income-tax Act, 1961 for Tax deducted at source on Salary
Name and address of the employer Name and designation of the employee
0 0
0 0
0
0
0
PAN No. of the Deductor TAN No. of the Deductor PAN of the Employee
0 0 0
CIT (TDS) Assessment Year PERIOD
FROM TO
Address 0
2011 - 12
City 0 Pin code 0 30-Dec-99 30-Dec-99

Summary of tax deducted at source
Amount of tax
Amount of tax deducted
Quarter Receipt Numbers of original statements of deposited/remitted in respect of
in respect of the employee
TDS under sub-section (3) of section 200 the employee
June 2010 0
September 2010 0
December 2010 0
March 2011 0
Total 0.00 0.00
PART B (Refer Note 1)
DETAILS OF SALARY PAID AND ANY OTHER INCOME AND TAX DEDUCTED
1. Gross Salary *
( a ) Salary as per provisions contained in section 17 (1) -
( b ) Value of perquisites under section 17 (2)
(as per Form No. 12 BA, wherever applicable) -
( c ) Profits in lieu of Salary under section 17 (3)
( d ) Total -
2. Less : Allowance to the extent exempt under section 10

Exemption u/s 10 (13A) House Rent Allowance -
Exempt U/s 10 (10B) Retrenchment Compensation -
Exempt U/s 10 (10) Gratuity -
Exempt U/s 10 (10AA) Leave Encashment -
Exempt U/s 10 (10CC) Tax on Non monetary Perquisites #VALUE!
Exempt U/s 10 (11), 10 (12) Provident Fund -
Exempt U/s 10 (14) Special Allowances - #VALUE!
3. Balance (1-2) #VALUE!
4. Deductions :
(a) Entertainment allowance Rs. -
(b) Tax on Employment Rs. -
5. Aggregate of 4 (a & b) -
6. Income chargeable under the Head ‘Salaries’(3-5) #VALUE!
7. Add. : Any other income reported by the employee -

Capital Gain -
Income From House Properties - -
8. Gross total income (6+7) #VALUE!
9. Deductions Under Chapter VI-A Deductible

(A) sections 80C, 80CCC and 80CCD Gross Amount Amount
(a) section 80C
(a) Accrued Interest on NSC Rs. -
(b) Life insurance premium Rs. -
(c) Non-commutable deferred annuity Rs. -
(d) Deferred annuity Rs. -
(e) Statutory provident fund and Recg.Provident fund Rs. -
(f) Public provident fund Rs. -
(g) Superannuation fund Rs. -
(i) NSC VIIIth Issue Rs. -
(j) ULIP (UTI) Rs. -
(k) ULIP (LIC) Rs. -
(l) Notified annuity plan of LIC Rs. -
(m) Notified units of Mutual Fund Rs. -
(n) Notified pension fund Rs. -
(o) Home Loan Account Scheme Rs. -
(p) Subscription to Housing Scheme Rs. -
(q) Tution Fees Rs. -
(r) Cost of purch./constn of a residential property Rs. -
(s) Approved debentures and equity shares Rs. -
(t) Fixed deposit for 5 years with Scheduled Banks Rs. -
(u) 5 Yr Post Office Time Deposit Account Rs. -
(v) Senior Citizen Savings Scheme Investment Rs. -
(w) notified bonds issued by NABARD Rs. -
(b) section 80CCC Rs. -
(c) section 80CCD Rs. -
Section 80CCE Total - -
(e) section 80CCF Investment in Infrastructure Bonds. Rs. - -
(B) other sections (e.g., 80E, 80G etc.) Gross Qualifying Deductible
Under Chapter VIA
(a) section 80 D Mediclaim Insurance policy Rs. - - -
(b) section 80 DD Rs. - - -
(c) section 80 E Interest on Educational Loan Rs. - - -
(d) section 80 G Deductions for Donations Rs. - - -
(e) section 81 GG Deductions for Rent paid Rs. - - -
(f) section 80 U Deductions for handicaped assessee Rs. - - -
10. Aggregate of deductible amount under chapter VI-A -

11. Total Income (8-10 ) #VALUE!
12. Tax on total Income #VALUE!
#VALUE!
13.Education Cess @ 3% on (on tax computed at S. No. 12) #VALUE!
14. Tax Payable on total income (12+13) #VALUE!

15. Relief under section 89 (attach details) -
16. Tax payable (14-15) #VALUE!
VERIFICATION
#VALUE!
Signature of the person responsible

for deduction of tax
Place : - Full Name : -

Date : December 30, 1899 Designation : -
ANNEXURE B
DETAILS OF TAX DEDUCTED AND DEPOSITED IN THE CENTRAL GOVERNMENT ACCOUNT THROUGH CHALLAN
(The Employer to provide payment wise details of tax deducted and deposited with respect to the employee)
Tax Deposited in Challan identification number

respect of the BSR Code of the Bank Date on which tax deposited Challan Serial
Sr. No. employee (Rs.) Branch (dd/mm/yyyy) Number
1 0 0000000 12/30/1899 00000
2 0 0000000 12/30/1899 00000
3 0 0000000 12/30/1899 00000
4 0 0000000 12/30/1899 00000
5 0 0000000 12/30/1899 00000
6 0 0000000 12/30/1899 00000
7 0 0000000 12/30/1899 00000
8 0 0000000 12/30/1899 00000
9 0 0000000 12/30/1899 00000
10 0 0000000 12/30/1899 00000
11 0 0000000 12/30/1899 00000
12 0 0000000 12/30/1899 00000
Total 0
Note:
1. In the column for TDS, give total amount for TDS, Surcharge (if applicable) and education cess
FORM NO. 12 BA
[See rule 26A(2)(b)]
Statement showing particulars of perquisites, other fringe benefits or

amenities and profits in lieu of salary with value thereof
1. Name and address of employer :
,,,,
2. TAN 0
3. TDS Assessment Range of the Employer : 0
4. Name and designation and PAN of employee : ,
0
5. Is the employee a director or a person with
substantial interest in the company No
6. Income under the head "Salaries" of the employee : #VALUE!
7. Financial Year : 2010 - 11
8. Valuation of Perquisities :
S. Nature of Perquisite Value of Amount,if any Amount of

No. (see rule 3) perquisite as paid by taxable
per rules employee perquisite
(Rs.) (Rs.) (Rs.)
1 Accommodation - - -
2 Cars - - -
3 Sweeper, gardener, watchman or personal attendant - - -
4 Employee owns any automotive conveyance other than car - - -
5 Gas, electricity, water - - -
6 Interest free or concessional loans - - -
7 Holiday expenses - - -
8 Free or concessional travel - - -
9 Free meals - - -
10 Free Education - - -
11 Gifts, vouchers, etc. - - -
12 Credit card expenses - - -
13 Club expenses - - -
14 Use of movable assets by employees - - -
15 Transfer of assets to employees - - -
16 Value of any other benefit/amenity/service/ previlege - - -
17 Stock options (non-qualified options) - - -
18 Medical Expenses Reimbursement - - -
19 Tax paid by employer - - -
20 Total value of perquisites - - -
21 Total value of profits in lieu of salary as per section 17(3) - - -
- - -
9. Details of tax,-
(a) Tax deducted from salary of the employee under section 192(1) -
(b) Tax paid by employer on behalf of the employee under section 192(1A) -
(c) Total tax paid -
(d) Date of payment into Government Treasury 30-Dec-1899
DECLARATION BY EMPLOYER
I, , Son of, working as do hereby declare on behalf of that the information given above is based on the books of account, documents and other relevant records or information
available with us and the details of value of each such perquisite are in accordance with section 17 and rules framed thereunder and that such information is true and correct.

Place : 0 Full Name : 0

Date : December 30, 1899 Designation : 0
Form 16 (Annexure)
Assessment Year 2011 - 12 Financial Year 2010 - 11
Employer : 0
Employee : 0
Particulars Rupees Rupees
Gross Salary
(a) Salary as per Provisions contained in Section 17(1)
Salary and other Salary Components -

Employer's Contribution to Provident Fund -
Bonus -
Gratuity -
Leave Encashment -
Retrenchment Compensation -
House Rent Allowance -
Employer's Contribution to Superannuation Fund -
Other Allowances -
Special Allowance -
(b) Value of perquisites under section 17(2) (as per Form

No. 12BA, wherever applicable)
(c) Profits in lieu of salary under section 17(3) (as per

Form No. 12BA, wherever applicable)
Gross Salary
Particulars Rupees Rupees Rupees
Allowance to the extent exempt under section 10
House Rent Allowance

Exemption u/s 10 (13A) read with Rule 2A
Since Salary/Rent paid/HRA Received during the previous year -
is varying and not constant through out the relevant period -
calculation of exemption has been made on monthly exemption - -
basis -
The gross exemption amount due to above reason -
Exempt U/s 10 (14) Special Allowances -
Total amount claimed to be exempt
For
0
December 30, 1899 0
FORM NO. 12 BA
ent showing particulars of perquisites, other fringe benefits or

menities and profits in lieu of salary with value thereof
t the information given above is based on the books of account, documents and other relevant records or information
quisite are in accordance with section 17 and rules framed thereunder and that such information is true and correct.
Form 16 (Annexure)
Financial Year 2010 - 11
Rupees
Rupees
#VALUE!
For
0
FORM NO.16
[See rule 31(1)(a)]
Certificate under section 203 of the Income-tax Act, 1961 for Tax deducted at source on Salary
TDS
Financial year 2010 - 11 Certificate
number#
If Amended give Previous TDS
Whether Original / Duplicate / Amended
Certificate number
Name of
TAN of Deductor - -
Deductor
Name of
PAN of Deductee - -
Deductee
Whether PAN uploaded

TDS Unique Transaction Number (UTN) as provided by Gross Amount
was validated by Income TDS/TCS Amount
Income Tax Department Paid/ Collected
Tax Department? (Y/N)
Gross amount of TDS / TCS -

Total TDS amount where PAN was found valid by Income Tax Department*
Details of Salary paid and any other income and tax deducted
1. Gross Salary
(a) Salary as per provisions contained in sec.17(1) Rs.0
Value of perquisites u/s 17(2) (as per Form No.12BB, wherever
(b) applicable) Rs.0
Profits in lieu of salary under section 17(3)(as per Form
(c) No.12BB, wherever applicable) Rs.0
(d) Total Rs.0
2. Less: Allowance to the extent exempt u/s 10
House Rent Allowance 10 (13A) Rs.0
Retrenchment Compensation 10 (10B) Rs.0
Gratuity 10 (10) Rs.0
Leave Encashment 10 (10AA) Rs.0
Special Allowances 10 (14) Rs.0
Provident Fund 10(11) or 10(12) Rs.0
Rs.0
Rs.0 Rs.0
3. Balance(1-2) Rs.0
4. Deductions :
(a) Standard deduction Rs -
(b) Entertainment allowance Rs -
(c) Tax on employment Rs -
5. Aggregate of 4(a) to (c) Rs.0
6. Income chargeable under the head 'salaries' (3-5) Rs.0
7. Add: Any other income reported by the employee
Income From the House Property Rs.0
Rs.0
Rs.0
Rs.0
8. Gross total income (6+7) Rs.0
9. Deductions under Chapter VIA
Qualifying Deductible
Gross Amount Amount Amount
(a) Deductions u/s 80C Rs.0 Rs.0
(b) Deductions u/s 80CCC Rs.0 Rs.0
(c) Deductions u/s 80CCD Rs.0 Rs.0
(d) Deductions u/s 80CCE Rs.0 Rs.0 Rs.0
(e) Deductions u/s 80D Rs.0 Rs.0 Rs.0
(f) Deductions u/s 80DD Rs.0 Rs.0 Rs.0
(g) Deductions u/s 80E Rs.0 Rs.0 Rs.0
(h) Deductions u/s 80G Rs.0 Rs.0 Rs.0
(i) Deductions u/s 80GG Rs.0 Rs.0 Rs.0
(j) Deductions u/s 80U Rs.0 Rs.0 Rs.0
(k)
(l)
10. Aggregate of deductible amount under Chapter VIA Rs.
11. Total Income (8-10) Rs.
12. Tax on total income Rs.
13. Rebate and relief under Chapter VIII
I. Under section 88 (please specify)
Qualifying Tax rebate/
Gross Amount Amount relief
(a) Rs.0 Rs.0 Rs.0
(b) Rs.0 Rs.0 Rs.0
(c) Rs.0 Rs.0 Rs.0
(d) Rs.0 Rs.0 Rs.0
(e) Rs.0 Rs.0 Rs.0
(f) Total [(a) to (e)] Rs.
II. (a) Under section 88B Rs.0 Rs.0
(b) Under section 88C Rs.0 Rs.0
III. Under section 89 (attach details) Rs
14. Aggregate of tax rebates and relief at 13 above [I(f) + II(a)+ II(b) + III]
15. Tax payable (12-14) and surcharge thereon Rs
16. Less: Tax deducted at source Rs
17. Tax payable/refundable (15-16) Rs
#VALUE!
Place:
Date: 30-Dec-1899 Signature of person responsible for deduction of tax
Designation: Full Name:
# TDS certificate number is an internal reference number to be given by the Deductor (optional)
FORM NO.16
[See rule 31(1)(a)]
he Income-tax Act, 1961 for Tax deducted at source on Salary
TDS/TCS Amount
ax deducted
Rs.0
Rs.0
Rs.0
0
0
0
0
0
0
0
-
-
nature of person responsible for deduction of tax

Name:
ernal reference number to be given by the Deductor (optional)
FORM NO. 12 BA
,,,,
2. TAN -
3. TDS Assessment Range of the Employer : -
4. Name and designation and PAN of employee :

,,

6. Income under the head "Salaries" of the employee : -

S. Nature of Perquisite Value of Amount,if any

No. (see rule 3) perquisite as paid by
per rules employee
(Rs.) (Rs.)
1 Accommodation - -
2 Cars - -
3 Sweeper, gardener, watchman or personal attendant - -
4 Employee owns any automotive conveyance other than car - -
5 Gas, electricity, water - -
6 Interest free or concessional loans - -
7 Holiday expenses - -
8 Free or concessional travel - -
9 Free meals - -
10 Free Education - -
11 Gifts, vouchers, etc. - -
12 Credit card expenses - -
13 Club expenses - -
14 Use of movable assets by employees - -
15 Transfer of assets to employees - -
16 Value of any other benefit/amenity/service/ previlege - -
17 Stock options (non-qualified options) - -
18 Medical Expenses Reimbursement - -
19 Total value of perquisites - -
20 Total value of profits in lieu of salary as per section 17(3) - -
Page 1 of 2 [FORM NO. 12 BA]

Form 16 (Annexure)
Assessment Year 2011 - 12 Financial Year 2010 -
Employer :
Employee :
Gross Salary

Bonus -
Gratuity -
Leave Encashment -
Other Allowances -
Special Allowance -


Gross Salary
Place:
December 30, 1899
-
FORM NO. 12 BA
particulars of perquisites, other fringe benefits or
d profits in lieu of salary with value thereof
,,
Amount of
taxable
perquisite
(Rs.)
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Form 16 (Annexure)
Rupees
-
9. Details of tax,-
(a) Tax deducted from salary of the employee under section 192(1) Rs.0
(b) Tax paid by employer on behalf of the employee under section 192(1A) Rs.0
(c) Total tax paid Rs.0
(d) Date of payment into Government Treasury
I, , Son of, working as do hereby declare on behalf of that the information given above is based on the books of account, documents and other
relevant records or information available with us and the details of value of each such perquisite are in accordance with section 17 and rules
framed thereunder and that such information is true and correct.

Place: Full Name :

Date: December 30, 1899 Designation :
Page 2 of 2 [FORM NO. 12 BA]

that the information given above is based on the books of account, documents and other
he details of value of each such perquisite are in accordance with section 17 and rules
correct.
FORM NO.16
[See rule 31 (1) (a)]
Certificate under section 203 of the Income Tax Act, 1961 for tax deducted
at source from income chargeable under the head “ Salaries “
0 0
0 0
0
0
0
PAN No. of the Deductor TAN No. of the Deductor PAN No. of the Employee
0 0 0
PERIOD Assessment Year
Acknowledgement Nos. of all quarterly statements of TDS under sub-section (3) of
FROM TO
section 200 as provided by TIN Facilitation Centre or NSDL web-site
Quarter Acknowledgement No.
June 2010 0 2011 - 12
September 2010 0 30-Dec-99 30-Dec-99
December 2010 0
March 2011 0
1. Gross Salary *
( a ) Salary as per provisions contained in section 17 (1) Rs. -
(as per Form No. 12 BA, wherever applicable) Rs. -
(as per Form No. 12 BA, wherever applicable) Rs. -
( d ) Total Rs. -
2. Less : Allowance to the extent exempt under section 10 Rs. #VALUE!
3. Balance (1-2) Rs. #VALUE!
4. Deductions :
(A) Standard Deduction Rs. -
(B) Entertainment allowance Rs. -
(C) Tax on Employment Rs. -
5. Aggregate of 4 (a to c) -
6. Income chargeable under the Head ‘Salaries’(3-5) Rs. #VALUE!
7. Add. : Any other income reported by the employee Rs. -

Capital Gain Rs. -
Income From House Properties Rs. -
8. Gross total income (6+7) Rs. #VALUE!
9. Deductions Under Chapter VI-A

Deductible
(a) section 80C
(a) Accrued Interest on NSC Rs. - - -
(b) Life insurance premium Rs. - - -
(c) Non-commutable deferred annuity Rs. - - -
(d) Deferred annuity Rs. - - -
(e) Statutory provident fund and Recg.Provident fund Rs. - - -
(f) Public provident fund Rs. - - -
(g) Superannuation fund Rs. - - -
(i) NSC VIIIth Issue Rs. - - -
(j) ULIP (UTI) Rs. - - -
(k) ULIP (LIC) Rs. - - -
(l) Notified annuity plan of LIC Rs. - - -
(m) Notified units of Mutual Fund Rs. - - -
(n) Notified pension fund Rs. - - -
(o) Home Loan Account Scheme Rs. - - -
(p) Subscription to Housing Scheme Rs. - - -
(q) Tution Fees Rs. - - -
(r) Cost of purch./constn of a residential property Rs. - - -
(s) Approved debentures and equity shares Rs. - - -
(t) Fixed deposit for 5 years with Scheduled Banks Rs. - - -
(u) 5 Yr Post Office Time Deposit Account Rs. - - -
(v) Senior Citizen Savings Scheme Investment Rs. - - -
(w) notified bonds issued by NABARD Rs. - - -
(b) section 80CCC Rs. - - -
(c) section 80CCD Rs. - - -
Section 80CCE Total -
(d) section 80CCF Investment in Infrastructure Bonds. Rs. - - -
(B) other sections (e.g., 80E, 80G etc.)
Under Chapter VIA
10. Aggregate of deductible amount under chapter VI-A Rs. -
11. Total Income (8-10 ) Rs. #VALUE!
12. Tax on total Income Rs. #VALUE!

13. Surcharge (on tax computed at S. No. 12) Rs. #VALUE!
14.Education Cess @ 3% on (tax at S. No. 12 plus surcharge at S. No. 13) Rs. #VALUE!
15. Tax Payable on total income (12+13+14) Rs. #VALUE!
16. Relief under section 89 (attach details) Rs. -
17. Tax payable (15-16) Rs. #VALUE!
18. Less:(a) Tax deducted at source u/s 192(1) Rs. -
(b) Tax paid by the employer on behalf of the employee Rs. -
u/s 192(1A) on perquisites u/s 17(2)
19. Tax payable / refundable (17-18) Rs. #VALUE!
DETAILS TAX DEDUCTED AND DEPOSITED INTO CENTRAL GOVERNMENT ACCOUNT
Education Date on which tax Transfer voucher/

TDS Surcharge Total tax Cheque/DD No. BSR Code of
S. No. Cess deposited Challan
Rs. Rs. deposited (if any) Bank branch
Rs. (dd/mm/yy) Identification No.
1 - - - - 0 0 30-Dec-1899 00000
2 - - - - 0 0 30-Dec-1899 00000
3
- - - - 0 0 30-Dec-1899 00000
4 - - - - 0 0 30-Dec-1899 00000
5 - - - - 0 0 30-Dec-1899 00000
6 - - - - 0 0 30-Dec-1899 00000
7 - - - - 0 0 30-Dec-1899 00000
8 - - - - 0 0 30-Dec-1899 00000
9 - - - - 0 0 30-Dec-1899 00000
10 - - - - 0 0 30-Dec-1899 00000
11 - - - - 0 0 30-Dec-1899 00000
12 - - - - 0 0 30-Dec-1899 00000
Total amount Paid -
#VALUE!

Place : - Full Name : -

Date : December 30, 1899 Designation : -
FORM NO. 12 BA

,,,,
2. TAN 0
4. Name and designation and PAN of employee : ,
0

(Rs.) (Rs.) (Rs.)
2 Cars - - -
6 Interest free or concessional loans - - -
9 Free meals - - -
11 Gifts, vouchers, etc. - - -
19 Tax paid by employer - - -
21 Total value of profits in lieu of salary as per section 17(3) - - -
- - -
9. Details of tax,-
(d) Date of payment into Government Treasury 30-Dec-1899
I, , Son of, working as do hereby declare on behalf of that the information given above is based on the books of account, documents and other relevant records or information
available with us and the details of value of each such perquisite are in accordance with section 17 and rules framed thereunder and that such information is true and correct.


Date : December 30, 1899 Designation : 0
Form 16 (Annexure)
Assessment Year 2011 - 12 Financial Year 2010 - 11
Employer : 0
Employee : 0
Gross Salary

Bonus -
Gratuity -
Leave Encashment -
Other Allowances -
Special Allowance -


Gross Salary

basis -
Total amount claimed to be exempt
For
0
December 30, 1899 0
FORM NO. 12 BA
ent showing particulars of perquisites, other fringe benefits or

menities and profits in lieu of salary with value thereof
t the information given above is based on the books of account, documents and other relevant records or information
quisite are in accordance with section 17 and rules framed thereunder and that such information is true and correct.
Form 16 (Annexure)
Rupees
Rupees
#VALUE!
For
0
0 0
0 0
0
0
0
PAN No. of the Deductor TAN No. of the Deductor PAN No. of the Employee
0 0 0
PERIOD Assessment Year
Acknowledgement Nos. of all quarterly statements of TDS under sub-section (3) of
FROM TO
section 200 as provided by TIN Facilitation Centre or NSDL web-site
Quarter Acknowledgement No.
June 2010 0 2011 - 12
September 2010 0 30-Dec-99 30-Dec-99
December 2010 0
March 2011 0
1. Gross Salary *
( a ) Salary as per provisions contained in section 17 (1) -
( d ) Total -
2. Less : Allowance to the extent exempt under section 10 #VALUE!
3. Balance (1-2) #VALUE!
4. Deductions :
(A) Standard Deduction Rs. -
(B) Entertainment allowance Rs. -
(C) Tax on Employment Rs. -
5. Aggregate of 4 (a to c) -
6. Income chargeable under the Head ‘Salaries’(3-5) #VALUE!
7. Add. : Any other income reported by the employee -

Capital Gain -
Income From House Properties -
8. Gross total income (6+7) #VALUE!
9. Deductions Under Chapter VI-A

Deductible
(a) section 80C
(a) Accrued Interest on NSC Rs. - - -
(b) Life insurance premium Rs. - - -
(c) Non-commutable deferred annuity Rs. - - -
(d) Deferred annuity Rs. - - -
(e) Statutory provident fund and Recg.Provident fund Rs. - - -
(f) Public provident fund Rs. - - -
(g) Superannuation fund Rs. - - -
(i) NSC VIIIth Issue Rs. - - -
(j) ULIP (UTI) Rs. - - -
(k) ULIP (LIC) Rs. - - -
(l) Notified annuity plan of LIC Rs. - - -
(m) Notified units of Mutual Fund Rs. - - -
(n) Notified pension fund Rs. - - -
(o) Home Loan Account Scheme Rs. - - -
(p) Subscription to Housing Scheme Rs. - - -
Page 36
(q) Tution Fees Rs. - - -
(r) Cost of purch./constn of a residential property Rs. - - -
(s) Approved debentures and equity shares Rs. - - -
(t) Fixed deposit for 5 years with Scheduled Banks Rs. - - -
(u) 5 Yr Post Office Time Deposit Account Rs. - - -
(v) Senior Citizen Savings Scheme Investment Rs. - - -
(w) notified bonds issued by NABARD Rs. - - -
(b) section 80CCC Rs. - - -
(c) section 80CCD Rs. - - -
section 80CCE Total -
(d) section 80CCF Investment in Infrastructure Bonds. Rs. - - -
(B) other sections (e.g., 80E, 80G etc.)
Under Chapter VIA
10. Aggregate of deductible amount under chapter VI-A -
11. Total Income (8-10 ) #VALUE!

Do You want to
12. Tax on total Income #VALUE!
accept the If you want to
13. Surcharge (on tax computed at S. No. 12) recommended accept the #VALUE!
14.Education Cess @ 3% on (tax at S. No. 12 plus surcharge at S. No. 13) tax on perk? If recommended #VALUE!
15. Tax Payable on total income (12+13+14) yes then select figure then please #VALUE!
16. Relief under section 89 (attach details) "Y" else leave it do not write any
17. Tax payable (15-16) blank the below amount in the #VALUE!
18. Less:(a) Tax deducted at source u/s 192(1) Yes - Y cell below cell -
(b) Tax paid by the employer on behalf of the employee No - N N - -
u/s 192(1A) on perquisites u/s 17(2)
19. Tax payable / refundable (17-18) #VALUE!
DETAILS TAX DEDUCTED AND DEPOSITED INTO CENTRAL GOVERNMENT ACCOUNT
Education Date on which tax Transfer voucher/

TDS Surcharge Total tax Cheque/DD No. BSR Code of
S. No. Cess deposited Challan
Rs. Rs. deposited (if any) Bank branch
Rs. (dd/mm/yy) Identification No.
1 -
2 -
3 -
4 -
5 -
6 -
7 -
8 -
9 -
10 -
11 -
12 -
Total amount Paid -
Page 37
Capital gain Tax Rate in
Fraction i.e. +10/100
0.1 0
###
###
###
Page 38
###
###
Avg. Rate #VALUE!
#VALUE!
###
Page 39
FORM NO. 12 BA

1. Name and address of employer : ,,,,
2. TAN 0
4. Name and designation and PAN of employee : ,,

0

(Rs.) (Rs.) (Rs.)
2 Cars - - -
6 Interest free or concessional loans - -
9 Free meals - - -
11 Gifts, vouchers, etc. - -
19 Tax paid by employer - -
21 Total value of profits in lieu of salary as per section 17(3)
- - -
9. Details of tax,-
(d) Date of payment into Government Treasury
I, , Son of, working as do hereby declare on behalf of that the information given above is based on the books of account, documents and other relevant records
or information available with us and the details of value of each such perquisite are in accordance with section 17 and rules framed thereunder and that such
information is true and correct.

Date : 12/30/1899 Designation : 0
FORM NO. 12 BA
culars of perquisites, other fringe benefits or

ofits in lieu of salary with value thereof
,,,,
mation given above is based on the books of account, documents and other relevant records
h perquisite are in accordance with section 17 and rules framed thereunder and that such
Form 16 A
[ANNEXURE]
Employer : 0
Employee : 0
Gross Salary

Bonus -
Gratuity -
Leave Encashment -
Other Allowances -
Special Allowance -
-

No. 12BA, wherever applicable) -

Form No. 12BA, wherever applicable) -
Gross Salary -

basis -
Total amount claimed to be exempt #VALUE!
For
0
30/Dec/1899 0
Age: (in Years) 3 Company Name Type the name of the company here Type the name of the employee
Sex: (Male or Female) Male Date of Joining Date of Leaving
Handicaped? (Yes or No.) No PAN No. Tax paid 0 Refund 0 To be paid 0
Particulars April May June July August September October November December January February March Annual
Basic 0 0 0 0 0 0 0 0 0 0 0 0 0
Dearness Pay 0 0 0 0 0 0 0 0 0 0 0 0 0
Dearness Allowance 0 0 0 0 0 0 0 0 0 0 0 0 0
Commission on Turn over 0 0 0 0 0 0 0 0 0 0 0 0 0
Commission 0 0 0 0 0 0 0 0 0 0 0 0 0
Bonus 0 0 0 0 0 0 0 0 0 0 0 0 0
Employer's cont to PF 0 0 0 0 0 0 0 0 0 0 0 0 0
Employer's cont to Approved Super Annuation Fund 0
Special Allowances 0 0 0 0 0 0 0 0 0 0 0 0 0
Voluntary Payment 0 0 0 0 0 0 0 0 0 0 0 0 0
Advance salary 0 0 0 0 0 0 0 0 0 0 0 0 0
Arrears of salary 0 0 0 0 0 0 0 0 0 0 0 0 0
Leave encashment for current period 0 0 0 0 0 0 0 0 0 0 0 0 0
Leave encashment for Preceding years 0 0 0 0 0 0 0 0 0 0 0 0 0
Salary in lieu of notice 0 0 0 0 0 0 0 0 0 0 0 0 0
Fees 0 0 0 0 0 0 0 0 0 0 0 0 0
Pension 0 0 0 0 0 0 0 0 0 0 0 0 0
Annuity 0 0 0 0 0 0 0 0 0 0 0 0 0
Retrenchment Compensation 0 0 0 0 0 0 0 0 0 0 0 0 0
Overtime/Extra Work 0 0 0 0 0 0 0 0 0 0 0 0 0
Gratuity In respect of Current yr Service 0 0 0 0 0 0 0 0 0 0 0 0 0
Gratuity in respect of Preceding Yr service 0 0 0 0 0 0 0 0 0 0 0 0 0
HRA 0 0 0 0 0 0 0 0 0 0 0 0 0
Conveyance/Transport Allowance 0 0 0 0 0 0 0 0 0 0 0 0 0
Children Education Allowance 0 0 0 0 0 0 0 0 0 0 0 0 0
Children Hostel Allowance 0 0 0 0 0 0 0 0 0 0 0 0 0
Other Allowances 0 0 0 0 0 0 0 0 0 0 0 0 0
Rent Free Accomodation 0
LTC 0 0 0 0 0 0 0 0 0 0 0 0 0
Gas Energy and Water 0 0 0 0 0 0 0 0 0 0 0 0 0
Free Education 0 0 0 0 0 0 0 0 0 0 0 0 0
Use of Moveable Assets other than CAR, Computer/Laptops 0 0 0 0 0 0 0 0 0 0 0 0 0
Sale of Movable Assets to Employee 0 0 0 0 0 0 0 0 0 0 0 0 0
Reimbursement of Medical expenses: 0 0 0 0 0 0 0 0 0 0 0 0 0
Any other Perk 0 0 0 0 0 0 0 0 0 0 0 0 0
Gross Salary 0 0 0 0 0 0 0 0 0 0 0 0 0
Deduction U/s 16(iii) 0 0 0 0 0 0 0 0 0 0 0 0 0
Net Amount 0 0 0 0 0 0 0 0 0 0 0 0 0
Deductions U/s
80 C 0 0 0 0 0 0 0 0 0 0 0 0 0
80 CCC 0 0 0 0 0 0 0 0 0 0 0 0 0
80 CCD 0 0
limit 80 C + 80 CCC = 80CCE 0 0 0 0 0 0 0 0 0 0 0 0 0
80 D 0 0 0 0 0 0 0 0 0 0 0 0 0
80 DD 0 0 0 0 0 0 0 0 0 0 0 0 0
80 E 0 0 0 0 0 0 0 0 0 0 0 0 0
80 G 0 0 0 0 0 0 0 0 0 0 0 0 0
80 GG 0 0
80 U 0 0 0 0 0 0 0 0 0 0 0 0 0
Taxable Income 0 0 0 0 0 0 0 0 0 0 0 0 0
Adjustable Income 0 0 0 0 0 0 0 0 0 0 0 0 0
Tax on Taxable income Annual Taxable income 0
IT 0 0 0 0 0 0 0 0 0 0 0 0 0
SCHG 0 0 0 0 0 0 0 0 0 0 0 0 0
EC 0 0 0 0 0 0 0 0 0 0 0 0 0
SHEC 0 0 0 0 0 0 0 0 0 0 0 0 0
(Based on Fixed Employer's
(if provided in terms of employment %of turnover Contribution if
(Commission
- Percenage that enters for achieved by an Employer's approved
5 1 Not based on Type of PF
calculation of Retirement benefit emplyee as per
turnover)
Contribution Fund then
please select the%) terms of please click
employment) the check box
4 0 Statutory PF Approved
FALSE
Approved
Superannuation
Basic Dearness Pay Dearness allowance Commission Commission Bonus PF Taxable PF Unrecognized fund Special Allowances advance salary
Month Recognised
Apr 2010 0 0 Statutory PF 1 0
May 2010 0 0 Statutory PF 1 0
Jun 2010 0 0 Statutory PF 1 0
Jul 2010 0 0 Statutory PF 1 0
Aug 2010 0 0 Statutory PF 1 0
Sep 2010 0 0 Statutory PF 1 0
Oct 2010 0 0 Statutory PF 1 0
Nov 2010 0 0 Statutory PF 1 0
Dec 2010 0 0 Statutory PF 1 0
Jan 2011 0 0 Statutory PF 1 0
Feb 2011 0 0 Statutory PF 1 0
Mar 2011 0 0 Statutory PF 1 0
TOTAL 0 0 0 0 0 0 0 0 0 0 0
Month Turnover
April -1 -1
May -1 -1
June -1 -1
July -1 -1
August -1 -1
September -1 -1
October -1 -1
November -1 -1
December -1 -1
January -1 -1
February -1 -1
March -1 -1
TOTAL
whether a lumpsum
payable in
payable in payment made
not pertaining to respect of
respect of un annuity remunerati gratuitiously or by way
pertaining to current current year while in service of
service of commuted from compensation on for of compensn. Or
year while in service service of preceeding the
the current pension employer extra work otherwise to the widow
year preceeding
year or legal hires of
year
employee
● Yes ● No 2
arrears of salary Leave encashment Leave encashment Salary in lieu of notice Fees Gratuity Gratuity Pension Annuity Retrenchment over time Voluntary Payments Professional Tax
click here
0.00 0.00 0
0.00 0.00 0
0.00 0.00 0
0.00 0.00 0
0.00 0.00 0
0.00 0.00 0
0.00 0.00 0
0.00 0.00 0
0.00 0.00 0
0.00 0.00 0
0.00 0.00 0
0.00 0.00 0
0 0 0 0 0 0 0 0 0 0 0 0 0
Special Allowances u/s 10(14)
CHILDREN'S HOSTEL ALLOWANCE Travelling / Transfer Daily Allowance Taxable
allowance Conveyance allowance while on tour Helper Allowance Research Allowance Uniform Allowance Income
No.OF Amount after
Month Tax Free Taxable Month
Children Received Receipt Utilised Receipt Utilised Receipt Utilised Receipt Utilised Receipt Utilised Receipt Utilised exempt
April 0 0 0 0 1 April 0
May 0 0 0 0 1 May 0
June 0 0 0 0 1 June 0
July 0 0 0 0 1 July 0
August 0 0 0 0 1 August 0
September 0 0 0 0 1 September 0
October 0 0 0 0 1 October 0
November 0 0 0 0 1 November 0
December 0 0 0 0 1 December 0
January 0 0 0 0 1 January 0
February 0 0 0 0 1 February 0
March 0 0 0 0 1 March 0
TOTAL 0 0 0 TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 0
Please select the city Others

Transport Allowance CHILDREN EDUCATION ALLOWANCE House Rent Allowances
Other Allowances
Others
Amount Amount HRA Rent Paid by Duty
Month Month No.OF Month Fixed Tribal Transport
Received Received Received employee
Children CCA EA Tiffin Medical Any other Servant Area ation
April 0 April 0 0 1 April 0
May 1 May 0 0 1 May 0
June 2 June 0 0 1 June 0
July July 0 0 1 July 0
August August 0 0 1 August 0
September September 0 0 1 September 0
October October 0 0 1 October 0
November November 0 0 1 November 0
December December 0 0 1 December 0
January January 0 0 1 January 0
February February 0 0 1 February 0
March March 0 0 1 March 0
0 0 0 0 0 0 0 0 0
1. Income From the head House Property 4 Fin . Year 2010-2011
House Locations >>>>>>>> Self Occupied Location 2 Location 3 Location 4 Location 5 Location 6 Location 7
1 Municipal Rental Value (a)
2 Fair Rental Value (b)
3 Standard Rental Value (c)
Actual Rent that could have been earned if the property is
4 let through out the year (d1)
5 Unrealised rent (d2)
6 Vacancy (d3)
7 Received or receivable rent (d1-d2-d3) 0 0 0 0 0 0
8 Reasonable Expected Rent 0 0 0 0 0 0
9 Gross Annual Value 0 0 0 0 0 0
10 Municipal taxes Paid by assessee
Please Fill the dates in the Format of DD MMM YYYY
Date of Borrowing or taking the loan
House Acquisition or construction Completion Date
Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable
Target Date of Acquisition or Completion of construction
Up Up Up Up Up Up Up
Please provide Pre Construction Interest from to to to to to to to
Pre Construction Interest

Sum total of Gross Annual Values -
Less, Municipal taxes Paid by the assessee -
Net Annual Value -
less, 30% of NAV u/s - 24 towards repair and maintainance -

Less, Interest Paid on Loan taken for house
Pre Construction Interest Self Occupied -
Current Yr. Interest for self occupied -
Total interest on self occupied property -
Pre Construction Interest for Let out property -
Current Yr. Interest for for Let out property -
Total interest on let out property -
Allowable Interest Deduction -
Income From the House Property -
HPLoss_Income
As on April 1, 2009 for the AY 2010-11
Upto Rs. 30 More than
Type of loan Period Others Lacs Rs. 30 Lacs
Housing loan Up to 5 years 9.75% 10.25%
Housing loan Above 5 years but up to 15 years 10.00% 10.50%
Housing loan Above 15 years but up to 25 years 10.25%
Car loan, for new car Up to 3 years (Rs. 7.5 lakh and above) 11.50%
Car loan, for new car Up to 3 years (below Rs. 7.5 lakh) 11.75%
Car loan, for new car Above 3 years but upto 5 years 11.75%
Car loan, for new car Above 5 years but upto 7 years 12.00%
Two wheeler loan 16.25%
Education loan Loan amount up to Rs. 4 lakh 11.75%
Education loan Loan amount > Rs. 4 lakh < 7.5 lakhs 13.25%
Education loan Loan amount above Rs. 7.5 lakh 12.50%
Education loan under SBI For Girl student [Concession of 0.50%] 10.25%
Scholar Loan Scheme For Others 10.75%
Personal loan upto 3 years 16.50%
Personal loan Above 3 years but upto 6 years 14.50%
As on April 1, 2007 for As on April 1, 2008 for

Type of loan Period the AY 2008-09 the AY 2009-10
<=20Lac >20Lacs <=20Lac
Housing loan Up to 5 years 10.25% 10.25% 10.00%
Housing loan Above 5 years but up to 10 years 10.75% 10.75% 10.25%
Car loan, for new car Up to 3 years (Rs. 7.5 lakh and above) 11.50% 11.50% 11.50%
Car loan, for new car Up to 3 years (below Rs. 7.5 lakh) 11.75% 11.75% 11.75%
Car loan, for new car Above 3 years but upto 5 years 11.75% 11.75% 11.75%
Car loan, for new car Above 5 years but upto 7 years 12.00% 12.00% 12.00%
Two wheeler loan 14.25% 14.25% 15.50%
Education loan Loan amount up to Rs. 4 lakh 11.50% 11.50% 12.25%
Education loan Loan amount > Rs. 4 lakh < 7.5 lakhs 13.25% 13.25% 13.25%
Education loan Loan amount above Rs. 7.5 lakh 13.25% 13.25% 13.25%
Personal loan upto 3 years 15.25% 15.25% 15.50%
Personal loan Above 3 years but upto 6 years 15.25% 15.25% 15.50%
As on April 1, 2010 for the AY 2011-12

Please refer Taxmann's Income tax book or ready reckoner following are only overview
1) Housing Loan - 8%
2) Car Loan (for new Car) - 8%
3) Two wheeler Loan - 15.75%
4) Education loan - {other than Scholor Loan scheme where Rate was 10.25% + concession of 0.5% for Girl student}
a) Upto Rs. 4 Lacs - 11.25%
b) Above 4 Lacs - 12.75%
5) Personal Loan - 16%
6) Loan to employees to suscribe ESOP's - 14%
April 1, 2009 for the AY 2010-11 Rs. 30
Lacs to 75 More than
Lacs Rs.75 Lacs
10.75% 11.00%
As on April 1, 2008 for

the AY 2009-10
>20Lacs
10.25%
10.50%
10.50%
10.75%
11.50%
11.75%
11.75%
12.00%
15.50%
12.25%
13.25%
13.25%
15.50%
15.50%
April 1, 2010 for the AY 2011-12
here Rate was 10.25% + concession of 0.5% for Girl student}

Perquisites Value of Loans Taken from the Company
Car loan, for PC Soft Salary Education Marriage Two wheeler Medical
Housing Loan Phone Loan Other Loan Treatement
new car Loan Loan Loan Loan Loan loan
Loan
Original Loan Amount 0 0 0 0 0 0 0 0 0 0 0
Co. interest rate
Prescribed interest rate

Differential int 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%
Maximum Outstanding Balance at the end of months
Apr 2010
May 2010
Jun 2010
Jul 2010
Aug 2010
Sep 2010
Oct 2010
Nov 2010
Dec 2010
Jan 2011
Feb 2011
Mar 2011
Total value of Perquisites for the year 0
“maximum outstanding monthly balance” means the aggregate outstanding balance for each loan as on the last day of each month
Instructions:
1. Enter the original loan amount, and company interest rate in rows 5, 6 respectively
2. Please enter the Interest rate on the 1st Day of month of April for the Financial Year which is fixed by the SBI
If medical Loan made for the following purposes then it is fully exempt for taxable perk calculation but for other purposes it is taxable as per RULE 3A
(a) cancer;
(b) tuberculosis;
(c) acquired immunity deficiency syndrome;
(d) disease or ailment of the heart, blood, lymph glands, bone marrow, respiratory system, central nervous system, urinary system, liver, gall bladder, digestive system, endocrine
glands or the skin, requiring surgical operation;
(e) ailment or disease of the eye, ear, nose or throat, requiring surgical operation;
(f) fracture in any part of the skeletal system or dislocation of vertebrae requiring surgical operation or orthopaedic treatment;
(g) gynaecological or obstetric ailment or disease requiring surgical operation, caesarean operation or laperoscopic intervention;
(h) ailment or disease of the organs mentioned at (d), requiring medical treatment in a hospital for at least three continuous days;
(i) gynaecological or obstetric ailment or disease requiring medical treatment in a hospital for at least three continuous days;
(j) burn injuries requiring medical treatment in a hospital for at least three continuous days;
(k) mental disorder - neurotic or psychotic - requiring medical treatment in a hospital for at least three continuous days;
(l) drug addiction requiring medical treatment in a hospital for at least seven continuous days;
(m) anaphylectic shocks including insulin shocks, drug reactions and other allergic manifestations requiring medical treatment in a hospital for at least three continuous days.
Explanation : For the purpose of this rule,—
(a) “qualified doctor” means a person who holds a degree recognised by the Medical Council of India and is registered by the Medical Council of any State;
(b) “nurse” means a person who holds a certificate of a recognised Nursing Council and is registered under any law for the registration of nurses;
(c) “surgical operation” includes treatment by modern methodology such as angioplasty, dialysis, lithotropsy, laser or cryo-surgery.]
Where the benefit relates to the loans made available for medical treatment referred to above, the exemption so provided shall not apply to so much of the loan as has been reimbursed
to the employee under any medical insurance scheme.
“member of household” shall include— (a) spouse(s), (b) children and t
Valuation of perquisite in respect of the Car
Owned/hired by
employer or
owned by
Actual cost of the Car to employee Please
the employer if owned Select Cubic Capacity of
MONTH by the employer \/ Engine (CC)
(A) (B) (C )
April
May
June
July
August
September
October
November
December
January
February
March
Credit Card expenses for Credit Card used by the employee or any
member of his household
Exp. Incurred by the

employer in respect of
Credit Card other than Recovery from the Value of the
MONTH official use employee perquisite taxable
(A) (B) (C ) (D)=(B)-(C )
April 0
May 0
June 0
July 0
August 0
September 0
October 0
November 0
December 0
January 0
February 0
March 0
0 0 0
Club Expenses for Club Facility used by the employee or any

member of his household other than official purpose
Club Expenses for Club Facility used by the employee or any
member of his household other than official purpose

employer in respect of Recovery from the Value of the
MONTH club facility employee perquisite taxable
(A) (B) (C ) (D)=(B)-(C )
April 0
May 0
June 0
July 0
August 0
September 0
October 0
November 0
December 0
January 0
February 0
March 0
0 0 0
Food and Non-alcoholic beverages provided in office premises or through non

transferable paid vouchers usable only in eating joints (a). excluding during working
hours in remote area or in an offshore installation, (b). excluding Tea or snacks
provided in working hours
No. of Holidays and

leaves during the
Exp. Incurred by the month incl.
employer in respect of Recovery from the Sundays(i.e. non
MONTH Meals employee working days)
(A) (B) (C ) (D)
April
May
June
July
August
September
October
November
December
January
February
March
0 0
Specified securities, Sweat Equity Share, Stock options (Being

equity share in a company or not) Fair Market Value to be
determined as per Rule 3[subrule 8 & 9] Please refer the Rule
mentioned in the adjacent cells for the determination of the value
of perk
Specified securities, Sweat Equity Share, Stock options (Being
equity share in a company or not) Fair Market Value to be
determined as per Rule 3[subrule 8 & 9] Please refer the Rule
mentioned in the adjacent cells for the determination of the value
of perk
Fair Market Value(FMV) Recovery from the

on the date of exercise employee as Value of the
MONTH of the option exercise price perquisite taxable
(A) (B) (C ) (D)=(B)-(C )
April 0
May 0
June 0
July 0
August 0
September 0
October 0
November 0
December 0
January 0
February 0
March 0
0 0 0
se(s), (b) children and their spouses, (c) parents, and (d) servants and dependan
e Car
Amount recovered
Whether Driver Total amount of Actual from the employee
provided? select exp. Incurred by towards Runnig and
from the drop employer Towards maintainance
down menu Running and (expenditure born by
\/ maintainance the employee)
(D) (E) (F)
Gift [or voucher/token in lieu of which such gift may be received by the
employee (or by the member of his household)] on ceremonial occasion or
otherwise.
Expenditure towars
MONTH Gifts, vouchers, etc. amount exempt
(A) (B) (C )
April 0
May 0
June 0
July 0
August 0
September 0
October 0
November 0
December 0
January 0
February 0
March 0
0 0
Perquisite in respect of Travelling, touring, accomodation and any other
expneses paid for any holiday availed by the employee (or any member of the
household) other than LTC or LTA (see the Note Also)
Perquisite in respect of Travelling, touring, accomodation and any other
expneses paid for any holiday availed by the employee (or any member of the
household) other than LTC or LTA (see the Note Also)
employer in respect of Recovery from the
MONTH Holiday Expenses employee
(A) (B) (C )
April
May
June
July
August
September
October
November
December
January
February
March
0 0
emises or through non Value of any other benefit/amenity/service/ previlege

excluding during working N.B.:- in case of free transport facility provided to the employees of
xcluding Tea or snacks who is a transport service provider (Except Railways/Airline) the cost
employer is the cost at which it provides service to the pu
Value of the
perquisite taxable Exp. Incurred by the
in excess of Rs. 50 employer in respect of
per meal MONTH benefit
(E) (A) (B)
0 April
0 May
0 June
0 July
0 August
0 September
0 October
0 November
0 December
0 January
0 February
0 March
0 0
The value of benefit to the employee (or any member of the household)
provided by the employer in the form of services of Sweeper, gardener,
watchman or personal attendant. (PLEASE SPECIFY WHETHER THE EMPLOYEE
IS SPECIFIED OR UNSPECIFIED EMPLOYEE) No need to select it is automatic
>>>>
N.B.:- Please don't include the expenditure towards the sweeper, gardener
etc. if provided to the employee for the maintainance of garden apurtenant to
The value of benefit to the employee (or any member of the household)
provided by the employer in the form of services of Sweeper, gardener,
watchman or personal attendant. (PLEASE SPECIFY WHETHER THE EMPLOYEE
IS SPECIFIED OR UNSPECIFIED EMPLOYEE) No need to select it is automatic
>>>>
N.B.:- Please don't include the expenditure towards the sweeper, gardener
etc. if provided to the employee for the maintainance of garden apurtenant to
the rent free house owned and provided by the employer to its employee.
Employed by
select from the Exp. Incurred by the
drop down menu employer in respect of Recovery from the
\/ benefit employee
(A) (B) (C )
0 0
nd (d) servants and dependants;
Amount of Running and Purpose of use of car

maintainance exp. OFFICIAL /PRIVATE AND
Relating to official purpose OFFICIAL / PRIVATE select
Amount not as per the records from the drop down
recovered from available (as certified by menu
employee employer) \/
(G)=(E)-(F) (H) (I)
0
0
0
0
0
0
0
0
0
0
0
0
may be received by the

n ceremonial occasion or EMPLOYEE OWNS ANY AUTOMOTIVE CONVEYANCE OTHER THAN
Amount recovered
Total amount of Actual from the employee
Taxable value of exp. Incurred by (expenditure born by
perquisite employer the employee)
(D)=(B)-(C ) (A) (B)
0
0
0
0
0
0
0
0
0
0
0
0
0 0
modation and any other Credit Card related Provision
yee (or any member of the
the Note Also)
amount of expenses including membership fees and annual fees incurred by t
employee or any member of his household, which is charged to a credit card (
Value of the
perquisite taxable add-on-card) provided by the employer, or otherwise, paid for or reimbursed b
(D)=(B)-(C ) employer shall be taken to be the value of perquisite chargeable to tax
0 Club Related Provisions
0 The value of benefit to the employee resulting from the payment or reimburse
0 the employer of any expenditure incurred (including the amount of annual or
0 a club by him or by a member of his household shall be determined to be the
0 expenditure
Where suchincurred
facility or
is reimbursed
maintained by the
suchemployer,
employerandon that account.
is not available unif
0 value of benefit shall be taken totouring,
Travelling, be the value at which such
accomodation andfacilities are offe
any other ex
0 public. Where the employee is on official tour and the expenses are incurred
0 his household accompanying him, the amount of expenditure so incurred sh
amenity:
0
Provided that where any official tour is extended as a vacation, the value of
0 limited to the expenses incurred in relation to such extended period of stay
0 determined shall be reduced by the amount, if any, paid or recovered from t
0 or amenity.
0
benefit/amenity/service/ previlege
acility provided to the employees of the Employer
r (Except Railways/Airline) the cost incurred by the
which it provides service to the public.
Recovery from the Value of the perquisite

employee taxable
(C ) (D)=(B)-(C )
0
0
0
0
0
0
0
0
0
0
0
0
0 0
er of the household)
Sweeper, gardener, 1-SPECIFIED
WHETHER THE EMPLOYEE 2-UNSPECIFIED
d to select it is automatic
the sweeper, gardener

ce of garden apurtenant to
1-SPECIFIED
2-UNSPECIFIED
2-UNSPECIFIED
Rule 3[subrule 8 & 9]
specified equity share of a company listed on a

Recognised Stock Exchange(RSE)
Value of the
perquisite taxable
(D)=(B)-(C ) FMV = (OP)Opening Price(+)(CP)Closing price
0 2
0
0
0 if listed on one RSE - price of first settlement is the OP and
0 price of last settlement is the CP on the Exercise Date(ExD).
0 If Listed in more than one RSE - OP & CP of RSE having
highest trading of the said share on the Exercise Date.
0
WHEN there is no trading on the ExD in any RSE then the
0 CLOSING PRICE on any RSE or RSE having Highest
0 Turnover as the case may be, on a date close to ExD
0 immediately preceding such ExD
0
0
0
Recovery Expenses TAXABLE PERK
(P) (Q)
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
IVE CONVEYANCE OTHER THAN CAR
Amount of exp.
Relating to official
purpose as per the
records available
(as certified by Amount of
employer) expendituer TAXABLE PERK
(C ) (D)
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
t Card related Provision
fees and annual fees incurred by the
which is charged to a credit card (including any
otherwise, paid for or reimbursed by such

perquisite chargeable to tax
ub Related Provisions
ing from the payment or reimbursement by
ncluding the amount of annual or periodical fee) in
hold shall be determined to be the actual amount of
hemployer,
employerand
on that account.
is not available uniformly to all employees, the
alue at which such
accomodation facilities
and are offered
any other by other agencies to the
expneses
our and the expenses are incurred in respect of any member of
ount of expenditure so incurred shall also be a fringe benefit or
amenity:
tended as a vacation, the value of such fringe benefit shall be
on to such extended period of stay or vacation. The amount so
nt, if any, paid or recovered from the employee for such benefit
or amenity.
ule 3[subrule 8 & 9]
Not a Specified equity share of a

company or not listed on a
recognised stock exchange
FMV = Value determined by the

merchant Banker on the Specified Date
"specified date” means,—
(i) the date of exercising of the option; or
(ii) any date earlier than the date of the
exercising of the option, not being a
date which is more than 180 days earlier
than the date of the exercising.
No
365
Month Salary
0 0 0 0 April 0
0 0 0 0 May 0
0 0 0 0 June 0
0 0 0 0 July 0
0 0 0 0 August 0
0 0 0 0 September 0
0 0 0 0 October 0
0 0 0 0 November 0
0 0 0 0 December 0
0 0 0 0 January 0
0 0 0 0 February 0
0 0 0 0 March 0
0 TOTAL 0
Delhi
Mumbai
Chennai
Kolkata
Others
Please Select the city from the control box
Rent free Accommodation
Lease rent paid

by employer (in
Taxable
case Rent Paid by value for
upto 90
Accomodation employee the year
days
not owned by
employer)
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0
5 Please select the city
House Rent Allownace
Taxable
Value HRA Rent Paid by
after 90 Month Salary Tax free Taxable
Taxable Received employee
days
0 April 0 0 0 0 0
0 May 0 0 0 0 0
0 June 0 0 0 0 0
0 July 0 0 0 0 0
0 August 0 0 0 0 0
0 September 0 0 0 0 0
0 October 0 0 0 0 0
0 November 0 0 0 0 0
0 December 0 0 0 0 0
0 January 0 0 0 0 0
0 February 0 0 0 0 0
0 March 0 0 0 0 0
0 0 TOTAL 0 0 0 0 0
max
min
0
RULE 2A
50% or
40% of
Salary
0
0
0
0
0
0
0
0
0
0
0
0
0
0
SELECT Govt.Emp Licence Fee SalaryClick here toemployer
of previous read theinnote:
the below During the course of Transfer, 0 2 Specified
Whether Rent free accomodation
provided? Please Select the option SELECT YES Owned by emplyer other than govt. box If Hotel Accomodation is provided EMPLOYEE IS A NON-SPECIFIED
EMPLOYEE
Un specified
NO Hired/Leased accom. or
Rent free Accommodation other than HOTEL Accommodation in hotel If Furnished please fill this also Accommodation in licenced hotel is provided
Lease rent/hire Charge

If Multiple paid/payable by employer (in Hotel Furnishing in
No. of Days Please Select the city case Accomodation not Please Select the option i.e. Type Taxable perk in
acquision Accommodatio If Furnitures If aquired on Hotel Charges Accommod respect of
occupied (if from the drop down Licence fee in owned by employer) of Accommodation from the drop Amount Recovered Difference To respect of Total Taxable
select the Amount recovered from n Owned by owned by the Lease or hired Excluding Food Hotel bill for ation furnished
Occupied menu case Govt. if Accommodation down menu recovered from from the be considered accommodation before recovery Final Value
houses the employee emplyer other Employer cost of then the lease rent and other tax calculation Taxable accommodation
whole year \/ Employee \/ the employee employee for taxation other than Rough
(Transfer owned by employer than govt. furniture or rental charge services before other than hotel
leave it blank) \/ \/ HOTEL
Cases Only) leave this column recovery accommodation
blank
FALSE 0 0 0 0 0 0 0 0
FALSE 0 0 0 0 0 0 0 0
FALSE 0 0 0 0 0 0 0 0
FALSE 0 0 0 0 0 0 0 0
FALSE 0 0 0 0 0 0 0 0
FALSE 0 0 0 0 0 0 0 0
FALSE 0 0 0 0 0 0 0 0
FALSE 0 0 0 0 0 0 0 0
FALSE 0 0 0 0 0 0 0 0
FALSE 0 0 0 0 0 0 0 0
FALSE 0 0 0 0 0 0 0 0
FALSE 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0
Leave Travel Concession Gas, Electricity energy or Water Suppy Provided Free of cost Recover 0 Value 0 Taxable 0
Amount paid or
Payable to Connection in
Outside agency the name of Note:
or from the drop For the purpose of calculation of rent free or concessional rent accommodation the salary of previous
Manufacturing down menu employer if the employee has more than one employer druring the previous year or financial year for which
Cost to Recovered from Gross \/ Net tax is to be calculated.
Month Total amount received Tax free amount Taxable Month employer emplyee Taxable \/ “salary” includes the pay, allowances, bonus or commission payable monthly or otherwise or any monetary
Taxable
payment, by whatever name called from one or more employers, as the case may be, but does not include
April 0 April 0 0 the following, namely:—
May 0 May 0 0 (a) dearness allowance or dearness pay unless it enters into the computation of superannuation or
June 0 June 0 0 retirement benefits of the employee concerned;
July 0 July 0 0 (b) employer’s contribution to the provident fund account of the employee;
August 0 August 0 0 (c) allowances which are exempted from payment of tax;
(d) the value of perquisites specified in clause (2) of section 17 of the Income-tax Act;
September 0 September 0 0 (e) any payment or expenditure specifically excluded under proviso to sub-clause (iii) of clause (2)* or
October 0 October 0 0 proviso to clause (2) of section 17;
November 0 November 0 0 (f) lump-sum payments received at the time of termination of service or superannuation or voluntary
December 0 December 0 0 retirement, like gratuity, severance pay, leave encashment, voluntary retrenchment benefits, commutation of
pension and similar payments;
January 0 January 0 0
February 0 February 0 0
March 0 March 0 0
0 0 0 0 0
Free education Use of Moveable Assets other than CAR, Computer/Laptops
In case asset Please

owned by Select the
Payment of School employer the Date on option
Payment of School Fees Fees of employee's actual cost of Amount which Item owned or
of employee's children Family Member Recovered No. of Children (Children Acquisition of recovered Given for Taxable hired by
directly to school or directly to school or From doesnot include Grand asset else hire from the Use by value in case employer
Month Reimbursement of fees Reimbursement Employee children) Taxable amount Tax 1 Month charge employee employee owned asset Below Taxable Value
1 April 0 0 April 0 0 0
1 May 0 0 May 0 0 0
1 June 0 0 June 0 0 0
1 July 0 0 July 0 0 0
1 August 0 0 August 0 0 0
1 September 0 0 September 0 0 0
1 October 0 0 October 0 0 0
1 November 0 0 November 0 0 0
1 December 0 0 December 0 0 0
1 January 0 0 January 0 0 0
1 February 0 0 February 0 0 0
1 March 0 0 March 0 0 0
0 0 0 0
Sale of Movable Assets to Employee (Fill only the white Highlighted areas)
WDV
Date of Sale (Note: 10% SLM
Cost of Acquisition to Date of Acquisition (DD/MMM/YY for Other Recovered from
Type of Asset Month Employer DD/MMM/YYYY YY) Completed Year Assets) Employee Taxable
Items
Decline Bal April 0 0 0
Items
Decline Bal May 0 0 0
Items
Decline Bal June 0 0 0
Items
Decline Bal July 0 0 0
Items
Decline Bal August 0 0 0
Items
Decline Bal September 0 0 0
Items
Decline Bal October 0 0 0
Items
Decline Bal November 0 0 0
Items
Decline Bal December 0 0 0
Items
Decline Bal January 0 0 0
Items
Decline Bal February 0 0 0
Items
Decline Bal March 0 0 0
Any other Perquisites
Employee
Value of any owns any
other Stock automotive
Sweeper, gardener, benefit/ameni options (non- conveyance
watchman or personal Credit card ty/service/ qualified other than
Interest free Loan Cars attendant Holiday expenses Free meals Gifts, vouchers, etc. expenses Club expenses previlege options) car Taxable
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
Reimbursement of Medical expenses:

if following conditions satisfied then it is fully
Hospital maintained by
any other person (for
exempted
example a Private Clinic) Hospital maintained by employer/ central or state
medical expenses government/local authority/any other person but
Month incurred Taxable perk approved by the government for the treatment of its
April 0 employees/ approved by the chief commissioner having
May 0 regard to the prescribed guidelines/ expenses towards
June 0
the health insurance policy (i.e. Group medical insurance
premium for the employees or medical insurance
July 0
premium for employees and dependent family
August 0
members. )
September 0
October 0
November 0
December 0
January 0
February 0
March 0
0
Dearness For
Please enter the Valid Date in Valid Format otherwise it may take wrong date DA enters Pay which calculation Date of retirement (whether on superannuation or otherwise) Amount Rs.
into Commission enters into of leave
retirement on fixed % of retirement encashme
Month Basic benefit Turnover benefit Total nt
Date of Joining (dd-mmm-yyyy) 1 6/1/1990 June 1990 June 2009 0 0 Before January 1, 1982 25,500
Date of Retirement (dd-mmm-yyyy) 5/24/2010 May
24 2010 July 2009 0 0 Between January 1, 1982 and June 30, 1986 30,000
Leave Encashment received (Rs.) August 2009 0 0 Between July 1, 1986 and December 31, 1986 73,400
leave entitlement per Year (Days) 0 September 2009 0 0 Between January 1, 1987 and June 30, 1987 75,600
Leave already Taken (Days) October 2009 0 0 Between July 1, 1987 and December 31, 1987 77,760
Duration of Service 20 November 2009 0 0 Between January 1, 1988 and March 31, 1995 79,920
Avg salary 0.00 December 2009 0 0 Between April 1, 1995 and June 30, 1995 1,30,320
Entitle ment 0.00 0.00 1 January 2010 0 0 Between July 1, 1995 and July 1, 1997 1,35,360
10 Month Salary 10 0.00 2 February 2010 0 0 Between July 2, 1997 and April 1, 1998 2,40,000
Statutory limit 300000.00 3 March 2010 0 0 After April 2, 1998 3,00,000
Received 0.00 4 April 2010 0 0
Minimum exempted 0.00 May 2010 0 0 Statutory limits fixed
Taxable 0.00 June 2010 0
Retrenchment Compensation Gratuity
Amount
Calculated
as per
Retrenchme section
nt 25F(b) of
Compensatio Industrial
Month n received Disputes Act Exempted Taxable Date of Joining (dd-mmm-yyyy) 6/1/1990
April 0 0 Date of Retirement (dd-mmm-yyyy) 5/24/2010
May 0 0 Gratuity received (Rs.)
June 0 0 Covered
Covered by Gratuity Act
by Gratuity Act
July 0 0 Not Covered by Gratuity Act 1
August 0 0 Duration of Service 20 19
September 0 0 Avg salary 0 0
October 0 0 Enter the Full DA amount of Last Month
November 0 0 15 Days' Salary for each yr. of service 0
December 0 0 Statutory limit 1000000
January 0 0 Received 0
February 0 0 Minimum exempted 0.00
March 0 0 Taxable 0.00
Notified limit 500000 0 0 0
NSC Accrued Interest
NSC Accrued Interest Calculation
Enter details of all NSCs purchased before the period 01-Apr-2011
Certificate No. Date of Purchase Amount invested
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Page 1
0
0
0
Total Accrued Interest
Instructions:
1. Enter details of all NSCs purchased before the period 01-Apr-2011
2. NSCs purchased before or after this date do not accrue interest for this financial year
3. Entry of certificate number is optional
Page 2
31-Mar-2012
Accrued Interest
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Page 3
0.00
0.00
0.00
0.00
31-Mar-2012
Page 4
Sr. No.
1
2
3
6
7(i)
7(ii)
8
10
11
12
13
14
15
16
17
18
19
20
21
a.
b.
c.
i.
ii.
iii.
iv.
v.
vi.
vii.
viii.
d.
a.
b.
c.
10
Please Put the Figures by reading the instructions carefully
Particulars
Life insurance premium (including payment made by Government employees to the Central Government
Employees’ insurance scheme and payment made by a person under children’s deferred endowment
assurance policy) [subject to a maximum of 20 per cent of sum assured (sum assured does not include any
premium agreed to be returned or any benefit by way of bonus)][see Note 1]
Payment in respect of non-commutable deferred annuity [see Note 2]

Any sum deducted from salary payable to a Government employee for the purpose of securing him a
deferred annuity (subject to a maximum of 20 per cent of salary) [see Note 3]
Contribution (not being repayment of loan) towards statutory provident fund and recognized provident
fund
Contribution (not being repayment of loan) towards 15 year Public Provident Fund (PPF) [see Notes 4
and 6]
Contribution towards an approved superannuation fund
Subscription to National Savings Certificates, VIII Issue [see Note 7]
Accrued interest on NSC Reinvested
Contribution for participating in the unit-linked insurance plan (ULIP) of Unit Trust of India [see Note 5]
Contribution for participating in the unit-linked insurance plan (ULIP) of LIC Mutual Fund (i.e., formerly
known as Dhanraksha plan of LIC Mutual Fund) [see Note 5]
Payment for notified annuity plan of LIC (i.e., New Jeevan Dhara and New Jeevan Akshay, New Jeevan
Dhara I, New Jeevan Akshay I and New Jeevan Akshay II)
Subscription towards notified units of Mutual Fund or UTI

Contribution to notified pension fund set up by Mutual Fund or UTI (i.e., Retirement Benefit Unit
Scheme of UTI and Kothari Pioneer Pension Plan of Kothari Mutual Fund)
Any sum paid (including accrued interest) as subscription to Home Loan Account Scheme of the National
Housing Bank or contribution to any notified pension fund set up by the National Housing Bank.
Any sum paid as subscription to any scheme of—

a. public sector company engaged in providing long-term finance for purchase/construction of residential
houses in India
b. housing board constituted in India for the purpose of planning, development or improvement of
cities/towns
Any sum paid as tuition fees (not including any payment towards development fees/donation/payment of
similar nature) whether at the time of admission or otherwise to any university/college/educational
institution in India for full time education
Any payment towards the cost of purchase/construction of a residential property (including repayment
of loan taken from Government, bank, cooperative bank, LIC, National Housing Bank, assessee’s
employer where such employer is public company/public sector company/university/co-operative society)
[see Note 9]
Amount invested in approved debentures of, and equity shares in, a public company engaged in
infrastructure including power sector or units of a mutual fund proceeds of which are utilised for the
developing, maintaining, etc., of a new infrastructure facility
Amount deposited in a fixed deposit for 5 years or more with a scheduled bank in accordance with a
scheme framed and notified by the Central Government (applicable from the assessment year 2007-08).
[see Note 10]
Five Year Post Office Time Deposit Account Investment made on or after 1st April 2007
Senior Citizen Savings Scheme Investment made on or after 1st April 2007
as subscription to any notified bonds issued by NABARD (the National Bank for Agriculture and Rural
Development )(applicable from the assessment year 2008-09)
Notes:
1. In the case of an individual policy should be taken on his own life, life of the spouse or any child (child
may be dependent/independent, male/female, minor/major or married/unmarried). In the case of a Hindu
undivided family, policy may be taken on the life of any member of the family.
2. Annuity plan should be taken in the name of the individual, his wife/her husband or any child of such
individual.
3. It should be for the benefit of the individual, his wife or children.
4. In the case of an individual, the provident fund account should be in his own name or in the name of
his/her spouse or any child (child may be dependent/independent, male/female, minor/major or
married/unmarried). In the case of a Hindu undivided family, provident fund account should be in the
name of any member of the family.
5. In the case of an individual, ULIP should be taken on his own life, life of the spouse or any child (child
may be dependent/independent, male/female, minor/major or married/unmarried). In the case of a Hindu
undivided family, ULIP may be taken on the life of any member of the family.
6. There is no maximum ceiling under the Income-tax Act. However, under the public provident fund
scheme, the maximum contribution is Rs. 70,000.
7. Accrued interest (which is deemed as reinvested) is also qualified for deduction for first 5 years.
8. While an individual can make payment in any of the above referred investments, an HUF cannot invest
in points 2, 3, 4, 6, 12 and 14 mentioned above.
9. The following payment made towards the cost of purchase/construction of a new residential house
property is qualified for the purpose of section 80C :
any instalment or part payment of the amount due under any self-financing or other scheme of any
development authority, housing board or other authority engaged in the construction and sale of house
property on ownership basis ; or
any instalment or part payment of the amount due to any company or co-operative society of which the
assessee is a shareholder or member towards the cost of the house property allotted to him (it is not
applicable if the assessee is not a shareholder or member of the company/co-operative society which
provides house to the assessee); or
repayment of the amount borrowed by the assessee from —
the Central Government or any State Government, or
any bank, including a co-operative bank, or
the Life Insurance Corporation of India, or
the National Housing Bank, or
any public company formed and registered in India with the main object of carrying on the business of
providing long-term finance for construction or purchase of houses in India for residential purposes which
is eligible for deduction under section 36(1)(viii), or
any company in which the public are substantially interested or any co-operative society, where such
company or co-operative society is engaged in the business of financing the construction of houses, or
the assessee’s employer where such employer is an authority or a board or a corporation or any other body
established or constituted under a Central or State Act, or
the assessee’s employer where such employer is a public company or public sector company, or a
university established by law or a college affiliated to such university or local authority or co-operative
society ;
stamp duty, registration fee and other expenses for the purpose of transfer of such house property to the
assessee.
The following payments are not qualified for the purpose of section 80C :
the admission fee, cost of the share and initial deposit which a shareholder of a company or a member of a
co-operative society has to pay for becoming such shareholder or member ; or
the cost of any addition or alteration to, or renovation or repair of, the house property which is carried out
after the issue of the completion certificate in respect of the house property by the authority competent to
issue such certificate or after the house property (or any part thereof) has either been occupied by the
assessee or any other person on his behalf or been let out ; or
any expenditure in respect of which deduction is allowable under the provisions of section 24.
For the purposes of this clause, “scheduled bank” means the State Bank of India constituted under the
State Bank of India Act, 1955 (23 of 1955), or a subsidiary bank as defined in the State Bank of India
(Subsidiary Banks) Act, 1959 (38 of 1959), or a corresponding new bank constituted under section 3 of the
Banking Companies (Acquisition and Transfer of Undertakings) Act, 1970 (5 of 1970), or under section 3
of the Banking Companies (Acquisition and Transfer of Undertakings) Act, 1980 (40 of 1980), or any
other bank, being a bank included in the Second Schedule to the Reserve Bank of India Act, 1934 (2 of
1934);]
April May June July Aug Sep Oct
0
0 0 0 0 0 0 0
Nov Dec Jan Feb Mar
0
0
0
0
0
0
0
0
0
0
0
0
0
0 0 0 0 0
Please Fill in the following data
Particulars April
Amount paid or deposited by any Individual in any annuity plan of the Life
Insurance Corporation of India or any other insurer for receiving pension from a
fund set up by the said corporation.
Total 0
One should keep in view the following points :
1. Where the assessee or his nominee surrenders the annuity before the maturity
date of such annuity, the surrender value shall be taxable in the hands of the
assessee or his nominee, as the case may be, in the year of the receipt.
2. The amount received by the assessee or his nominee as pension will be taxable,
in the hands of the assessee or the nominee, as the case may be, in the year of the
receipt.
May June July Aug Sep Oct Nov
0 0 0 0 0 0 0
Dec Jan Feb Mar
0 0 0 0
Particulars April May June July
Other Other Other Other
Amount Paid For Self, Spouse or

Dependent Children (Please Specify the
mode of Payment Also.[Cash or Other])
OR
Contribution made to the Central
Government Health Scheme

Amount Paid for the Self, Spouse or
Dependent Children who is a senior
Citizen. (Please Specify the mode of
Payment Also.[Cash or Other])

Amount paid for the benefit of the Senior
Citizen Parent who is Resident in India.
(Please Specify the mode of Payment
Also.[Cash or Other])
Amount paid for the benefit of the

Parents (who are Not Senior Citizen) who
is Resident in India. (Please Specify the
mode of Payment Also.[Cash or Other])
Total 0 0 0 0
Such insurance shall be in accordance with a scheme framed in this behalf by (The Scheme
The General Insurance Corporation of India formed under section
(a) 1972) and approved by the Central Government in this behalf; o
Any other insurer and approved by the Insurance Regulatory and

(b) the Insurance Regulatory and Development Authority Act, 1999 (
On the health of the taxpayer, spouse, parents or dependent children of the taxpayer.
Senior Citizen:
One who is resident in India and who is at least of 65 years of age at any time during the previous year
Dependent Children Does not mean the Grandson or Grand doughter
Aug Sep Oct Nov Dec Jan Feb
Other Other Other Other Other Other Other
0 0 0 0 0 0 0
his behalf by (The Scheme Should be 'Mediclaim Insurance Policy' or equivalent)
f India formed under section 9 of the General Insurance Business (Nationalisation) Act, 1972 (57 of
Government in this behalf; or
he Insurance Regulatory and Development Authority established under sub-section (1) of section 3 of
opment Authority Act, 1999 (41 of 1999).]]
the previous year

hter
Mar
Other
Other
Other
Other
0
ivalent)
n) Act, 1972 (57 of
on (1) of section 3 of
Particulars April
% DISABLE
The taxpayer has incurred an expenditure for the medical treatment 1
(including nursing), training and rehabilitation of a dependent (being a
person with disability)
% DISABLE
The taxpayer has paid or deposited under any scheme framed in this behalf 1
by the Life Insurance Corporation or any other insurer, or the
administrator1 or specified company2 and approved by the Board in this
behalf, for maintenance of dependent (being a person with disability)
Total 0
1. “Administrator” means the Administrator as referred to in clause (a) of
section 2 of the Unit Trust of India (Transfer of Undertaking and Repeal)
Act, 2002.
2. “Specified company” means a company as referred to in clause (h) of

section 2 of the Unit Trust of India (Transfer of Undertaking and Repeal)
Act, 2002.
Meaning of “disability” has been extended from the assessment year 2005-
06 to include “autism”, “cerebral palsy” and “multiple disability” referred
to in clauses (a), (c) and (h) of section 2 of the National Trust for Welfare
of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple
Disabilities Act, 1999.
section 2(i) of the Persons with Disabilities (Equal Opportunities,

Protection of Rights and Full Participation) Act, 1995, "Disability" means-
blindness, low vision, leprosy-cured, hearing impairment, locomotor
disability, mental retardation, mental illness
May June July Aug Sep Oct
% DISABLE % DISABLE % DISABLE % DISABLE % DISABLE % DISABLE
0 0 0 0 0 0
For the above purpose, a “dependent being a person with disability” is a person who
satisfies the following points—
in the case of an individual, dependent means the spouse,

a. children, parents, brothers and sisters of the individual or
any of them;
such person has not claimed any deduction under section

b. 80U in computing his total income for the assessment year
relating to the previous year;
“disability”* shall have the meaning assigned to it in section

c. 2(i) of the Persons with Disabilities (Equal Opportunities,
Protection of Rights and Full Participation) Act, 1995
Person with disability means- a person suffering from not

d. less than 40 % of any disability as certified by medical
authority.
Nov Dec Jan Feb Mar
% DISABLE % DISABLE % DISABLE % DISABLE % DISABLE
1
0 0 0 0 0
Deduction in respect of interest on loan taken
Particulars April May June July Aug Sep
Amount paid during the
year by way of interest
Total 0 0 0 0 0 0
(1) In computing the total income of an assessee, being an individual, there shall be deducted, in accordance with an
of this section, any amount paid by him in the previous year, out of his income chargeable to tax, by way of interest o
any financial institution or any approved charitable institution for the purpose of pursuing his higher education or fo
education of his relative.
(2) The deduction specified in sub-section (1) shall be allowed in computing the total income in respect of the initial a
assessment years immediately succeeding the initial assessment year or until the interest referred to in sub-section (1
full, whichever is earlier.
(3) “higher education” means any course of study pursued after passing the Senior Secondary Examination or its eq
board or university recognised by the Central Government or State Government or local authority or by any other au
Central Government or State Government or local authority to do so;]
Following are the conditions to be satisfied

1. The assessee is an individual.
2. He had taken a loan from any financial institution [i.e., a banking company or notified financial institution HDFC B
657(E) 21-6-2002)] or an approved charitable institution [i.e., an institution approved for the purpose of section 10(23
3. The loan was taken for the purpose of pursuing higher education [i.e., full-time studies for any graduate or post-gra
engineering (including technology/architecture), medicine, management or for postgraduate course in applied science
including mathematics and statistics].
4. Amount is paid by the individual during the previous year by way of repayment of such loan or interest on such loa
5. Such amount is paid out of his income chargeable to tax.
Entire payment of interest is deductible. The deduction is available for a maximum of 8 years or till the interest is
This deduction is allowed in computing the taxable income of the initial assessment year (i.e., the assessment year
year in which the assessee starts paying the interest on the loan) and seven immediately succeeding assessment
interest is paid in full, whichever is earlier).
For the purposes of this section,

(a) approved charitable institution means an institution specified in, or, as the case may be, an institu
charitable purposes and 74b[notified by the Central Government] under clause (23C) of section 10 or
to in clause (a) of sub-section (2) of section 80G;
(b) financial institution means a banking company to which the Banking Regulation Act, 1949 (10 of 1
any bank or banking institution referred to in section 51 of that Act); or any other financial institution
Government may, by notification in the Official Gazette75, specify in this behalf;
(c) higher education means any course of study pursued after passing the Senior Secondary Examina
from any school, board or university recognised by the Central Government or State Government or lo
other authority authorised by the Central Government or State Government or local authority to do so
(d) initial assessment year means the assessment year relevant to the previous year, in which the ass
the interest on the loan.]
(e) relative, in relation to an individual, means the spouse and children of that individual or the studen
individual is the legal guardian.(wef 1-4-2010)
n loan taken for higher education
Oct Nov Dec Jan Feb Mar
0 0 0 0 0 0
in accordance with and subject to the provisions

ax, by way of interest on loan taken by him from
higher education or for the purpose of higher
n respect of the initial assessment year and seven

red to in sub-section (1) is paid by the assessee in
y Examination or its equivalent from any school,

ority or by any other authority authorised by the
ncial institution HDFC Bank (Notification no.SO

purpose of section 10(23C) or 80G(2)(a)].
any graduate or post-graduate course in

ourse in applied sciences or pure sciences
n or interest on such loan.
rs or till the interest is paid, whichever is earlier.

e., the assessment year relevant to the previous
succeeding assessment years (or until the above
se may be, an institution established for
23C) of section 10 or an institution referred
on Act, 1949 (10 of 1949) applies (including

financial institution which the Central
Secondary Examination or its equivalent

ate Government or local authority or by any
cal authority to do so;(wef 1-4-2010)
ear, in which the assessee starts paying
dividual or the student for whom the

Donee
1
----------Please select----------- 0
1
----------Please select----------- 0
1
----------Please select----------- 0
1
----------Please select----------- 0
1
----------Please select----------- 0
1
----------Please select----------- 0
1
----------Please select----------- 0
1
----------Please select----------- 0
1
----------Please select----------- 0
1
----------Please select----------- 0
1
----------Please select----------- 0
1
----------Please select----------- 0
1
----------Please select----------- 0
1
----------Please select----------- 0
1
----------Please select----------- 0
1
----------Please select----------- 0
1
----------Please select----------- 0
1
----------Please select----------- 0
1
----------Please select----------- 0
1
----------Please select----------- 0
TOTAL
NB:
Please Select only one donee for each row. The donee Should not be repeated.
Apr May June July Aug Sep
0 0 0 0 0 0
d not be repeated. If the donee is not in the list don't fill up the Row and leave it as "--------
Oct Nov Dec Jan Feb Mar Total
0 0 0 0 0 0 0
nd leave it as "--------Please select----------"

Particulars for the months of April May June July
Actual Rent Paid by the Assessee
Salary Income
Income or loss from house property Accomodation located in the
Bank interest
Income from Business
Caution: the employee is not receiving the HRA and

The following persons Should not own any residential Accommodation
tax payer
his/her spouse
his/her minor child (including Step child and adopted child)
HUF of which he is a member
N.B. : Please fill in all the cells. If the rent has been paid as arrear then
Also please Specify the Location of the House property if there is incom
this cell depends upon the number of Actual rent paid cells filled up more than Re. 0, if you fill more t
Aug Sep Oct Nov Dec Jan Feb Mar
ation located in the place other than place of employment Locality
Total Income
25% of Total Income
Excess of actual rent paid over 10% of Total income
2000 per month for 0 Months
Deduction amount eligible
d as arrear then specify in the respective month for which payment has been
if there is income or loss from the house property
Re. 0, if you fill more than Rs..0 in all cells this cell will also change with the figures
Total
0
0
-
0
0
0
0
0
0
0
0
0
0
0
0
0
0
ment has been made

Particulars April May June July Aug
Please specify the
percentage of
Disablility in the
percent dropdown
menu
0 0 0 0 0
TOTAL 0 0 0 0 0
107.32 Deduction in case of a person with disability [Sec. 80U] - The present section 80U has been substituted by a
107.32-1 CONDITIONS - Deduction is available if the following conditions are satisfied—
107.32-1a INDIVIDUAL - The taxpayer is an individual (maybe a citizen of India or foreign country).
united
107.32-1b RESIDENT IN INDIA - He is resident in India (maybe ordinarily resident or not ordinarily resident). Ded
107.32-1c PERSON WITH DISABILITY(The meaning of disability has been extended from the assessment ye
i. blindness;
ii. low vision;
iii. leprosy-cured;
iv. hearing impairment;
v. locomotor disability;
vi. mental retardation;
vii. mental illness.
Blindness - “Blindness” refers to a condition where a person suffers from any of the following conditions, namely :—
i. total absence of sight; or
ii. visual acuity not exceeding 6/60 or 20/200 (snellen) in the better eye with correcting lenses; or
iii. limitation of the field of vision subtending an angle of 20 degree or worse.
Low vision - “Person with low vision” means a person with impairment of visual functioning even after treatment or
Leprosy cured person - “Leprosy cured person” means any person who has been cured of leprosy but is suffering fr
i. loss of sensation in hands or feet as well as loss of sensation and paresis in
ii. manifest deformity and paresis but having sufficient mobility in their han
iii extreme physical deformity as well as advanced age which prevents him fr
Hearing impairment - “Hearing impairment” means loss of sixty decibels or more in the better ear in the conversatio
Locomotor disability - “Locomotor disability” means disability of the bones, joints or muscles leading to substantial
Mental retardation - “Mental retardation” means a condition of arrested or incomplete development of mind of a pe
Mental illness - “Mental illness” means any mental disorder other than mental retardation.
107.32-1d CERTIFIED BY MEDICAL AUTHORITY (Form No. 10-IA if the person is suffering from autism, c
“Medical authority” for this purpose means any hospital or institution specified by notification by the appropr
FORM
107.32-2 AMOUNT OF DEDUCTION – If the aforesaid conditions are satisfied, then a fixed deduction of Rs. 50,000
Sep Oct Nov Dec Jan Feb
0 0 0 0 0 0
0 0 0 0 0 0
has been substituted by a new section with effect from the assessment year 2004-05. The provisions of the new section are give
ot ordinarily resident). Deduction under this section is not available if he is non-resident in India for the relevant assessment year
d from the assessment year 2005-06 to include “autism”, “cerebral palsy” and “multiple disability” referred to in clauses
wing conditions, namely :—
ng even after treatment or standard refractive correction but who uses or is potentially capable of using vision for the planning o
leprosy but is suffering from—
sensation and paresis in the eye and eye-lid but with no manifest deformity;
ient mobility in their hands and feet to enable them to engage in normal economic activity;
age which prevents him from undertaking any gainful occupation.
better ear in the conversational range of frequencies.
scles leading to substantial restriction of the movement of the limbs or any form of cerebral palsy.
velopment of mind of a person, which is specially characterised by subnormality of intelligence.
suffering from autism, cerebral palsy, etc. ) - The taxpayer shall have to furnish a copy of the certificate issued
otification by the appropriate Government for the purpose of the Persons with Disabilities (Equal Opportunities, Protect
ed deduction of Rs. 50,000 is available. A higher deduction of Rs. 75,000 is allowed in respect of a person with severe disability
Mar
% DISABLE
0
0
visions of the new section are given below—
ia for the relevant assessment year.

disability” referred to in clauses (a), (c) and (h) of section 2 of the National Trust for Welfare of Persons with Autism, C
e of using vision for the planning or execution of a task with appropriate assistive device.
copy of the certificate issued by the medical authority (format of certificate is given below)† along with the ret
es (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995.
ct of a person with severe disability (i.e., having any disability over 80 per cent).
elfare of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities Act, 1999.)- It means a perso
ven below)† along with the return of income. Where the condition of disability requires reassessment, a fresh ce
999.)- It means a person suffering from not less than 40 per cent of any disability given below—
ssessment, a fresh certificate from the medical authority shall have to be obtained after the expiry of the period
e expiry of the period mentioned on the original certificate in order to continue to claim the deduction.
e deduction.
Form No. 10-IA
STANDARD FORMAT OF THE CERTIFICATE
Name & address of the institute/hospital issuing the certificate
Certificate No. ........................... Date........................
Certificate for the persons with disabilities
This is to certify that Shri/ Smt./ Kum....................................................................................... son/ wife/ daughter of Shri................................................................................................ Age ...........................
old male/female, Registration No. ........................................ is a case of ........................................................................................ He/She is physically disabled/visual disabled/speech & hearing disabled and
has .......................% (....................... per cent) permanent (physical impairment/visual impairment/speech & hearing impairment) in relation to his/her .............................................. ..........................
Notes:—
1. This condition is progressive/non-progressive/likely to improve/not likely to improve.*
2. Re-assessment is not recommended/is recommended after a period of .....................................................................months/years.*
*Strike out whichever is not applicable.
Sd/- (Doctor) Sd/- (Doctor) Sd/- (Doctor)

Seal Seal Seal
Signature/Thumb impression of the patient. Countersigned by the Medical

Superintendent/CMO/Head of Hospital (with seal)
Recent attested photograph showing the disability affixed here.

Form No. 10-IA
CERTIFICATE OF MENTAL RETARDATION FOR GOVERNMENT BENEFITS
This is to certify that Shri/Kum............................................................................................ son/daughter of...........................................................................of

Village/Town/City .......................................................with particulars given below :—
(a) Age
(b) Sex
(c) Signature/Thumb impression
Categorisation of Mental Retardation

Mild/Moderate/Severe/Profound
Validity of the Certificate : Permanent
Signature of Government
Doctor/Hospital with seal
Chairperson Mental Retardation
Certification Board
Recent Attested Photograph
showing the disability affixed here.
Dated :
Place :
SL no.
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Please select a State --Select--
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Assessement Year 2011-12 4

Please log on to www.jitenkumarsahu.blogspot.com for revised and updated version

Receipt number to be quoted in Form 16/16A will be generated by T

Receipt number provided by TIN is in addition to the provisional rece

PAN No. of the Deductor

TAN No. of the Deductor

TDS Assessment Range of the Employer :

Name of the employee

Is the employee a director or a person with

Receipt no. of Original statements

eipt number provided on acceptance/upload of quarterly TDS/TCS statement.

City 0 Pin code 0 30-Dec-99 30-Dec-99

2. Less : Allowance to the extent exempt under section 10

3. Balance (1-2) #VALUE!

6. Income chargeable under the Head ‘Salaries’(3-5) #VALUE!

7. Add. : Any other income reported by the employee -

8. Gross total income (6+7) #VALUE!

9. Deductions Under Chapter VI-A Deductible

10. Aggregate of deductible amount under chapter VI-A -

14. Tax Payable on total income (12+13) #VALUE!

Signature of the person responsible

Place : - Full Name : -

Tax Deposited in Challan identification number

Statement showing particulars of perquisites, other fringe benefits or

1. Name and address of employer :

(where the employer is a company)

6. Income under the head "Salaries" of the employee : #VALUE!

7. Financial Year : 2010 - 11

S. Nature of Perquisite Value of Amount,if any Amount of

Signature of the person responsible

Place : 0 Full Name : 0

Assessment Year 2011 - 12 Financial Year 2010 - 11

Particulars Rupees Rupees

Salary and other Salary Components -

(b) Value of perquisites under section 17(2) (as per Form

(c) Profits in lieu of salary under section 17(3) (as per

Particulars Rupees Rupees Rupees

Allowance to the extent exempt under section 10

House Rent Allowance

Total amount claimed to be exempt

ent showing particulars of perquisites, other fringe benefits or

Financial Year 2010 - 11

Whether PAN uploaded

Gross amount of TDS / TCS -

nature of person responsible for deduction of tax

Statement showing particulars of perquisites, other fringe benefits or

amenities and profits in lieu of salary with value thereof

1. Name and address of employer :

3. TDS Assessment Range of the Employer : -

4. Name and designation and PAN of employee :

5. Is the employee a director or a person with

6. Income under the head "Salaries" of the employee : -

7. Financial Year : 2010 - 11

S. Nature of Perquisite Value of Amount,if any

per rules employee

Page 1 of 2 [FORM NO. 12 BA]

Assessment Year 2011 - 12 Financial Year 2010 -

Particulars Rupees Rupees

Salary and other Salary Components -

(b) Value of perquisites under section 17(2) (as per Form

(c) Profits in lieu of salary under section 17(3) (as per

particulars of perquisites, other fringe benefits or