FOR INDIVIDUAL & OTHER TAXPAYERS (OTHER THAN COMPANY)

FORM OF RETURN OF INCOME UNDER THE INCOME TAX

IT-11GA

Be a Respectable Taxpayer
Submit Return in Due Time
Avoid Penalty

Photograph of the
Assessee
[to be attested on
the photograph]

Put the tick () mark wherever applicable

Self
1

Universal Self

Name of the Assessee : Anil Ambani

National ID No. (If any) :

UTIN (If any) :

TIN :

(a) Circle :

Normal

2650898251835
3

36

Assessment Year :

(b) Taxes Zone :

2015-2016

Individual :

Firm :

7 Residential Status :

Status :

Name of employer/business (where applicable)

4, Dhaka

Resident:

Non Resident :

Association of Persons :

Hindu Undivided Family :

Agricultural Marketing Co. Ltd.

10 Wife/Husband`s Name (If applicable, please mention TIN :

11

Father`s Name :

12 Mother`s Name:
13 Date of Birth (in case of Individual):
Day
1 5
14 Address :

Month
0 8

Year
9 7

(a) Present :

(b) Permanent :

15

Telephone : Office/Business :

16

VAT Registration Number (If any) :

Residential :
N/A

Statement of income of the Assessee

Statement of income during the income year ended on 30-06-08
Heads of Income
1 Salaries : U/S 21 (as per Schedule 1)
2 Interest on Securities : U/S 22
3
4
5
6
7
8
9
10
11
12
13
14
15
16

Amount in Taka
Tk.
3,000,000.00
Tk.
600,000.00
Tk.
Tk.
Tk.
Tk.
Tk.
Tk.
Tk.
Tk.
3,600,000.00
Tk.
Tk.
3,600,000.00
Tk.

special pay
Income from House Property U/S 24 (As per Schedule 2)

Agricultural Income U/S 26

Income from Business or Profession : U/S 28
Share of Profit in a Firm
Income from Spouse or Minor Child as applicable U/S 43(4)
Capital Gains : U/S 31
Income from Other Sources U/S 33
Total (Serial 1 to 9)
Foreign Income
Total income (Serial 10 & 11)
Tax Leviable on Total income
Tax Rebate U/S 44(2)(b)(As Per Schedule-3)
Tax Payable (Difference between Serial 13 and 14)
Tax Payments
(a) Tax Deducted and Collected at Source
(Please submit supporting Documents/Statement)

Tk.

(b) Advance Tax U/S 64/68 (Please Attach Chalan)

Tk.

Tax Paid on the basis of this Return (U/S 74)

(Please Attach Challan/Pay Order/Bank Draft/Cheque)
(d) Adjustment of Tax Refund (if any)

Tk.
Tk.

Tk.
Tk.

Total of (a), (b), , and (d)

17 Difference between Serial 15 and 16 (if any)

18 Tax Exempted & Tax Fre Income
19 Income Tax Paid in Last Assessment Year

19,667.00

3,000.00
Tk.
Tk.
Tk.

Tk.
Verification

I,

Major. Md. Anisur Rahman (Rtd).

Md. Arfan Ali

solemnly declare that to the best of my knowledge
and belief the information given in this return and statements and documents annexed herewith is correct
and complete.
UTIN/TIN

Father / Husband

Signature
Name: Major. Md. Anisur Rahman (Rtd).
Designation and Seal for other than Individual

SCHEDULES SHOWING DETAILS OF INCOME

Name of the Assessee :

Major. Md. Anisur Rahman (Rtd). TIN 3

Schedule -1 (Salaries)

Amount of income

Pay & Allowance

(Tk)

Basic Pay
Special Pay
Deamess allowance
Conveyance Allowance
House rent allowance
Medical allowance
Discomfort allowance
Overload allowance
City allowance
Children Education Allowance
Entertainment allowance
Other Allowances
Leave encashment
Leave allowance
Honorarium/Reward/Fee
Overtime allowance
Rent free accommodation
Transport facility
Sevrant allowance
Gratuity
Bonus/Ex-gratis
Interest on RPF
Other Allowances
Employer`s Contribution to Recognized
Provident Fund
Deemed income for transport facility
Deemed Income for free furnished/unfurnished
accomodation
Others if any (give detail) PENSION
Net taxable income from Salary

Location and descriptipon of the

property

Amount of exempted

3,000,000.00
600,000.00
360,000.00
60,000.00
600,000.00
240,000.00
72,000.00
48,000.00
30,000.00
36,000.00
33,600.00
120,000.00
250,000.00
75,000.00
85,000.00
750,000.00
150,000.00
330,000.00
565,000.00
750,000.00
285,000.00
300,000.00
8,739,600.00

Net Taxable income

income (Tk.)

(Tk)

3,000,000.00
600,000.00
360,000.00
30,000.00
300,000.00
120,000.00
72,000.00
48,000.00
30,000.00
36,000.00
33,600.00

30,000.00
300,000.00
120,000.00

120,000.00
250,000.00
75,000.00
85,000.00
690,000.00
150,000.00
330,000.00
750,000.00

60,000.00

565,000.00

300,000.00
7,664,600.00

1,075,000.00

Schedule-2 (House Property income)

Particulars
1. Annual rental income
2. Claimed Expenses:
Land Revenue
Insurance Premium
Interest on loan/ Mortgage/Capital charge
Municipal or local tax
Repair, Collection,ect.
Vacancy allowance
Other if any

Tk.

Tk.
-

Total =
3. Net income (Difference between serial 1 & 2 )

1
2
3
4
5
6
7
8
9
10

Schedule-3 (Investment tax credit)

(Section 44(2)(b) read with part `B` of Sixth Schedule)
Life Insurance Premium
Contribution to Deffered Annuity
Contribution to Provident fund to which Provident Fund Act 1925 applies
Self contribution and employer`s contribution to Recognized Provident Fund
Contribution to Super Annution Fund
Investment in approved Debenture or Debenture Stock,Stock or Shares
Contribution to Deposit Pension Scheme
Contribution to Benevolent Fund and Group Insurance Premium
Contribution to Zakat Fund
Others, if any (Give Details)

List of Documents Furnished

1
2
3
4
5
6

7
8
9
10

Salary Certificate
Martgage Balance
Bank Statement
DPS Copy
BO Account Copy

Tk.
Tk.
Tk.
Tk.
Tk.
Tk.
Tk.
Tk.
Tk.
Tk.

IT-10B
Statement of Assets and Liabilities as on 30-06-08
Name of the Assessee :

TIN

(a). Business Capital (Closing Balance) Invested in Partnership Business ( As Before)

(b). Directors Shareholdings in Limited Companies (At cost)
Name of Companies

Tk.

Number of Shares

2 Non-Agricultural Property (at cost with legal expenses)

Land/House Property (Description and Location of Property)

Tk.

2,873,650.00

Flat # 5/C, House # 67, Road # 7, Cantonment Residential Area

Dhaka Cantonment, Dhaka-1206

3 Agricultural Property (at cost with legal expenses)

Land (Total Land and Location of Land Property)

4 Investments :
(a) Share/Debentures B.O. Account
(b) Savings Certificate/Unit Certificate/Bond (Wage Earner Bond)
Prize Bond/Savings Scheme
(d) Loans Given
(e) Other Investment

Tk.

Tk.
Tk.
Tk.
Tk.
Tk.

310,000.00
1,000,000.00
500,000.00
Total = Tk.

1,810,000.00

Tk

350,000.00

6 Jewellery (Quantity and Cost)

Tolla, stated as before

Tk.

474,000.00

7 Furniture (at Cost)

Tk.

250,000.00

8 Electronic Equipment (at Cost)

Tk.

270,000.00

5 Motor Vehicles (At Cost )

Type of Motor Vehicale and Registration Nuimber
Toyota Corona, Ctg. Metro BHA ( f ) 02-0886

9 Cash Asset Outside Business

(a) Cash in Hand
(b) Cash at Bank

Tk.
Tk.

192,280.00
3,638.00

 Other Deposits

Tk.

Total = Tk.

195,918.00

B/F = Tk.

6,223,568.00

10 Other Assets (give Details)

Tk.

Total Assets = Tk.

11 Less Liabilities
(a) Mortgages secured on Property or Land
(b) Un Secured Loans
Bank Loans
(d) Others

Tk.
Tk.
Tk.
Tk.
Tk.

6,223,568.00

2,322,013.00
Total Liabilities = Tk.

2,322,013.00

12 Net Wealth as on Last date of this Income Year

(Difference Between Total assets and Total Liabilities )

Tk.

3,901,555.00

13 Net wealth as on Last Date of Previous Income Year

Tk.

4,431,897.00

14 Accretion in Wealth (Difference Between Serial No. 12 & 13)

Tk.

(530,342.00)

15 (a) Family Expenditure : (Total Expenditure as per Form IT 10BB)

(b) Number of Dependant children of the family)
4
Adult
Child

Tk.

551,127.00

16 Total accretion of wealth (Total of Serial 14 & 15 )

Tk.

20,785.00

Total Source of Fund = Tk.

4,675,000.00

Tk.

(4,654,215.00)

17 Sources of Fund
(i) Shown Return Income
(ii) Tax Exempted / Tax Free Income
(iii) Other Receipts

18. Difference Between Serial 16 & 17

Tk.
Tk.
Tk.

3,600,000.00
1,075,000.00

I solemnly declare that to the best of my knowlwdgw and belief the information given in the IT-10B is
Correct and Complete.

Major. Md. Anisur Rahman (Rtd).

Name and Signature of the Assessee
Date:

Form No. IT-10BB

Statement Under Section 75(2)(d)(i) and Section 80 of the Income Tax Ordinance, 1984 (XXXVI of 1984)
Regarding Particulars of Life Style
Name of the Assessee :

Major. Md. Anisur Rahman (Rtd).

Serial No Particulars of Expenditure

1
Personal & Fooding Expenses
2
3
4
5
6
7
8
9
10
11

TIN

Amount of Tk.
12,000.00

Tax Paid including deduction at source of the

last Financial Year
Accomodation Expenses (Loan Amortization)
Transport Expenses
Electric Bill for Residence
WASA Bill for Residence
Gas Bill for Residence
Telephone Bill for Residence
Education Expenses for Children
Personal Expenses for Foreign Travel
Festival and other Special Expenses, if any
Total Expenditure

Comments
Also incurred by Wife

19,667.00
507,660.00
5,800.00
6,000.00
551,127.00

Totally on Wife Account

Totally on Wife Account
Totally on Wife Account
Totally on Wife Account
Totally on Wife Account
Totally on Wife Account
Partialy on Wife Account

I solemnly declare that to the best of my knowlwdgw and belief the information given in the IT-10B is
Correct and Complete.

Major. Md. Anisur Rahman (Rtd).

Name and Signature of the Assessee
Date:

"

Acknowledgement Receipt of Income Tax Return

Major. Md. Anisur Rahman (Rtd).

Name of the Assessee :

UTIN/TIN

Assessment Year : 2008-09

Circle :

36

Taxes Zone : 4, Dhaka

Instructions to Fill up the Return Form

Instructions :
(1). This return of Income shall be signed and verified by the individual assessee or person as prescribed u/s 75 of the Income Tax
Ordinance,
1984 Applicable:
Enclose where
2
(a) Salary Statement for Salary Income, Bank Statement for Interest, Certificate for Interest on Savings Instruments,
Rent Agreement,
receipts
of Municipal Tax
and Land Revenue,Statement
House
Property
Loan
Interest,
(b) Statement
of Income
and Expenditure,
Manufacturing
Account, Trading & for
Profit
& Loss
Account,
and
Balance
Premium
for House
Property I as per THIRD SCHEDULE of the Income Tax Ordinance, 1984
Sheet
Insurance
Depriciation
Chart claiming
Depreciation
(d) Computation of Income According to Income Tax Law
Enclose Separate Statement for :
3
(a) Any Income of the Spouse of the Assessee(if she/he is not an assessee), Minor Children and Dependant
(b) Tax Exempted/Tax Free Income
4
5
6
7

Fulfillment of the conditions laid down in rule -38 is mandatory for submission of a return under ~Self Assessment"
Documents furnished to support the declaration should be signed by the Assessee or his/her Authosized
Representative
The Assessee shall submit his/herphotograph with return after every five year.
Furnish the Following Information
(a) Name, Address & TIN of the Partners if the Assessee is a Firm
(b) Name of the Firm, Address & TIN if the Assessee is a Partner
name of the Company, Address & TIN if the Assessee is a Director

8
9
10

Assets and Liabilities of Self, Spouse(if she/he is not an assessee), minor Children and dependant(s) to be shown in
the
IT-10Bis mandatory for all the assesseeor his /her authorized representative. For Individual, Signature is also
Signature
mandatory
in I.T.-10B
I.T. 10BB
If needed, please
use &
separate
sheet.

"
Total Income shown in Return :
Net Wealth of Assessee :

Tk.

Tk.

3,600,000.00 Tax Paid :Tk.

3,901,555.00

Date of Receipt of Return :

Nature of Return :

Self

Serial No. in Return Register :

Universal Self

Nornal

Signature of Receiving Officer with Seal

150,000.00

7,379,600.00
(285,000.00)

FOR INDIVIDUAL & OTHER TAXPAYERS (OTHER THAN COMPANY)

FORM OF RETURN OF INCOME UNDER THE INCOME TAX

Be a Respectable Taxpayer
Submit Return in Due Time
Avoid Penalty

IT-11GA

Photograph of the
Assessee
[to be attested on
the photograph]

Put the tick () mark wherever applicable

Self

Universal Self

Name of the Assessee :

National ID No. (If any) :

UTIN (If any) :

TIN :

(a) Circle :

Normal

(b) Taxes Zone :

Assessment Year :
Individual :

7 Residential Status :

Status :

Firm :

Name of employer/business (where applicable)

Resident:

Association of Persons :

10 Wife/Husband`s Name (If applicable, please mention TIN :

11

Father`s Name :

12 Mother`s Name:
13 Date of Birth (in case of Individual):
Day
14 Address :

Month

Year

(a) Present :

(b) Permanent :

15

Telephone : Office/Business :

16

VAT Registration Number (If any) :

Residential :

Non Resident :

Hindu Undivided Family :

Statement of Income of the Assessee

Statement of income during the income year ended on
Heads of Income
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16

Amount in Taka

Salaries : U/S 21 (as per Schedule 1)

Interest on Securities : U/S 22
Income from House Property U/S 24 (As per Schedule 2)

Agricultural Income U/S 26

Income from Business or Profession : U/S 28
Share of Profit in a Firm
Income from Spouse or Minor Child as applicable U/S 43(4)
Capital Gains : U/S 31
Income from Other Sources U/S 33
Total (Serial 1 to 9)
Foreign Income
Total income (Serial 10 & 11)
Tax Leviable on Total income
Tax Rebate U/S 44(2)(b)(As Per Schedule-3)
Tax Payable (Difference between Serial 13 and 14)
Tax Payments
(a) Tax Deducted and Collected at Source
(Please submit supporting Documents/Statement)

Tk.

(b) Advance Tax U/S 64/68 (Please Attach Chalan)

Tk.

Tax Paid on the basis of this Return (U/S 74)

(Please Attach Challan/Pay Order/Bank Draft/Cheque)
(d) Adjustment of Tax Refund (if any)

Tk.

Tk.
Tk.

Tk.
Tk.

Tk.
Tk.
Tk.

Tk.
Tk.

Tk.
Tk.

Tk.
Tk.

Tk.
Tk.

Tk.

Tk.

Tk.
Tk.

Tk.
Total of (a), (b), , and (d)

17 Difference between Serial 15 and 16 (if any)

18 Tax Exempted & Tax Fre Income
19 Income Tax Paid in Last Assessment Year
Verification
I,

Father / Husband

solemnly declare that to the best of my knowledge

and belief the information given in this return and statements and documents annexed herewith is correct
and complete.
UTIN/TIN

Signature
Name:
Designation and Seal for other than Individual

SCHEDULES SHOWING DETAILS OF INCOME

TIN

Name of the Assessee :

Schedule -1 (Salaries)

Amount of income
(Tk)

Pay & Allowance

Basic Pay
Special Pay
Deamess allowance
Conveyance Allowance
House rent allowance
Medical allowance
Servant allowance
Leave allowance
Honorarium/Reward/Fee
Overtime allowance
Bonus/Ex-gratis
Other Allowances
Employer`s Contribution to Recognized
Provident Fund
Deemed income for transport facility
Deemed Income for free furnished/unfurnished
accomodation
Others if any (give detail)
Net taxable income from Salary

Location and descriptipon of the

property

Amount of exempted
income (Tk.)

Net Taxable income

(Tk)

Schedule-2 (House Property income)

Particulars
1. Annual rental income
2. Claimed Expenses:
Land Revenue
Insurance Premium
Interest on loan/ Mortgage/Capital charge
Municipal or local tax
Repair, Collection,ect.
Vacancy allowance
Other if any
Total =
3. Net income (Difference between serial 1 & 2 )

Tk.

Tk.
-

1
2
3
4
5
6
7
8
9
10

Schedule-3 (Investment tax credit)

(Section 44(2)(b) read with part `B` of Sixth Schedule)
Life Insurance Premium
Contribution to Deffered Annuity
Contribution to Provident fund to which Provident Fund Act 1925 applies
Self contribution and employer`s contribution to Recognized Provident Fund
Contribution to Super Annution Fund
Investment in approved Debenture or Debenture Stock,Stock or Shares
Contribution to Deposit Pension Scheme
Contribution to Benevolent Fund and Group Insurance Premium
Contribution to Zakat Fund
Others, if any (Give Details)

List of Documents Furnished

1
2
3
4
5
6

7
8
9
10

Tk.
Tk.
Tk.
Tk.
Tk.

Tk.
Tk.
Tk.

Tk.
Tk.

IT-10B
Statement of Assets and Liabilities as on
Name of the Assessee :

TIN

1 (a). Business Capital (Closing Balance)

(b). Directors Shareholdings in Limited Companies (At cost)
Name of Companies

Tk.

Number of Shares

2 Non-Agricultural Property (at cost with legal expenses)

Land/House Property (Description and Location of Property)

Tk.

3 Agricultural Property (at cost with legal expenses)

Land (Total Land and Location of Land Property)

Tk.

Total = Tk.

4 Investments :
(a) Share/Debentures
(b) Savings Certificate/Unit Certificate/Bond
Prize Bond/Savings Scheme
(d) P.F.
(e) Other Investment

Tk.
Tk.
Tk.
Tk.
Tk.

5 Motor Vehicles (At Cost )

Type of Motor Vehicale and Registration Nuimber

Tk

6 Jewellery (Quantity and Cost)

Tk.

7 Furniture (at Cost)

Tk.

As Before

8 Electronic Equipment (at Cost)

As Before

9 Cash Asset Outside Business

(a) Cash in Hand
(b) Cash at Bank
Other Deposits

Tk.
Tk.
Tk.

Tk.

Total = Tk.

B/F = Tk.

Tk.

Total Assets = Tk.

10 Other Assets (give Details)

11 Less Liabilities
(a) Mortgages secured on Property or Land
(b) Un Secured Loans
Bank Loans
(d) Others

Tk.
Tk.
Tk.
Tk.
Tk.

Total Liabilities = Tk.

12 Net Wealth as on Last date of this Income Year

(Difference Between Total assets and Total Liabilities )

Tk.

13 Net wealth as on Last Date of Previous Income Year

Tk.

14 Accretion in Wealth (Difference Between Serial No. 12 & 13)

Tk.

15 (a) Family Expenditure : (Total Expenditure as per Form IT 10BB)

(b) Number of Dependant children of the family)
4
Adult
Child

Tk.

16 Total accretion of wealth (Total of Serial 14 & 15 )

Tk.

Total Source of Fund = Tk.

Tk.

17 Sources of Fund
(i) Shown Return Income
(ii) Tax Exempted / Tax Free Income
(iii) Other Receipts

18. Difference Between Serial 16 & 17

Tk.
Tk.
Tk.

I solemnly declare that to the best of my knowlwdgw and belief the information given in the IT-10B is
Correct and Complete.

Name and Signature of the Assessee

Date:

Form No. IT-10BB

Statement Under Section 75(2)(d)(i) and Section 80 of the Income Tax Ordinance, 1984 (XXXVI of 1984)
Regarding Particulars of Life Style
Name of the Assessee :

Serial No
1
2
3
4
5
6
7
8
9
10
11

TIN

Particulars of Expenditure
Personal & Fooding Expenses
Tax Paid including deduction at source of the
last
Financial Year
Accomodation
Expenses
Transport Expenses
Electric Bill for Residence
WASA Bill for Residence
Gas Bill for Residence
Telephone Bill for Residence
Education Expenses for Children
Personal Expenses for Foreign Travel
Festival and other Special Expenses, if any
Total Expenditure

Amount of Tk.
-

Comments

I solemnly declare that to the best of my knowlwdgw and belief the information given in the IT-10BB is
Correct and Complete.

Name and Signature of the Assessee

Date:

"

Acknowledgement Receipt of Income Tax Return

Assessment Year :

Name of the Assessee :

UTIN/TIN

Circle :

Taxes Zone :

Instructions to Fill up the Return Form

Instructions :
(1). This return of Income shall be signed and verified by the individual assessee or person as prescribed u/s 75 of the Income Tax
Ordinance,
1984 Applicable:
Enclose where
2
(a) Salary Statement for Salary Income, Bank Statement for Interest, Certificate for Interest on Savings Instruments,
Agreement,
receipts
of Municipal Tax
and Land Revenue,Statement
House
Property
Loan
Interest,
(b) Rent
Statement
of Income
and Expenditure,
Manufacturing
Account, Trading & for
Profit
& Loss
Account,
and
Balance
Sheet
Depriciation Chart claiming Depreciation as per THIRD SCHEDULE of the Income Tax Ordinance, 1984
(d) Computation of Income According to Income Tax Law
Enclose Separate Statement for :
3
(a) Any Income of the Spouse of the Assessee(if she/he is not an assessee), Minor Children and Dependant
(b) Tax Exempted/Tax Free Income
4
5
6
7

Fulfillment of the conditions laid down in rule -38 is mandatory for submission of a return under ~Self Assessment"
Documents furnished to support the declaration should be signed by the Assessee or his/her Authosized
Representative
The Assessee shall submit his/herphotograph with return after every five year.
Furnish the Following Information
(a) Name, Address & TIN of the Partners if the Assessee is a Firm
(b) Name of the Firm, Address & TIN if the Assessee is a Partner
name of the Company, Address & TIN if the Assessee is a Director

8
9
10

Assets and Liabilities of Self, Spouse(if she/he is not an assessee), minor Children and dependant(s) to be shown in
the IT-10Bis mandatory for all the assesseeor his /her authorized representative. For Individual, Signature is also
Signature
mandatory
in I.T.-10B
I.T. 10BB
If needed, please
use &
separate
sheet.

"
Total Income shown in Return :
Net Wealth of Assessee :
Date of Receipt of Return :

Tk.

Tk.

Tax Paid :Tk.

Serial No. in Return Register :

Nature of Return :

Self

Universal Self

Nornal

Signature of Receiving Officer with Seal

Major Md. Anisur Rahman (Rtd.)

Flat# 5/C, House # 67, Road # 7
Cantonment R/A, Dhaka Cantt. Dhaka.

INCOME TAX COMPUTATION STATEMENT

ASSESSMENT YEAR-2008-09
T.I.N. : 309-104-6031

INCOME FROM SALARY

Per Month

# Months

Basic Salary
House Rent allowance
Bonus

Received
12
12

Total

TOTAL INCOME FROM SALARY

INCOME FROM BANK INTEREST
TOTAL INCOME
TAX PAYABLE

Amount
First
Next
Next
Next
Next

Rate
0.00
0.10
0.15
0.20
0.25

GROSS TAX PAYABLE

Tax Payable
-

REBATE

Net Tax Payable

PAYMENT DETAIL

Chalan/P.O. #

Date

TDS on Salary

Total

Amount

Relif if Any
-

Taxable
-

Major Md. Anisur Rahman (Rtd.)