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SALARY PARTICULARS OF Sri/Smt/Kum , ,
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
1 Mar-10 12070 40 0 7277 0 1207 0 650 0 2655 23899 6000 60 0 20 IF(Progra 6080 17819
2 Apr-10 12070 40 0 7277 0 1207 0 650 0 2655 23899 6000 60 0 6060 17839
3 May-10 12070 40 0 7277 0 1207 0 650 0 2655 23899 6000 60 0 6060 17839
4 Jun-10 22430 40 0 2112 0 2243 0 900 0 27725 6000 60 0 6060 21665
5 Jul-10 22430 40 0 3648 0 2243 0 900 0 29261 6000 60 0 6060 23201
6 Aug-10 22430 40 0 3648 0 2243 0 900 0 29261 6000 60 0 6060 23201
7 Sep-10 22430 40 0 3648 0 2243 0 900 0 29261 6000 60 0 6060 23201
8 Oct-10 23040 40 0 3747 0 2304 0 900 0 30031 6000 60 0 6060 23971
9 Nov-10 23040 40 0 3747 0 2304 0 900 0 30031 6000 60 0 6060 23971
10 Dec-10 23040 40 0 5719 0 2304 0 900 0 32003 6000 60 0 20 6080 25923
11 Jan-11 23040 40 0 5719 0 2304 0 900 0 32003 6000 60 0 6060 25943
12 Feb-11 23040 40 0 5719 0 2304 0 900 0 32003 6000 60 0 6060 25943
13 SL 11520 20 0 1874 1152 0 14566 0 14566
14 RPS Arrears
(Feb-10 ) 3577 3577 0 3577 0
RPS Arrears
15 (March-10 to 7767 0 0 -144 0 3108 0 10731 0 0 10731
May-10
Notional Inc
16 Arrears 0 0 0 0
(Jan-10 to
17 DA Arrears Jun-10) 9272 9272 9272 9272 0
(July-10 To
18 DA Arrears Nov-10 ) 10690 10690 10690 10690 0
Child Edn
19 Concession 0 0 0 0
20 8/16/24 Arrears 0 0 0 0 0 0
TOTAL 260417 500 81230 0 28373 0 0 10050 0 7965 392112 95539 0 720 0 0 40 0 0 96299 295813
0
2 Permanent Account No 0
3 Whether living in Own/Rented House Rented House
PROFESSIONAL TAX 0
b) APGLIF No : 0
j) ULIP 0
k) PLI 0
t)
a) Female Assesses 0
i) Up to 190000/-
Up to Nov-2009 : NIL
Dec-2009 : NIL
Jan-2010 : NIL
Feb-2010 : NIL
TOTAL : 0
Signature of the
Drawing & Disbursing Officer Signature Of the Assessee
0 0
PAN No. of the deductor TAN No. of the deductor PAN/GIR No. of the Employee
0 0 0
Acknowledgement Nos. of all Quarterly Statements of TDS under sub-section(3) of section 200 as provided
by TIN Facilitation Centre of NSDL Web-site
Period
Quarter Acknowledgement No. Assessment Year
From To
01.04.2010 31.03.2011 2011-2012
DETAILS OF SALARY PAID AND ANY OTHER INCOME AND TAX DEDUCTED
1 Gross Salary
a) Salary as per provisions contained in Section 17(1) 392112.00 392112.00
b) Value of perquisites under section 17(2) (as per Form No.
12 BA, wherever applicable)
c) Profit in lieu of Salary under section 17(3) (as per Form
No. 12 BA, wherever applicable)
d) TOTAL 392112.00 392112.00
2 Less: Allowance to the extent exempted under section 10 28373.00 28373.00
3 BALANCE (1-2) 363739.00 363739.00
4 DEDUCTIONS
a) Exemption conveyance allowance 10050.00 10050.00
a) Entertainment allowance:
Transfer
Secendory
Total Tax Date on which Voucher/
TDS Education & Higher Cheque/DD BSR Code of
Sl.No Deposited tax deposited Challan
No. Cess Rs. Education No. (if any) Bank Branch
Rs. (DD/MM/YY) Identification
Cess Rs.
No.
I, working in the capacity of do here by certify that a sum of Rs.10031.00 (in words Ten Thousand and Thirty one
rupees only) has been deducted at source and paid to the credit of the central Government. I further certify that the
information given above is true and correct based on the books of accounts, documents and other available records.
Full Name: 0
Designation : 0
Designation : #REF!
Office/Branch : #REF!
#REF!
#REF!
I here by conform that I have actually incurred expenditure/Amount incurring expenditure as payment of rent in
respect of the residential accommodation occupied by me and the amount of HRA exempted from tax as above is
calculated as per the relevant provisions of the income tax Act.
#REF!
Date : Signature
(1) For purpose of the above deductions "Salaries" means only basic pay, personal allowance and special allowance
ranking for the purpose of RP deductions, if any.
(2) Attachment receipt if HRA exceeds Rs. 600/- per month