Prepare Income Tax , With Salary Statement, ITR-I, Form 16, FOR Financial YEAR 2010-11.

This Calculation sheet for All Govt. & Private concern Employees
For Contact :- pranab.banerjee83@gmail.com, bpranab78@yahoo.com OR Contact No. 9474316768 ,8906279547

if any discripency is arise for FIRST NAME

calculation of income tax by This New I T R - I(SARAL II),For Assessment Year 2011-2012,which
this software,I am not MIDDLE NAME
recent published by the MINISTRY OF FINANCE(Deptt.of
responisible for that LAST NAME Revenue)Central Board of Taxes,New Delhi. Notification Dated
23/04/2010 in the Gazette of India Extraordinary,Part-II, Section 3,(S
pranab banerjee DESIGNATION Sec(ii)]
Employee's Permanent A/C No.(PAN NO)
Gender ( Male or Female ) Male If Handicapped Employee Pl. put "Yes" If
General put "No" No
DATE OF BIRTH

EMPLOYEE'S RESIDENTIAL ADDRESS

Flat/Door/Block No.
Village
Post Office: First your Fill the Pay Sheet ,
Area/Locality:
If you live in Rented house of Metro City OR Othrs City Type
Yes
Yes ,else Type No After you fill this Bio Data
District: Sheet
PIN CODE: UPDATE
State: CLICK DON'T

Designation of Assessing Officer( Ward/Circle)

Date of Submit this RETURN

Office Address

STATUS- Govt/PSU/Others Govt DIN NO

Full Name of Deductor/D.D.O. Pan No. of Deductor
 Name & Address of the Employer Tan No. of Employer

PARTICULARS OF SALARY
Gross Income from Salary (Salary+H.R.A.+Bonus+Arrear if
360280 This Cell is Auto filled( The Data Comes from Pay Sheet)
any+Int.Bank/NSC+House Property)

Total Income from Salary( This Cell Auto filled) 282760 This Cell is Auto filled (The Data comes from Pay Sheet)

Taxable income of previous year (Col-11) Form No. 16 of After Deduction of 80C & Chapter VA(Taxable Income)
PREVIOUS YEAR,[For Arrears Relief U/s 89(1)] [ From Previous Year's Form-16]

1 Deduction under chapter VI-A (LIC,PF,Tuition Fees,H.B.Principal):80C (Maximum Deposit Rs.1,00,000)

2 a) G.P.F/EPF/PF 0

3 b) L.I.C. 0

4 c) N.S.C. 0
DEDUCTION ONLY U/S 80C, 80CC (MAXIMUM LIMIT NO
5 d) H.B. Loan Principal 0 EXCCEED RS.1,20,000/- including New Tax Savings
Bond(Max Rs.20000/-)
6 f) GROUP INSURANCE (G.I./GISL/CGEIS) 0

7 f)New Flexible Bond ( Maximum Rs. 20,000/-)

8 g) Tuition Fees (Max.Rs.1,00,000) 0

TOTAL DEDUCTION U/S 80C Max. Rs 1,00,000/- + 20,000 Total Deduction U/S 80C (Max.limit 1,00,000/-) + 20,000/- New
Infrustructure Bond, Total Rs.1,20,000/- 0 declared Infrustructure Bond
9
Interest given from Bank/N.S.C/Others Fixed Deposited of previo
10 Income from Bank Interest/N.S.C/Others Source
Years & Current Years
11 Income from House Property Income From House Property if any
12 80G Donation in Charitable Fund Maximum 100% of donation)
Premium in health insurance of self,spouse,children,dependent,Maximum Rs
13 80D 15000/-

14 80E For Higher Education Loan Maximum No Limit

15 80DD Medical treatment for self or dependent as Handicapped

16 80DDB 40000 Medical Treatment for self or dependent for sever desease
17 80CC Deposit in Pension Fund (Maximum Rs. 1,00,000/-

18 80U Permanent disability including blindnes as handicapped(Max Rs.75000/-)

19 80CCD New Pension Scheme (Maximum 10% or Salary)

20 House Rent Paid 72000 For Rented House. Must Submit the receipt of House Rent.

21 Transport OR Conveyance Allowances U/s 10(14)(i) 9600 Maximum Rs. 9600 P.A.
22 Children Education Allowances 2400 Maximum Rs. 100 P.M. for two Children
23 Children Hostel Allowances Maximum Rs. 300 P.M. (Not encluded in Chapter VA)
24 Leave Travel Allowances For Govt Employees Fully Exempted, For Private Max.Ra.3,00,000/-

25 Intertenment Allowances 0 Max.Rs.5000/- P.A.

26 Medical Reimbursment Max 15000 P.A 15000 Submit herewith your actual Medical Bills up to Rs. 15000/-
TOTAL DEDUCTION CHAPTER VI-A Rs. 40000 TOTAL DEDUCTION CHAPTER VI-A Rs.

27 Arrear Received if any 0 The Data Comes From Pay Sheet

Relief under Section 89(1) 0 The Data Comes From 10E

 ,8906279547

ssment Year 2011-2012,which

RY OF FINANCE(Deptt.of
ew Delhi. Notification Dated
ordinary,Part-II, Section 3,(Sub

Sheet ,

fill this Bio Data

t
m Pay Sheet)

Pay Sheet)

able Income)
Form-16]

00)

CC (MAXIMUM LIMIT NOT

ding New Tax Savings
20000/-)

00/-) + 20,000/- New

xed Deposited of previous

ears

onation)
ren,dependent,Maximum Rs

capped

r desease
-

capped(Max Rs.75000/-)

eceipt of House Rent.

Chapter VA)
Max.Ra.3,00,000/-

s up to Rs. 15000/-
Pay Calculation Sheet for -Income Tax Calculation ,
for the financial year 2010-2011, Assessment Year 2011-
12
A Name & Designation of the Assesses - - -

Put TOTAL
Other Put Hill/ Put Intert If Arrear
Basic Any Any Hill/ Arrears H.R.A. Child. (2+3++4+ G.P.F./
MONTH Alwnc Rural D.A. ainme Conv salary
+Grade other other Rural D.A. D.A. if H.R.A. M.A. Educ. Bonus +5+6+7+8+9 E.P.F./P P.Tax
&Year es if Alwn Rate of nt Allwn. Receive
Pay Allown Allown Alwnce any Rate of Alwnc +10+11+12+ .F.
any Rate of % % Alwnc d
% 13+14)

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 TOTAL 16 17
Apr-10 18000 0 0 0 0% 0 0% 0 0 33% 5940 3000 200 0 800 25000 0 27940 0 110
May-10 18000 0 0 0 0% 0 0% 0 0 33% 5940 3000 200 0 800 27940 0 110
Jun-10 18000 0 0 0 0% 0 0% 0 0 33% 5940 3000 200 0 800 27940 0 110
Jul-10 18000 0 0 0 0% 0 0% 0 0 33% 5940 3000 200 0 800 27940 0 110
Aug-10 18000 0 0 0 0% 0 0% 0 0 33% 5940 3000 200 0 800 27940 0 110
Sep-10 18000 0 0 0 0% 0 0% 0 0 33% 5940 3000 200 0 800 This Sheet is 27940 0 110
not Printable.
Oct-10 18000 0 0 0 0% 0 0% 0 0 33% 5940 3000 200 0 800 27940 0 110
Only Data
Nov-10 18000 0 0 0 0% 0 0% 0 0 33% 5940 3000 200 0 800 Entry Sheet 27940 0 110
Dec-10 18000 0 0 0 0% 0 0% 0 0 33% 5940 3000 200 0 800 27940 0 110
Jan-11 18000 0 0 0 0% 0 0% 0 0 33% 5940 3000 200 0 800 27940 0 110
Feb-11 18000 0 0 0 0% 0 0% 0 0 33% 5940 3000 200 0 800 27940 0 110
Mar-11 18000 0 0 0 0% 0 0% 0 0 33% 5940 3000 200 0 800 27940 0 110
TOTAL 216000 0 0 0 0 0 71280 36000 2400 0 9600 335280 0 1320
 Double Click
on the Yellow
cell and Put
- the Password
"pranab" and
G.I.S./H.B.Edit the
H.B.L
GISL/ yellow Cell
Pr. Int TDS
CGEIS Paid Paid

18 19 20 21
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 1000
0 0 0 1000
0 0 0 1000
0 0 0 1000
0 0 0 1000
0 0 0 1500
0 0 0 2024
0 0 0 8524
 INCOME TAX STATEMENT FOR THE FINANCIAL YEAR 2010-2011
ASSESSMENT YEAR 2011-2012
A. Name & Designation of the Assesses - - - -
B. Residential Address - - - Pin Code No. -
C. Pan Card No -
1 Salary income with allowance excluding hra,ma,ch-educ,convalw,) Rs. 216000
2 House Rent Allowance :-…………………………………………………………… Rs. 71280
3 Bonus :-………………………………………………………………………………… Rs. 25000
4 Arrear,if any :-………………………………………………………………………….. Rs. 0
5 Medical Allowances Received………………………………………………. 36000
6 Income from N.S.C./Bank interest etc:-…………………………………………. Rs. 0
7 Income from House Property:-……………………………………………………. Rs. 0
8 Children Education allowances……………………………………….. 2400
9 Conveyance Allowances………………………………………………. 9600
10 Gross Income(Col.1 + 2+3+4+5+6+7+8 ) :-………………………………… Rs. 360280
11 Interest paid as H.B.Loan (1.5 Lacks maximum) U/S 24(B):-………………………. Rs. 0
12 Professional Tax U/S 16(iii) :-(For Handcpd employees are exempt from P.tax) Rs. 1320
13 Exemption of Conveyance Allowances U/s 10(14)(i)[Max.Rs 9600/-P.A. 9600
14 Exemption U/S 10(13A) :- ###
a) House Rent paid :-………………………………………………………….. Rs. 72000 ###
b)Expenditure on house rent in excess of 50% in Metro Pol City
others 40% & 10% of B.Pay .
c) Amount exempted (which is less of a & b):-…………………………….. Rs. 50,400 Rs. 50400
15 Exemption of Medical Reimbursment Max Rs. 15000/-P.A. 15000
16 Children Education Allowances Max.Rs.100 p.m.(Two Children)U/s 10(14)(ii) Rs. 1200
18 Intertenment Allowances U/s 16(ii) Max.Rs. 5000/- P.A……………….. 0
19 Leave Travel Concession For Govt employees Fully Exempt Rs. 0
20 Total Income(Col.9-10-11-12-13-14-15-16-17-18)……………. Rs. 282760
21 Deduction U/S 80 C (Maximum Rs.1,20,000/- including T.Svngs Bond) ###
a) Contribution to G.P.F./E.P.F. ………………………………………. Rs. 0
c) Group Insurance Savings Scheme …………………. :- Rs. 0 ###
d) L.I.C./P.L.I./U.Lip Premiam paid(including Notified ###
Pension Scheme for maximum Rs.10,000/-:- Rs. 0
e)Purchase of N.S.C. :-……………………………………. Rs. 0
f) Amount paid as excluisively tuition fees to any
University/College/School for maximum of two
Children( 2 )Maximum Rs1,00,000/-………………………… Rs. 0
g) Payment of H.B.Loan (Principal) :-………………………… Rs. 0
h) New Flexible Tax savings bond{Max-20000/-}……………………. Rs. 0 ###
j) Others, if any as notified :- 80DDB 40000 80G 0 Hnd
i) 80U 0 ii)80DD 0 iii)80D 0 80E 0 Rs. 40000 ###
k) Total Amount Deducted (a to j) :-………………………. Rs. 40000 Rs. 40000
22 Taxable Income (19-20) :-[Rounded off to the next 10]………………… Rs. 242760
23 i)
iii)Upto Rs.1,60,000/-
Rs.5,00,0001/- Tax Nil, Tax(ii)Rs.1,60,001/-to
to 8,00,000/- 5,00,000/-Tax
20%, iv)Rs.8,00,001/-to 10%
Onwards Tax
30%
v) For Women employee upto Rs.1,90,000/- Tax Nil
24 Total Tax Computed………………………………………………………… Rs. 8,276
25 3% Educational cess on tax :-…………………………………………………… Rs. 248
26 Tax Payable including Education & Cess(Col.12+13)………………… Rs. 8,524
27 Relief U/S 89(1)[Arrears Relief from Salary]……………………………… Rs. -
28 Net Tax Payable ( 13-14)…………………………………………………….. Rs. 8,524
29 Tax already deducted from source :-…………………………………………. Rs. 8,524
30 Balance Tax :-Refundable Payable …………………………….. Rs. -
 ###
Dated:- Signature of the Employees with Designation
 Pay Statement For the Year 2010-2011
Name of the Employee - - -

Basic Other Hill/ Child. Intertain G.P.F./ G.I.S./

MONTH Any other Any other Conv H.B. Pr. H.B.L
+Grade Alwnces if Rural D.A. H.R.A. M.A. Educ. ment E.P.F./P.F P.Tax GISL/ TDS
&Year Allown Allown Allwn. Paid Int Paid
Pay any Alwnce Alwnc Alwnc . CGEIS

Apr-10 18000 0 0 0 5940 3000 200 0 0 0 800 0 110 0 0 0 0

May-10 18000 0 0 0 5940 3000 200 0 0 0 800 0 110 0 0 0 0

Jun-10 18000 0 0 0 5940 3000 200 0 0 0 800 0 110 0 0 0 0

Jul-10 18000 0 0 0 5940 3000 200 0 0 0 800 0 110 0 0 0 0

Aug-10 18000 0 0 0 5940 3000 200 0 0 0 800 0 110 0 0 0 0

Sep-10 18000 0 0 0 5940 3000 200 0 0 0 800 0 110 0 0 0 1000

Oct-10 18000 0 0 0 5940 3000 200 0 0 0 800 0 110 0 0 0 1000

Nov-10 18000 0 0 0 5940 3000 200 0 0 0 800 0 110 0 0 0 1000

Dec-10 18000 0 0 0 5940 3000 200 0 0 0 800 0 110 0 0 0 1000

Jan-11 18000 0 0 0 5940 3000 200 0 0 0 800 0 110 0 0 0 1000

Feb-11 18000 0 0 0 5940 3000 200 0 0 0 800 0 110 0 0 0 1500

Mar-11 18000 0 0 0 5940 3000 200 0 0 0 800 0 110 0 0 0 2024

TOTAL 216000 0 0 0 71280 36000 2400 0 0 0 9600 0 1320 0 0 0 8524

Signature of the Employee

Date:-
Designation:-
 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

PART- A
Name and address of the Employer Name and designation of the employee

- - - - -

PAN NO.of Deductor TAN No.of the Deductor PAN NO. of the Employee To
From
- - -
CIT (TDS) Assessment Year Period
Address 0
2011 2012
0 1/4/2010 31/3/2011
City 0 Pin Code 0
Summary of tax deducted at source
Receipt Numbers of original statements of TDS Amount of tax deducted in Amount of tax deposited remitted in
Quarter under sub-section (3) of section 200 respect of the employee respect of the employee
Q1
Q2
Q3
Q4
PART- B (Refer Note 1)
Details of Salary paid and any other income and tax deducted
1 Gross Salary IN RUPEES IN RUPEES IN RUPEES
Salary as per provisions contained in
(a) section 17(1) 360280
Value of perquisites under section 17(2)
(b) (as per Form No. 12BA,wherever 0
applicable)
Profits in lieu of salary under section
(c) 17(3)(as per Form No. 12BA, wherever 0
applicable)
(d) TOTAL 360280
2 Less: Exempted Allowance u/s 10 Ed
Allowance Rs. ###
(i) H.R.A Exemption 50400 50400
Convences Allowances
(ii)
Exemp
9600
(iii) Childr Edu Allownc Exemp 1200
Medical Reimbursment
(v)
Exemp
15000
3 Balance(1-2) Rs. 284080 ###
4 Deductions :
H.B.Loan Int.(Max-1,50,000/-)
(a) u/s 24(B) 0
(b) Tax on employment 1320
(e) Leave Travel Allowances 0
(f) Intertainment Allowances 0
5 Aggregate of 4(a) to (f) 1320
Income chargeable under the head 'salaries'
6 282760
Add: Any other income reported by the (3-5)
7
employee
a)Income form N.S.C./Bank int.etc. Rs. 0
8 Gross total income (6+7) Rs. 282760
 9 Deductions under Chapter VIA
U/s 80C (Aggregate amount Gross
A Deductible Amount Rs.
Max.Rs.1,20,000/-) Amount
(a)(i)Sec.80C-G.P.F. Rs. 0
(ii) G.I.S. Rs. 0
(iii) L.I.C.+P,L.I.+U.LIP+Tuition
Fees+NSC+Tax Savings Bond
Rs. 0
(iv) H.B.LOAN(PRINCIPAL) Rs. 0 0 0
Qulfy
B Other sections e.g.,80E,80G,etc under chapter VI A Gross Amount Deductible Amount Rs.
amount
(a) Section 80 E Rs. 0 0
(b) Section 80 G Rs. 0 0
( c ) Section 80U Rs. 0 0
(d) Section 80DD Rs. 0 0
(e) Section 80D Rs. 0 0
f) Section 80CC Rs. 0 0
G) Section 80DDB Rs. 40000 40000
Aggregate of deductible amount under Chap.
10
VIA
40000
11 Total Income (8-10) 242760
12 Tax on total income 8,276
13 Education & cess @3% on col.no.12 248
14 Tax payable (12+13+14) 8524
Less Relief U/s 89(1)(attach
15
dtls
0
Tax payable/refundable (15-
16
16)
8524
17 Less (a) Tax deducted at source 8524
Net Tax col.No.17-
18
18)
Refundable Tax payable 0
Verification
I son/daughter of

working in the capacity of(designation do hereby certify that a sum of Rs [Rs.

(in words)] has been deducted and deposited to the credit of the Central Governement. I further

certifify that the information given about is true, complete and correct and is based on the books of account, documents, TDS

statement ,TDS deposited and other available records.

Place:-

Date:- Signature of person responsible for deduction of tax

Designation Full Name:-

Note:-
1 If an assessee is employed under more than one employer during the year, each of the employers shall i
of the certificate in Form No. 16 pertaining to the period for which such assessee was employed with each
of the employers. Part B may be issued by each of the employers or the last employer at the option of the
assessee.
2 Government deductors to enclose Annexure-A if tax is paid without production of an income-tax
challan and Annexure-B if tax is paid accomanied by an income-tax challan.

3 Non-Government deducto5rs to enclose Annexure-B

4 The deductor shall furnish the address of the Commissioner of Income-tax(TDS) having jurisdiction
as regards TDS statements of the assesee.
 5 This Form shall be applicable only in respect of tax deducted on or after 1st day of April, 2010.

ANNEXURE-A
DETAILS OF TAX DEDUCTED AND DEPOSITED IN THE CENT5RAL GOVERNMENT ACCOUNT THROUGH BOOK ENTRY
(The Employer to provide payment wise details of tax deducted and deposited with respect to the employee)
Tax Deposited in respefct on of
Sl.No Book Identification Number (BIN)
the employee (Rs.

DDO Sequence Number in the Date on which

Receipt Numbers of
Book Adjustment Mini tax deposited
Form No 24G
Statement (dd/mm/yy)

Note:-
1. In the column for TDS, give total amount for TDS,Surcharge(if applicable) and education cess.

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 employee)

Challan Identification Number ( C I N )

Tax Deposited in respect on of
Sl.No
the employee (Rs.) Date on which tax deposited Challan Serial
BSR Code of the Bank Branch
(dd/mm/yy) Number
1 0 30-Dec-99 0
2 0 30-Dec-99 0
3 0 30-Dec-99 0
4 0 30-Dec-99 0
5 0 30-Dec-99 0
6 1000 28/9/2010 6
7 1000 28/10/2010 7
8 1000 28/11/2010 8
9 1000 28/12/2010 9
10 1000 28/1/2011 10
11 1500 28/2/2011 11
12 2024 28/3/2011 12
Total 8,524

1 In the column for TDS, GIVE TOTAL AMOUNT FOR TDS, Surcharge(if applicable) and Education Cess
 INDIAN INCOME TAX RETURN Assessment Year
[For Individual having Income from Salary/Pension/income from One
FORM

SARAL-II House Property(Excluding loss brought forward from previous

(ITR-I) years)/Income from Other Sources (Excluding Winning from Lottery and 2 0 1 1 - 1 2
income from Race Horses)]

(Please see Rule 12 of the Income-tax Rules, 1962)(Also see attached instuctions)
First name Middle name Last Name Pan No DIN NO
- - - - -
PERSONAL INFORMATION

Flat /Door/Block No. Name Of Premises/Building/Village Date of Birth

- - 12/30/1899

Road/Street/Post Office Area/Locality Employer Category √

- - √ Govt PSU Others
Town/City/District State Pin code Employer Category
- - 0 √ male√ -
Email Addrs. (STD Code) - Phone Number
Designation of Assessing Officer (Ward/Circle) Return Filed Under Section- 1 1
FILING STATUS

- [Please see instruction number-9(i)]

Whether original or Revised return? (Tick)
√ √ Original Revised
If revised, enter Receipt No and Date of ORIGINAL
filing original return (DD/MM/YYYY)
Original return(DD/MM/YYYY) -
Residential Status (Tick)√ √ Resident Non-Resident Resident but not ordinarily Reside
1 Income chargeable under the Head 'Salaries',Pension 282760 1
2 Income chargeable under the Head 'House Property'(enter-ve sign in case2of loss,0 if any)
Income chargeable under the Head 'Other Sources' (enter-ve sign in
INCOME & DEDUCTIONS

3 case 0
GrossofTotal
loss,Income
if any) 3
4 (1+2+3) 4 282760
5 Deductions under chapter VIA (Section
a 80C 0 e 80DD 0 I 80GG 0
b 80CCC 0 f 80DDB 40000 j 80GGA 0
c 80CCD 0 g 80E 0 k 80GGC 0
d 80D 0 h 80G 0 l 80U 0
6 Deductions (Total of 5a to5i) 6 40,000
7 Total Income (4-6) 7 242760
8 Tax Payable on 'Aggregate Income' 8 8276 ###
248
TAX COMPUTATION

9 Education Cess on (on 8) 9

### Total Tax, Surcharge and Education cess payable (8+9) ### 8524
### Relief under Section 89 ### 0 ###
### Relief under Section 90/91 ### 0
### Balance Tax Payable (10-11-12) ### 8524
14 Total interest payable u/s 234A/234B/234C 14 0
### Total Tax and Interest payable (12+13) 15 8524
Do not write or stamp in this areas for office Seal and signature of receiving official
use only

Receipt No.

Date

1
1
 16 Taxes Paid
a Advance Tax (from item 25) 16a 0
TAXES PAID

b TDS (column 7 of item23+column 7 of item 24) 16b 8524

c Self Assessment Tax (from item 25) 16c 0
17 Total Taxes paid (16a+16b+16c) 17 8524
18 Tax payable(15-17)(enter if 15 is greater than 17, else leave blank) 18 0 ###
19 Refund (18-17) (enter if 15d is greater than 14, also give Bank account details below)
19 0
REFUND

20 Enter your bank account chequnumber (mandatory in case of refund) 501

21 Do you want your refund bye or deposited directly into your bank account? (tick as applicable
√
22 Give additional details of your bank account
MICR Code 000558 Type of Account (tick as applicable) √ Savings
23 Details of Tax Deducted at Source from Salary [As per Form 16 issued by Employer(s)]
TDS ON SALARY

Tax TAX
Tax Deduction Deduction
Name and Income payable Payble
Sl Account under Total tax
No Number(TAN) of the
address of the chargeable under (incl.
Chapter VI- deposited
Employer the head salaries surch. And Refundabl
Employer A
edn. Cess) e
(1) (2) (3) (4) (5) (6) (7) (8)
0 0 282,760 40,000 8,524 8,524 0
24 Details of Tax Deducted at Source other than salary
Amount
Tax Deduction Namee and out of
TDS ON INTEREST

Sl Account Amount paid/ Date of Total tax

No Number(TAN) of the address of the (6) claim
credited Payment /Credit deposited
Deductor Deductor for this
year
(1) (2) (3) (4) (5) (6) (7)
- 0
0
0
NOTE Enter the total of column (7) of 23and column (7) of 17 of TAXES PAID
25 Details of Advance Tax and Self Assessment Tax Payments
Sl Name of Bank & Date of Deposit Serial Number of
No BSR Code Amount (Rs.)
Branch (DD/MM/YYYY) Challan
TAX PAYMENTS

(i)
(ii)
(iii)
(iv)
NOTE Enter the total of Advance tax and Self Assessmen tax in Sl.No.17 of TAXES PAID0
26 Other Information (Transactions reported through Annual Information Return) (Please see instruction number-9(ii)
Sl. Code Amount (Rs.) Sl. Code Amount (Rs.) Sl. Code Amount (Rs.)
a 001 e 004 h 007
b 002 f 005 i 008
c 003 g 006 j
27 Exempt income only for reporting purposes(from Dividend, Capital gains 27 etc)
VERIFICATION
I, son/ daughter of solemnly
declare that to the best of my knwledge and belief, the information given in the return thereto is correct and
complete and that the amount of total income and other particulars shown therein are truly stated and in
accordance with the provisions of the Income -tax Act, 1961, in respect of income chargeable to income-tax
for the previous year relevant to the Assessment
Year 2010-11

Place Date Sign here

28 If the return has been prepared by a Tax Return Preparer (TRP) give further details as below :
Identification No. of TRP Name of TRP Counter Signature of TRP
 If TRP is entitled for any reimbursement from the Government, amount thereof
29 (to be filled by TRP) ###
 Government of India

INCOME TAX DEPARTMENT

ACKNOWLEDGEMENT

Received with thanks form: - - - a return of income &/return

of fringe benefits in Form No ITR - 1 for assessment year 20011-2012, having the following particulars:

Name PAN NO DIN NO

PERSONAL INFORMATION

- - - - -
Flat/Door/Block No: Name of Premises/Building/Village:
- -
Road/Street/Post Office: Area/Locality:
- -
Town/City/District: State: Status(fill the code)
- - Govt 11
Designation of Assessing Officer Original/Revised Original
COMPUTATION OF INCOME & TAX THEREON

1 Gross total income 1 282760

2 Deduction under Chapter-VI-A 2 40000
3 Total Income 3 242760
4 Net tax payable 4 8524
5 Interest payable 5 0
6 Total tax and interest payable 6 8524
7 Taxes paid
a Advance Tax 7a -
b TDS 7b 8,524
c TCS 7c -
d Self Assessment Tax 7d -
e Total Taxes paid (7a+7b+7c+7d) 7e 8524
8 Tax payable (6-7e) 8 0 ###
9 Refund (7e-6) 9 0 ###
Fringe Benefits & Tax Thereon

10 Value of Fringe Benefits 10 NA

Computation of Income &

11 Total fringe benefit tax liability 11 NA

12 Total interest payable 12 NA
13 Total tax and interest payable 13 NA
14 Taxes paid NA
a Advance Tax 14a
b Self Assessment Tax 14b
c Total Taxes paid (14a+14b) 14c NA
15 Tax payable (13-14c) 15 NA
16 Refund (14c-13) 16 NA
Receipt No. Seal and Signature of receiving official:
Date:
 FORM NO.10 E
[See rule 21AA]

Form for furnishing particulars of income under section 192(2A) for the year ending 31 st March, 2010 for claiming
relief under section 89(1) by a Government servant or an employee in a 2[company,co-operative society,local
authority ,university, instituty
1 Name and address of the employee - -
2 Permanent account number -

3 Residential status PERMANENT RESIDENT

Particulars of income referred to in rule 21A of the Income-tax Rules, 1962,during the previous year relevant to
assessment year 2010-11

1 (a) Salary received in arrears or in advance in accordance with the provisions of sub-rule (2)
of rule 21A. -
(b)
Payment in the nature of gratuity in respect of past services, extending over a period of not
less than 5 years in accordance with the provisions of sub-rule (3) of rule 21A. Not Applicable

(c)
Payment in the nature of compensation from the employer or former employer at or in
connection with termination of employment after continuous service of not less than 3 Not Applicable
years or where the unexpired portion of term of employment is also not less than 3 ye

(d) Payment in commutation of pension in accordance with the provisions of sub-rule (5) of
rule 21A Not Applicable
2 Detailed particulars of payments referred to above may be given in Annexure I,II,IIA,III,
or IV as the case may be. ANNEX-I

…………………………………………..
Signature of the employee

Verification
I, _______,do hereby declare that what is stated above
is true to the best of my knowledge and belief.
Verified today, the Day of

Place: …………………….
………………………………………
Date:…………………… Signature of the employee
 ANNEXURE-I
[See item 2 of Form No.10E]
Arrears or advance salary
Sl No. Particulars Amount (Rs.)
1 Total income (excluding salary received in arrears or advance) 242,760
2 Salary received in arrears or advance 0
Total income (as increased by salary received in arrears or advance)
3
[Add item 1 and item 2] 242,760
4 Tax on total income [as per item 3] 8,524 ###
5 Tax on total income [as per item 1] 8,524 ###
Tax on salary received in arrears or advance
6
[Difference of item 4 and item 5] 0
Tax computed in accordance with Table "A"
7
[Brought from column 7 of Table A] 0
Relief under Section 89(1) [Indicate difference between the amounts mentioned
8
against item 6 and item 7] 0

TABLE "A"
[See item 7 of Annexure 1]

Total income Salary received Total income (as Tax on total Tax on total Difference in tax
of the in arrears or increased by income [as per income[as per [Amount under
relevent advance salary received in column (2)-After column (4) column (6)
previous year relating to the arrears or Rebate and After Rebate minus amount
(Rs.) relevent advance) of the including Edn and including under column
previous year relevent previous Cess and Edn Cess and (5)] (Rs.)
Previous as mentioned year mentioned in Surcharge] Surcharge]
year in column (1) column (1) [add (Rs.) (Rs.)
(Rs.) colmn 2 & 3]
(Rs.)

(1) (2) (3) (4) (5) (6) (7)

2009-10 0 0 0 0 0 0 ###

###

Signature:

Place: Name:

Date: Designation:
Dept: