FORMAT FOR THE PREPARATION OF INCOME TAX

CALCULATION STATEMENT FOR 2014-15

I

General Information :

Name

ARYASUNANDA.A.V

Whether Gazetted

No

Sex

Female

Designation

LPSA

AUPS SREEKRISHNAPURAM
5

Office / Department
SREEKRISHNAPURAM

Whether residing in rented house

No

(a) PAN : ALNPA0753A

(b) TAN :
SATHEEDEVI.K.M

Name & Address of Employer

VASUDEVAN NAMBUDIRI

SREEKRISHNAPURAM

Circle of filing Income Tax Return

MONTH OF BILL
MARCH 2014

Ward3-pkd

PAY
20240

DA

FILL

12751

10

APRIL

2014

20240

FILL

12751

MAY

2014

20240

FILL

12751

JUNE

2014

20240

FILL

14775

JULY

2014

20240

FILL

14775

AUG.

2014

20240

FILL

14775

SEPT.

2014

20240

FILL

14775

OCTOB. 2014

20240

FILL

14775

NOV.

2014

20240

FILL

14775

DEC.

2014

20740

FILL

15140

JAN.

2015

20740

FILL

15140

FEB.

2015

20740

15140

Total Salary during the year (Basic Pay+DA+HRA)

1

13

DA Arrear To PF

DA Arrear in Cash

Pay Arrear to PF

Pay Arrear in Cash

419703

TOTAL ARREARS RECEIVED

2200

Festival/Bonus

15

Other Allowances (CCA/PG/Risk/Uniform/Special. etc.)

Surrender Leave Salary Received

Total

421903

Deduct : HRA-Least of the following if residing in rented house :

(i) Actual HRA received Yearly

Actual Rent Paid (if residing in

rented house)

(ii) Rent paid in excess of 10% of salary(Pay + DA))

(iii) 40% or 50% of salary according to the Employee's Location

III

Agricultural Income If Any

Income From House Property If Any

Entertainment Allowance

Recoveries & Other Payments :

Number

17

Non-Metro

PF Contribution

P18736

Subscription
0

53500

18

SLI Premium

6000

6000

19

GIS Premium

2400

2400

20

LIC Premium (Direct Payment)

21

LIC Premium (Salary Deduction)

PLI

22

FBS

23

Income Tax deducted from

Salary Bill Upto Jan.2015

25

Profession Tax Paid

27

Interest on
Housing Loan

2500
If availed before 31/3/99

If availed after 31/3/99

0
0

28

Public PF

29

NSC

30

Mutual funds

31

Eductional expenses of children(for 2 children)

32

Equity shares & debentures

33

Repayment of Housing loan

No :

34
35

Investment in Long term Infrastructure Bond of IDBI, ICICI etc.

(For claiming addition deduction of up to Rs. 20000)

Any other deductions,if

0
any

GPAIS

36

80CCC-Pension Fund(Annuity Plan of LIC or other Insurer)

37

80CCD-Contribution to Pension scheme of Central Govt. Employees

IV

OTHER DEDUCTIONS

38

Medical Insurance Premium u/s 80 D : (Acc.Fund)

(Max. Rs. 15000/- or 20000/- as the case may be)

39
40

Maintenance and Medical treatment of Handicapped

Dependent u/s 80 DD :
(Max. Rs. 50000/- or 75000/- as the case may be)
Medical treatment for certain specified disease or
ailment u/s 80 DDB : (Maximum of Rs. 40000/and Rs. 60000/- as the case may be)

41

Interest on loan taken for higher education u/s 80 E :

42

Contribution toPolitical Parties u/s 80GGC

43

Donation to certain funds, charitable institutions etc.: u/s 80G

(100% in the case of Special Funds & 50%in other cases)

44

Deduction inrespect of persons with disability :

(Rs. 50000/- or Rs. 75000/- as the case may be)

45

Relief u/s 89(1)

OF INCOME TAX
FOR 2014-15
ANNEXT
URE

RYASUNANDA.A.V

FORM10-E

WELCOME

Statement

DATA

emale

PSA

PRINT STATEMENT

UPS SREEKRISHNAPURAM

REEKRISHNAPURAM

Enter Data in White cells

CHNA02345A
SATHEEDEVI.K.M

HM

ANNEXT
URE

VASUDEVAN NAMBUDIRI

DATA

Statement

WELCOME

FORM-16

REEKRISHNAPURAM

PRINT STATEMENT

FORM10-E

ard3-pkd

DA

HRA

12751

250

TOTAL

FILL

33241

IF HPL IS AVAILED ENTER THE NUMBER OF LEAVES TAKEN IN THE

RELEVANT MONTH
MARCH

SEPT

12751

250

33241

APRIL

OCTOB

12751

250

33241

MAY

NOV.

14775

250

35265

JUNE

DEC

14775

250

35265

JULY

JAN

14775

250

35265

AUG

FEB

14775

250

35265

14775

250

35265

14775

250

35265

15140

250

36130

15140

250

36130

15140

250

36130

419703
3

0
0

0
2200
0
0

421903

0
0
0
Non-Metro

0
0
0
0

IF PF-MONTHLY SUBSCRIPTION
IS CHANGED ENTER DETAILS
HERE

53500

MARCH

APRIL

MAY

JUNE

JULY

6000

3500

3500

3500

4000

4000

2400

SEPT.

OCTOB.

NOV.

DEC.

JAN.

5000

5000

5000

5000

5000

0
0
0
0
2500
0
0
0
0
0
0
0
0

0
0

300
0
0

Statement
WELCOME

0
0
0
0
0
0
0
0

DATA

ANNEXT
URE

FORM10-E

PRINT STATEMENT

PRINT STATEMENT

R OF LEAVES TAKEN IN THE

NTH

416703

AUG.

5000
53500
FEB.

5000

DATA

FORM10-E

INCOME TAX CALCULATION STATEMENT

FOR THE YEAR 2014-15
Name

Whether Gazetted :
Designation
:

ARYASUNANDA.A.V
Sex
: Female
No
LPSA

PAN :

ALNPA0753A
MONTH OF BILL
PAY
20240
MAR
2014
20240
APRIL 2014
20240
MAY
2014
20240
JUNE
2014
20240
JULY 2014
20240
AUG.
2014
20240
SEPT
2014
20240
OCT.
2014
20240
NOV.
2014
20740
DEC.
2014
20740
JAN.
2015
20740
FEB.
2015
TOTAL
DA+Pay Arrears received in Cash
festival Allowance/Bonus
Surrender
DA+Pay Arrears Mergged to P.F
1

Office/Institution/Department :
AUPS SREEKRISHNAPURAM
SREEKRISHNAPURAM
TAN
DA
12751
12751
12751
14775
14775
14775
14775
14775
14775
15140
15140
15140

HRA
250
250
250
250
250
250
250
250
250
250
250
250

TOTAL
33241
33241
33241
35265
35265
35265
35265
35265
35265
36130
36130
36130
419703
0
2200
0
0

421903

PTA/PCA and inclusive of Surrender Leave Salary, Bonus/Spl.

Festival allowances and Arrears of DA/pay and other allowances)

Deduct : HRA-Least of the following if residing in rented house

3
4

Balance Gross Income (1 - 2)

Less Profession Tax u/s 16(iii)
Less any other if
Deduct : Interest on Housing Loan (Maximum Rs. 30000/- or

(i) Actual HRA received

(ii) Rent paid in excess of 10% of salary(Pay + DA))
(iii) 40% or 50% of salary as the case may be

0
0
0

0
421903
2500
419403

Agricultural Income

Income from House Property

Rs. 200000/- as the case may be)

6
7

CHNA02345A

Total Salary Income (Pay+DA+HRA+Other allowances except

Gross Total Income

Deduction as per Chapter VI A U/s

419403
(a) 80 C :

i)

Public Provident Fund :

No.

ii)

General Provident Fund :

No.

P18736

iii) Arrear DA merged to GPF

iv) Group Insurance Scheme
v)

FBS

vi) PLI
vii) State Life Insurance
viii) LIC Premia (salary deduction) Pol. Nos:
ix) LIC Direct Premia- Pol. Nos.
x) NSC
xi) Mutual funds
xii) Repayment of Housing Loan
xiii)Equity Shares&Debentures

0
53500
0
2400
0
0
6000
0
0
0
0
0
0

xiv) Educational expenses of children

xv)GPAIS
xvi) Any other item (specify)

Total Deductions u/s 80C

0
300
0
62200

62200

(b) 80CCC
(c) 80CCD
(d) 80CCE

Pension fund (Annuity plan of LIC or any other insurer)

Contribution to pension scheme of Central Govt.employees

entering the service on or after Jan.2001
The aggregate amount of deductions u/s 80C, 80CCC,80CCD
shall not, in any case exceed One Lakh and Fifty
Thousand Rupees

62200

62200

(e) 80CCF

Investment in Long Term Infrastructural Bonds notified by the

Central Govt.
(Additional deduction upto Rs. 20000)

(e) 80D

Medical Insurance Premium u/s 80 D : (Acc.Fund)

(Max. Rs. 15000/- or 20000/- as the case may be)

(f) 80DD

Maintenance and Medical treatment of Handicapped Dependent (Max. Rs.

50000/- or 75000/- as the case may be)

(g) 80DDB

Medical treatment for certain specified disease or ailment

(Maximum of Rs. 40000/- and Rs. 60000/- as the case may be)

(h) 80E

Repayment of loan taken for higher education

(Maximum of Rs. 40000/-)

(i) 80G

Donation to certain funds, charitable institutions etc.:

(j) 80GGC

Contributions to Political Parties

Deduction inrespect of persons with disability :
(Rs. 50000/- or Rs. 75000/-

0
0

(k) 80U

8
9

10
11
12
13
14
15

as the case may

be)

Total
Net Taxable Income (Rounded to nearest ten)
Income Tax on Total Income :
Rebate u/s 87A
Total
Add Educational Cess (3% of tax )
Total Tax
Less Relief u/s 89(i)
Balance Tax
Less Tax deducted from the salary bill upto Jan 2015
Tax Payable

62200
357203
10720
2000

8720

Signature of the Employee:

Place : SREEKRISHNAPURAM
Date:

01/25/2015

62200
357200

Signature of the Head of Office in case of NGO

Signature of the Officer in the case of Gazetted Officer.

8720
262
8982
0
8982
0
8982

DATA

DATA SHEET FOR ARREARS RELIEF U/S 89(1)

This Calculation Start From FY 2000 -2001 to FY 2013- 2014
AND

Assessment Year 2001 - 2002 to 2014-2015

Employee's Status (Male or Female)

Female

DETAILS OF TAXABLE INCOME SINCE FINANCIAL YEAR 2000 TO

Total Income for the Financial Year 2000-01
Total Income for the Financial Year 2001-02
Total Income for the Financial Year 2002-03
Total Income for the Financial Year 2003-04
Total income for the Financial Year 2004-05
Total Income for the Financial Year 2005-06
Total Income for the Financial Year 2006-07
Total Income for the Financial Year 2007-08
Total Income for the Financial Year 2008-09
Total Income for the Financial Year 2009 - 10

Page 39

DATA
Total Income for the Financial Year 2010-11
Total Income for the Financial Year 2011-12
Total Income for the Financial Year 2012-2013
Total Income For The Financial Year2013-14

DETAILS OF ARREARS RECEIVED

Arrears received For the Financial Year 2000-2001
Arrears received For the Financial Year 2001-2002
Arrears received For the Financial Year 2002-2003
Arrears received For the Financial Year 2003-2004
Arrears received For the Financial Year 2004-2005
Arrears received For the Financial Year 2005-2006
Arrears received For the Year 2006-2007)
Arrears received For the Year 2007-2008

Arrears received For the Year 2008-2009)

Page 40

DATA
Arrears received For the Year 2009-2010)
Arrears received For the Year 2010-2011)
Arrears received For the Financial Year 2011-2012
Arrears received For the Financial Year 2012-2013
Arrears received For the Financial Year 2013-2014

Actual Arrears Relief U/s 89(1) Entitled

Page 41

DATA

Page 42

DATA

F U/S 89(1)
to FY 2013- 2014

o 2014-2015

AL YEAR 2000 TO 2013

Rs. 0
Rs. 0
Rs. 0
Rs. 0
Rs. 0
Rs. 0
Rs. 0
Rs. 0
Rs. 0
Rs. 0

Page 43

DATA
Rs. 0
Rs. 0
Rs. 0
Rs. 0

EIVED

Enter Relief 89(1) availed in any relevant year if any

Rs. 0

2004-2005

2003-2004

Rs. 0

2005-2006

2002-2003

Rs. 0

2006-2007

2001-2002

Rs. 0

2007-2008

2000-2001

Rs. 0

2008-2009

Rs. 0

2009-2010

Rs. 0

2010-2011

Rs. 0

2011-2012

Rs. 0

2012-2013

Page 44

DATA
Rs. 0

2013-2014

ANNEXTURE
FORM 16

Rs. 0

Form
Rs. 0

WELCOME

Rs. 0
Total

Rs. 0

Rs. 0

FORM10-E
STATEMENT

Not Eligible

Page 45

DATA

Page 46

DATA

Page 47

DATA

y relevant year if any

0
0
0
0

Page 48

DATA
ANNEXTURE
FORM 16
Form
WELCOME
FORM10-E
STATEMENT

Page 49

DATA

Page 50

DATA

Page 51

DATA

Page 52

DATA

Page 53

DATA

Page 54

DATA

Page 55

DATA

Page 56

DATA

Page 57

DATA

Page 58

ANNEXURE&TABLE-A

ANNEXURE-I
[See item 2 of Form No.10E]

Arrears or advance salary

Sl No.

Particulars

Amount (Rs.)

Total income (excluding salary received in arrears or advance)

Rs. 357,200

Salary received in arrears or advance

Rs. 0

Total income (as increased by salary received in arrears or advance) [Add item 1
and item 2]

Rs. 357,200

Tax on total income [as per item 3]

Rs. 8,982

Tax on total income [as per item 1]

Rs. 8,982

Tax on salary received in arrears or advance [Difference of item 4 and item 5]

Rs. 0

7
8

Tax computed in accordance with Table "A" [Brought from column 7 of Table A]

Rs. 0

Relief under Section 89(1) [Indicate difference between the amounts mentioned
against item 6 and item 7]

Rs. 0

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

Previous
year

Total income (as

Tax on total
Salary received in
increased by
Tax on total
income [as
arrears or advance salary received in
income[as per
per column
relating to the
arrears or
column (4) After
Total income of the
(2)-After
relevant previous
advance) of the
Rebate and
relevant previous
Rebate and
year as mentioned relevant previous
including Edn
year (Rs.)
including Edn
in column (1)
year mentioned in
Cess and
Cess and
column (1)
Surcharge]
Surcharge]
(Rs.)
(Rs.)
(Rs.)
(Rs.)

Difference in tax
[Amount under
column (6)
minus amount
under column
(5)]
(Rs.)

2000-01

Rs. 0

Rs. 0

Rs. 0

Rs. 0

Rs. 0

Rs. 0

2001-02

Rs. 0

Rs. 0

Rs. 0

Rs. 0

Rs. 0

Rs. 0

2002-03

Rs. 0

Rs. 0

Rs. 0

Rs. 0

Rs. 0

Rs. 0

2003-04

Rs. 0

Rs. 0

Rs. 0

Rs. 0

Rs. 0

Rs. 0

2004-05

Rs. 0

Rs. 0

Rs. 0

Rs. 0

Rs. 0

Rs. 0

2005-06

Rs. 0

Rs. 0

Rs. 0

Rs. 0

Rs. 0

Rs. 0

2006-07

Rs. 0

Rs. 0

Rs. 0

Rs. 0

Rs. 0

Rs. 0

2007-08

Rs. 0

Rs. 0

Rs. 0

Rs. 0

Rs. 0

Rs. 0

2008-09

Rs. 0

Rs. 0

Rs. 0

Rs. 0

Rs. 0

Rs. 0

2009-10

Rs. 0

Rs. 0

Rs. 0

Rs. 0

Rs. 0

Rs. 0

2010-11

Rs. 0

Rs. 0

Rs. 0

Rs. 0

Rs. 0

Rs. 0

2011-12

Rs. 0

Rs. 0

Rs. 0

Rs. 0

Rs. 0

Rs. 0

2012-13

Rs. 0

Rs. 0

Rs. 0

Rs. 0

Rs. 0

Rs. 0

2013-14

Rs. 0

Rs. 0

Rs. 0

Rs. 0

Rs. 0

Rs. 0

TOTAL

Rs. 0

Rs. 0

Rs. 0

Rs. 0

Rs. 0

Rs. 0

Place:

Signature

:-

Name

:-

SREEKRISHNAPURAM

Page 59

ARYASUNANDA.A.V

ANNEXURE&TABLE-A
Date

:-

1/25/15

Designation

:-

LPSA

Department

:-

AUPS SREEKRISHNAPURAM
SREEKRISHNAPURAM

Page 60

ANNEXURE&TABLE-A

Col 1
6-May

Page 61

ANNEXURE&TABLE-A
FORM

FORM10-E

FORM 16

STATEMENT

DATA

WELCOME

2495

Page 62

ANNEXURE&TABLE-A

Page 63

ANNEXURE&TABLE-A

Page 64

ANNEXURE&TABLE-A

Page 65

ANNEXURE&TABLE-A

Page 66

ANNEXURE&TABLE-A

Page 67

ANNEXURE&TABLE-A

Page 68

ANNEXURE&TABLE-A

Page 69

ANNEXURE&TABLE-A

Page 70

ANNEXURE&TABLE-A

Page 71

ANNEXURE&TABLE-A

Page 72

ANNEXURE&TABLE-A

Page 73

ANNEXURE&TABLE-A

Page 74

ANNEXURE&TABLE-A

Page 75

ANNEXURE&TABLE-A

Page 76

FORM-10E

FORM NO.10 E
[ See rule 21AA]
Form for furnishing particulars of income under section 192(2A) for the year ending 31 st
March, 2014 for claiming relief under section 89(1) by a Government servant or an employee
in a 2[company,co-operative society,local authority ,university, institution,association or
body]
1

ARYASUNANDA.A.V

Name and Designation of the employee

LPSA
2

PERMANENT ACCOUNT NUMBER

ALNPA0753A

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 2014-15

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

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
(c)
not less than 3 years or where the unexpired portion of term of employment is Applicable
also not less than 3 years
(d)

Payment in commutation of pension in accordance with the provisions of subrule (5) of rule 21A

Not
Applicable

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

Verification
I, NARAYANAN.M.S. ,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:

SREEKRISHNAPURAM
1/25/15

1/25/15

Signature of the Employee

Page 77

FORM-10E

Page 78

FORM-10E

Page 79

FORM-10E

WELCOME

ANNEXTURE

FORM

STATEMENT

DATA

FORM 16

Page 80

FORM-10E

Page 81

FORM-10E

Page 82

Form 16

FORM 16-PART B
[See Rule 31(1)(a)]

CERTIFICATE UNDER SECTION 203 OF THE INCOME TAX, 1961 FOR

TAX DEDUCTED AT SOURCE FROM INCOME CHARGEABLE UNDER
THE HEAD "SALARIES"

PAN:

Name and address of the Employer

Name and Designation of the Employee

SATHEEDEVI.K.M
HM
AUPS SREEKRISHNAPURAM
SREEKRISHNAPURAM

ARYASUNANDA.A.V
LPSA
AUPS SREEKRISHNAPURAM
SREEKRISHNAPURAM

ALNPA0753A

TAN

CHNA02345A

TDS Circle where Annual Return /

Statement under section 206 is to be filled

Period

Assessment Year

Ward3-pkd

From
To
01/04/14 31/03/15

2015-16

DETAILS OF SALARY AND OTHER INCOME TAX DEDUCTIONS

1
2
3
4

5
6

7
8
9

10

Gross Salary
Less Allowance to the extent under section 10
Net Salary Income (1-2)
Add : Any other income reported by the employee
(a) Agriculture Income
(b) Income from house property
Total
Total Income (3-4)
Deductions : (Under section 16)
(a) Tax on employment
(b) Entertainment allowance
Total 6 (a+b)
Under section 24
Interest on HBA
Gross Total Income
Under section 80 - C
a) LIC
( i) Salary Deduction
(ii) Direct Payment
b) GPF Contribution
c) PPF Contribution
d) Arrear DA
e) SLI
f) GIS
g)GPAIS
h) PLI
i) FBS
j) HBA
k) Tution Fee paid (Limited to 2 Children)
l) Equity Shares/Debentures
m) NSC VIII Issue
n) Mutual Fund
0
o) Others
Total u/s 80C
Under section 80 - CCC
Page 83

421903
0
421903
0
0
0
421903
2500
0
2500
0
419403
0
0
53500
0
0
6000
2400
300
0
0
0.00
0
0
0
0
0
62200
0

Form 16

11

Under section 80 - CCD

Under Section 80CCE-limited to 150000

62200

Page 84

0
62200

62200

Form 16

OTHER DEDUCTIONS
12
14
15
16
17
18
19
20
22
23
24
25
26
27
28
29
30

Under section 80 - CCF

Under section 80 - D
Under section 80 - DD
Under section 80 - DDB
Under section 80 - E
Under section 80 - G
Under section 80 - U
Under section 80 - GGC
Total deduction admissible
Taxable Income (8-22)

(Rounded to nearest ten rupee)

0
0
0
0
0
0
0
0
62200 62200
357203 357200

Income taxpayable
Educational Cess @ 3%
Total Tax Payable (24+25)
Less Relief u/s 89(i)

8720
262
8982
0
8982
8982
0

Balance Tax
Tax already paid / deducted
Balance Tax to be paid / refunded
DETAILS OF TAX DEDUCTED AND DEPOSITED INTO CENTRAL GOVERNMENT ACCOUNT
Name of Bank & Branch
Amount
Date of Payment
where tax Deposited

0
I
SATHEEDEVI.K.M
S/D of
VASUDEVAN NAMBUDIRI
HM
do hereby
certifying
that
sum of
working in the capacity of
Rs
8982
only)
has been
(Rupees
eight thousand nine hundred and eighty-two
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 book of accounts, documents and other
available records.

Place:

SREEKRISHNAPURAM

Date:

01/25/2015

Signature of the person

responsible for deduction of tax
Name: SATHEEDEVI.K.M
Designation : HM

Page 85

Form 16

Page 86

Form 16

Page 87

Form 16

Page 88

Form 16

WELCOME

STATEMENT

ANNEXTURE

DATA

Form

FORM10-E

Page 89

Form 16

Page 90

Form 16

Page 91