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FORM OF RETURN OF INCOME UNDER THE INCOME TAX

ORDINANCE, 1984 (XXXVI OF 1984)

IT-11GA

FOR INDIVIDUAL AND OTHER TAXPAYERS


(OTHER THAN COMPANY)

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

Universal Self

1. Name of the Assessee:

Normal

Khandakar Shafiqur Rahman


2

2. National ID No (if any):

3. UTIN (if any):


4. TIN:

e-TIN:

Firm

7. Residential Status: Resident

Association of Persons

/ Non-resident

UNIVERSAL FINANCIAL SOUTIONS LTD.

11. Father's Name:

Khandakar Siddiqur Rahman

12. Mother's Name:

Late Rowshan Ara Begum

Mrs. Rubana Rahman

13. Date of Birth (in case of individual) :

8
Day

Month
, Dhaka.

14. Address (a) Present:

62/A, Green Road, Dhanmondi, Dhaka.

N/A

15. Telephone: Office/Business:

Hindu Undivided Family

10. Wife/Husband's Name (if assessee, please mention TIN):

(b) Permanent:

12, Dhaka

9. Name of the employer/business (where applicable):

16. VAT Registration Number (if any):

(b) Taxes Zone:

2016-2017

6. Assessment Year:

6
-

252

5. (a) Circle:

8. Status: Individual

Residential:

N/A

7
Year

Statement of income of the Assessee


Statement of income during the income year ended on
Sl

30-Jun-16

Heads of Income

Amount in Taka
42,40,000.00

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 of the spouse or minor child as applicable : u/s 43(4)

Capital Gains : u/s 31

Income from other source : u/s 33


42,40,000.00

10 Total (serial no. 1 to 9)

11 Foreign Income:

42,40,000.00

12 Total income (serial no. 10 and 11)


13 Tax leviable on total income

8,57,500.00

14 Tax rebate: u/s 44(2)(b)(as per schedule 3)

1,28,500.00

15 Tax payable (difference between serial no. 13 and 14)

7,29,000.00
3,149

Balance Tax U/S 74 Tk. 78,732 of 4% (U/S-73A) = 3,149

7,32,149.00

Net Tax Payable


16 Tax Payments:
(a) Tax deducted/collected at source
(Please submit supporting documents/statement)

Tk. 15,000

(b) Advance tax u/s 64/68 (Please attach challan )

Tk. 6,35,268.00

(c) Tax paid on the basis of this return (u/s 74)


(Please attach challan/pay order/bank draft/cheque)

Tk.

(d) Adjustment of Tax Refund (if any)

Tk.

81,881

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

7,32,149.00
0

17 Difference between serial 15 and 16 (if any)


18 Tax exempted and Tax free income
19 Income tax paid in the last assessment year
* If needed, please use separate sheet.

Verification
Khandakar Shafiqur Rahman
Khandakar Siddiqur Rahman
I
father /husband
UTIN/TIN: 7 4 7 9 2 6 3 8 3 8 9 3 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.

Place: Dhaka
Date :
Signature
Khandakar Shafiqur Rahman
3

(Name in block letters)


Designation and Seal (for other than individual)

SCHEDULES SHOWING DETAILS OF INCOME


Name of the Assessee:

Khandakar Shafiqur Rahman

TIN

7 4 7 9 2 6 3 8 3 8 9 3

Schedule-1 (Salaries)
Amount of
Income
(Tk.)

Pay & Allowance

Amount of
exempted income
(Tk.)

29,40,000.00

Basic pay

Net taxable
income
(Tk.)
29,40,000.00

Special pay
Dearness allowance
Conveyance allowance

2,10,000.00

30,000.00

1,80,000.00

House rent allowance

6,30,000.00

3,00,000.00

3,30,000.00

Medical allowance

4,20,000.00

1,20,000.00

3,00,000.00

Servant allowance
Leave allowance
Honorarium / Reward/ Fee
Overtime allowance
4,90,000.00

Bonus / Ex-gratia

4,90,000.00

Other allowances
Employers contribution to Recognized
Provident Fund
Interest accrued on Recognized Provident
Fund
Deemed income for transport facility
Deemed income for free
furnished/unfurnished accommodation
Other, if any (give detail)
46,90,000.00

Net taxable income from salary

4,50,000.00

42,40,000.00

Schedule-2 (House Property income)


Location and
description of property

Particulars

Tk.

1. Annual rental income


2. Claimed Expenses :
Repair, Collection, etc.
Municipal or Local Tax
Land Revenue
Interest on Loan/Mortgage/Capital
Charge
Insurance Premium
Vacancy Allowance
Other, if any
Total =

Tk.

3. Net income ( difference between item 1 and 2)

Schedule-3 (Investment tax credit)


(Section 44(2)(b) read with part B of Sixth Schedule)
1. Life insurance premium

Tk.

2. Contribution to deferred annuity

Tk.

3. Contribution to Provident Fund to which Provident Fund


Act, 1925 applies

Tk.

4. Self contribution and employers contribution to


Recognized Provident Fund

Tk.

5. Contribution to Super Annuation Fund

Tk.

6. Investment in approved debenture or debenture stock,


Stock or Shares

Tk.

7. Contribution to deposit pension scheme

Tk.

8. Contribution to Benevolent Fund and Group Insurance premium

Tk.

9. Contribution to Zakat Fund

Tk.

10. Others, if any (Sanchaypatra)

Tk.
Total =

*Please attach certificates/documents of investment.

List of documents furnished


1. Statement of Salary

6.

2. AIT Deduction Documents

7.

3. BSP Certificate

8.

4. Car AIT Money Receipt

9.

5. Bank Statement

10.

Tk.

11,00,000.00

11,00,000.00

*Incomplete return is not acceptable

IT-10B
30-Jun-16

Statement of Assets and Liabilities (as on


Name of the Assessee:

Khandakar Shafiqur Rahman

TIN 7

4 7 9 2 6 3 8 3 8 9 3

1. (a) Business Capital (Closing balance)

Tk.
Tk.

(b) Directors Shareholdings in Limited Companies ( at cost)


Name of Companies
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.

4. Investments:
(a) Shares/Debentures

Tk.

(b) Saving Certificate/Unit Certificate/Bond

Tk.

(c) Prize bond/ DPS

Tk.

(d) Loans given to wife

Tk.

(e) Other Investment

Tk.

41,00,000.00

Total =
5. Motor Vehicles (at cost) :
Dhaka Metro-GA-5173
Type of motor vehicle and Registration number

B/F

Tk.

41,00,000.00

Tk.

19,58,000.00

6. Jewellery (quantity and cost) :

B/F

Tk.

1,20,000.00

7. Furniture (at cost) :

B/F

Tk.

2,40,000.00

8. Electronic Equipment (at cost) :

B/F

Tk.

1,00,000.00

9. Cash asset Outside Business:


(a) Cash in hand & at bank

Tk.

(b) Cash at bank

Tk.

(c) Other deposits

Tk.
9

1,19,91,145.00

Total =

10

Tk.

1,19,91,145.00

Tk.

1,77,09,145.00

Tk.

Total assets

Tk.

1,77,09,145.00

Total liabilities

Tk.

B/F =
10. Any other assets
(With details)

11. Less Liabilities:


(a) Mortgages secured on property or land

Tk.

(b) Unsecured loans

Tk.

(c) Bank loan

Tk.

(d) Others

Tk.

12. Net wealth as on last date of this income year


(Difference between total assets and total liabilities)

Tk.

1,77,09,145.00

13. Net wealth as on last date of previous income year

Tk.

1,48,28,313.00

14. Accretion in wealth (Difference between serial no. 12 and 13)

Tk.

28,80,832.00

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

Tk.

18,09,168.00

(b) Number of dependant children of the family:


Adult
Child
(c) Fees & Charges for Share Business

Tk.

16. Total Accretion of wealth (Total of serial 14 and 15)


17. Sources of Fund :
(i) Shown Return Income

Tk.
Tk.

42,40,000.00

(ii) Tax exempted/Tax free Income

Tk.

4,50,000.00

(iii) Other receipts

Tk.
Total source of Fund =

18. Difference (Between serial 16 and 17)

Tk.

46,90,000.00

46,90,000.00

Tk.

I solemnly declare that to the best of my knowledge and belief the information given in the IT-10B is
correct and complete.

Khandakar Shafiqur Rahman

Name & signature of the Assessee


Date

Assets and liabilities of self, spouse (if she/he is not an assessee), minor children and
dependant(s) to be shown in the above statements.
11

nil

Form No. IT-10BB

FORM
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:
Seria
l No.

TIN 7

Khandakar Shafiqur Rahman

Particulars of Expenditure

4 7 9 2 6 3 8 3 8 9 3

Amount of Tk.

Personal and fooding expenses

4,50,000.00

Tax paid including deduction at source of the


last financial year

6,50,268.00

Accommodation expenses

3,30,000.00

Transport expenses

72,500.00-

Electricity Bill for residence

Wasa Bill for residence

--

Gas Bill for residence

7,800.00

Telephone Bill for residence (Mobile Bill)

Education expenses for children

10

Personal expenses for Foreign travel

11

Festival and other special expenses, if any

Comments

Self Driven Vahicle

63,100.00

-1,23,000.00

-1,12,500.00
18,09,168.00

Total Expenditure with Tax

I solemnly declare that to the best of my knowledge and belief the information given in the
IT-10BB is correct and complete.

Khandakar Shafiqur Rahman


Name and signature of the Assessee
Date:

*If needed, please use separate sheet.


"

Acknowledgement Receipt of Income Tax Return


Name of the Assessee:

Khandakar Shafiqur Rahman

UTIN/TIN: 7 4 7 9 2 6 3

Circle:

12

Assessment Year:

252

2016-2017

Taxes Zone:

12, Dhaka

13

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.
(2) Enclose where applicable:
(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 of house property loan interest, insurance premium for house property
income; Statement of professional income as per IT Rule-8; Copy of assessment/
income statement and balance sheet for partnership income; Documents of capital gain;
Dividend warrant for dividend income; Statement of other income; Documents in
support of investments in savings certificates, LIP, DPS, Zakat, stock/share etc.
(b) Statement of income and expenditure; Manufacturing A/C, Trading and Profit & Loss
A/C and Balance sheet;
(c) Depreciation chart claiming depreciation as per THIRD SCHEDULE of the Income Tax
Ordinance, 1984;
(d) Computation of income according to Income tax Law;
(3) Enclose separate statement for:
(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) Fulfillment of the conditions laid down in rule-38 is mandatory for submission of a return
under "Self Assessment".
(5) Documents furnished to support the declaration should be signed by the assessee or his/her
authorized representative.
(6) The assesse shall submit his/her photograph with return after every five year.
(7) Furnish the following information:
(a) Name, address and TIN of the partners if the assessee is a firm;
(b) Name of firm, address and TIN if the assessee is a partner;
(c) Name of the company, address and TIN if the assessee is a director.
(8) Assets and liabilities of self, spouse (if she/he is not an assessee), minor children and
dependant(s) to be shown in the IT-10B.
"
Total income shown in Return:

Tk.

42,40,000.00

Net Wealth of Assessee :

Tk.

1,77,09,145.00

Date of receipt of return :


Nature of Return :

Self

Tax paid:

Tk.

7,32,149.00

Serial No. in return register:


Universal Self

Normal

Signature of Receiving
14

officer with seal

15

Masthan Maligai
TIN : 694485916602
Cash Flow Statement
(30-06-15)

Particulars
B/F
Gross Salary Income

Total Inflow

Taka

Taka

Taka

Less:
Family Expenses with Tax

Total Outflow
Net Cash/Bank balance

(Masthan Maligai)

Annexure -3

Md. Abdus Sobhan Miah


C/o. Office of the Prime Minister, Dhaka
TIN: 114005467902/Survey Circle-4
U/S-82BB

Statement of Share Income for the Year Ended 30th June,2014


Cost value of Securities :
1. Midway Securities Ltd.
a) BOID-9199:
b) BOID-9834:
Balance as on Cr./Dr.(Loan) :
1. Midway Securities Ltd.
a) BOID-9199:
b) BOID-9834:
Capital Gain :
1. Midway Securities Ltd.
a) BOID-9199:
b) BOID-9834:
Fees & Charges :
1. Midway Securities Ltd.
a) BOID-9199:
b) BOID-9834:

26,035,353
46,813
26,082,166

181,589
2,936

2,027,550
37,899
2,065,449

564
500
1,064

(Md. Abdus Sobhan Miah)

1/H-1/43 Mirpur, Dhaka


JASIM UDDIN BHUIYAN MONNO

TIN: 175367455472

Cost value of Securities :


1.
LankaBangla Securities:
2.
Midway Securities Ltd.
3.
a) BOID-9199:
b) BOID-9834:

6568606

###

24189953
12349
30770908

###
46,813
###

Annexure-1

Md. Abdus Sobhan Miah


C/o. Office of the Prime Minister, Dhaka
TIN: 114005467902/Survey Circle-4
U/S-82BB

Statement of Salary Income for the Year Ended 30th June,2014


a) Salary Income from Government Service :
Pay and Allowances
Basic Pay
Special pay
Dearness allowances
Conveyance allowances
House Rent allowances
Medical Allowances
Servent allowances
Leave allowances
Bonus / Ex-gratia
Other allowances
Other, if any (give detail) Expense Allowance
Net taxable income from salary(Govt. Service)

Amount of income Amount of exempted Net taxable income


(Tk.)
income (Tk.)
(Tk.)
480,000

480,000

72,000

72,000

8,400
36,000

8,400
36,000

80,000

80,000

12,000
688,400

12,000
208,400

480,000

b) Salary Income from Private Ltd. Company


Pay and Allowances
Basic Pay
Special pay
Conveyance allowances
House Rent allowances
Medical Allowances
Servent allowances
Leave allowances
Overtime allowance
Bonus / Ex-gratia
Other
allowances
Employer's
Contribution to Recognized Provident
Fund
Other, if any (give detail)
Net taxable income from salary(Private Service)

Total Salary Income(a+b)

Amount of income Amount of exempted Net taxable income


(Tk.)
income (Tk.)
(Tk.)
1,200,000
60,000
600,000
60,000

1,200,000
30,000
240,000
60,000

200,000

30,000
360,000
-

200,000

2,120,000

330,000

1,790,000

2,808,400

538,400

2,270,000

(Md. Abdus Sobhan Miah)

Annexure-2

Md. Abdus Sobhan Miah


C/o. Office of the Prime Minister, Dhaka
TIN: 114005467902/Survey Circle-4
U/S-82BB

Statement of House Property Income for the Year Ended 30th June,2014
Location and description of property: Five storied Building at 35 Baishteki, Section-13,
Mirpur, Dhaka-1216
Ground Floor
1st Floor
2nd Floor
3rd Floor
4th Floor
4th Floor

@
@
@
@

Parking
TK. 6,000 X
TK. 6,000 X
TK. 6,000 X
Self Occupied
TK. 5,500 X

12 Months = TK.
12 Months = TK.
12 Months = TK.
= TK.
12 Months = TK.
Total
= TK.

144,000
144,000
144,000
Nil
66,000
498,000

Less:

25% for Repairs


TK.
124,500
Interest on Loan
TK.
Municipal Tax
TK.
39,137
Land Revenue
TK.
- TK.
Net House Property Income TK.

163,637
334,363

2 X
2 X
2 X
1 X

(Md. Abdus Sobhan Miah)

Statement of House Property Income for the Year Ended 30th June,2013

d 30th June,2013

Annexure-5

Md. Abdus Sobhan Miah


C/o. Office of the Prime Minister, Dhaka
TIN: 114005467902/Survey Circle-4

Statement Of Income for the year ended 30th June,2014

1. Income from House Property :

334,363

2. Income From Salary :

2,270,000

3. Income From Bank Interest :

11,034

4. Capital Gain

###

Total Taxable Income

2,615,397

Tax Calculation
1st
Next
Next
Next
Next

220,000
300,000
400,000
500,000
1,195,397

0%
10%
15%
20%
25%

Nil
30,000
60,000
100,000
298,849

Total

2,615,397

Tax

488,849

Total Tax Payable


Add : 10% Surcharge on PayableTax
Total Tax Payable
Less:AIT Deducted from Salary
AIT From Bank Interest
Balance Tax Paid by PO No.

488,849
48,885
537,734
238,956.00
1,655.00

240,611
297,123

(Md. Abdus Sobhan Miah)

#REF!
375,000.00 56,250.00

607768
1,195,397

#REF!

Date :
Deputy Commissioner of Taxes
Circle-64, Taxes Zone-03
Dhaka.
Subject: Payment of Tax.
Reference: JASIM UDDIN BHUIYAN MONNO, Son of Alhaj Md. Shahabuddin
Bhuiyan;1/H-1/43 Mirpur, Dhaka
TIN : 058-113-4795/Cir-64
E-TIN: 175367455472/Cir-64
Assessment Year: 2011-2012
P.O. No.-

1331812

Taka: 46,793/Date : 16-01-2014


Bank: Dutch-Bangla Bank Ltd.
Branch: Mirpur Branch, Dhaka
Please Acknowledge the Receipt
Thanks

(JASIM UDDIN BHUIYAN MONNO)

27

28

Statement of income of the Assessee


Statement of income during the income year ended on
Sl

Heads of Income

Amount in Taka
546,000.00

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 of the spouse or minor child as applicable : u/s 43(4)

Capital Gains : u/s 31

Income from other source : u/s 33

10

Total (serial no. 1 to 9)

11

Foreign Income:

12

Total income (serial no. 10 and 11)

13

Tax leviable on total income

14

Tax rebate: u/s 44(2)(b)(as per schedule 3)

15

Tax payable (difference between serial no. 13 and 14)

16

30-Jun-13

671,000.00

Untaxed Income (U/S-19E )

1,217,000.00
0.00
1,217,000.00
149,400.00
14,400.00
135,000.00
8,237.00

Add : 10% Panalty on Tax of Untaxed Income


Total Tax Payable

Tax Payments:
(a) Tax deducted/collected at source
(Please submit supporting documents/statement)

Tk.

(b) Advance tax u/s 64/68 (Please attach challan )

Tk.

(c) Tax paid on the basis of this return (u/s 74)


(Please attach challan/pay order/bank draft/cheque)

Tk. 143,237.00

(d) Adjustment of Tax Refund (if any)

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

17

Difference between serial 15 and 16 (if any)

18

Tax exempted and Tax free income

19

Income tax paid in the last assessment year

143,237.00

143,237.00
0.00

* If needed, please use separate sheet.

Verification
0
0
I
father /husband
0
8
7
1
0
9
3
6
2
8
UTIN/TIN:
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.

Place: Dhaka
Date :
Signature
Md. Belal Uddin
29

(Name in block letters)


Designation and Seal (for other than individual)

30

SCHEDULES SHOWING DETAILS OF INCOME


Name of the Assessee:

TIN

0 0 0 - 0 0 0 0 0 0 0 0

Schedule-1 (Salaries)
Amount of
Income
(Tk.)

Pay & Allowance

Amount of
exempted income
(Tk.)

432,000.00

Basic pay

Net taxable
income
(Tk.)
432,000.00

Special pay
Dearness allowance
45,600.00

30,000.00

216,000.00

216,000.00

Conveyance allowance
House rent allowance

15,600.00

Medical allowance
Servant allowance
Leave allowance
Honorarium / Reward/ Fee
Overtime allowance
Bonus / Ex-gratia

72,000.00

72,000.00

Other allowances (Transport)

26,400.00

26,400.00

Employers contribution to Recognized


Provident Fund
Interest accrued on Recognized Provident
Fund
Deemed income for transport facility
Deemed income for free
furnished/unfurnished accommodation
Other, if any (give detail)
792,000.00

Net taxable income from salary

246,000.00

546,000.00

Schedule-2 (House Property income)


Location and
description of property

Particulars

Tk.

1. Annual rental income


2. Claimed Expenses :
Repair, Collection, etc.
Municipal or Local Tax
Land Revenue
Interest on Loan/Mortgage/Capital
Charge
Insurance Premium
Vacancy Allowance
Other, if any
Total =

31

Tk.

3. Net income ( difference between item 1 and 2)

32

Schedule-3 (Investment tax credit)


(Section 44(2)(b) read with part B of Sixth Schedule)
1. Life insurance premium

Tk.

2. Contribution to deferred annuity

Tk.

3. Contribution to Provident Fund to which Provident Fund


Act, 1925 applies

Tk.

4. Self contribution and employers contribution to


Recognized Provident Fund

Tk.

5. Contribution to Super Annuation Fund

Tk.

6. Investment in approved debenture or debenture stock,


Stock or Shares

Tk.

7. Contribution to deposit pension scheme

Tk.

8. Contribution to Benevolent Fund and Group Insurance premium

Tk.

9. Contribution to Zakat Fund

Tk.

10. Others, if any

Laptop
Total =

*Please attach certificates/documents of investment.

List of documents furnished


1. Photocopy Salary Certificate

6.

2. Cash Flow Statement

7.

3. Income Statement

8.

4. A Photocopy of Deed of Land Purchase

9.

5. Photocopy of Purchase of a Laptop

10.

33

Tk.

96,000.00

Tk.

96,000.00

*Incomplete return is not acceptable

34

IT-10B
30-Jun-13

Statement of Assets and Liabilities (as on


Name of the Assessee:

TIN 0

0 0 - 0 0 0 - 0 0 0 0

1. (a) Business Capital (Closing balance)

Tk.
Tk.

(b) Directors Shareholdings in Limited Companies ( at cost)


Name of Companies
Number of shares

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


Land/House property (Description and location of property)
5 Decimal Land at Genda Mouga, Saver, Dhaka
(Total Cost with Registration)

Tk.

3. Agricultural Property (at cost with legal expenses ) :


Land (Total land and location of land property)

Tk.

4. Investments:
(a) Shares/Debentures

671,000.00

Tk.

(b) Saving Certificate/Unit Certificate/Bond

Tk.

(c) Prize bond/Savings Scheme

Tk.

(d) Loans given

Tk.

(e) Other Investment

Tk.
Total =

5. Motor Vehicles (at cost) :


Type of motor vehicle and Registration number

Tk.
Tk.

(Gift from Marriage)

6. Jewellery (quantity and cost) :


35 Tola

B/F

Tk.

7. Furniture (at cost) :

B/F

Tk.

180,000.00

Tk.

140,000.00

8. Electronic Equipment (at cost) :


9. Cash asset Outside Business:
(a) Cash in hand & at bank

B/F

Value Not Known

Tk.

(b) Cash at bank

Tk.

(c) Other deposits

Tk.
35

(Annexure-1)

Total =

36

Tk.

1,369,400.00

Tk.

2,360,400.00

Laptop

Tk.

96,000.00

Total assets

Tk.

2,456,400.00

Total liabilities

Tk.

B/F =
10. Any other assets
(With details)

11. Less Liabilities:


(a) Mortgages secured on property or land

Tk.

(b) Unsecured loans

Tk.

(c) Bank loan

Tk.

(d) Others

Tk.

12. Net wealth as on last date of this income year


(Difference between total assets and total liabilities)

Tk.

2,456,400.00

13. Net wealth as on last date of previous income year

Tk.

1,193,600.00

14. Accretion in wealth (Difference between serial no. 12 and 13)

Tk.

1,262,800.00

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

Tk.

200,200.00

Tk.

1,463,000.00

Tk.

1,463,000.00

(b) Number of dependant children of the family:


2

Adult

Child

16. Total Accretion of wealth (Total of serial 14 and 15)


17. Sources of Fund :
(i) Shown Return Income
(ii) Tax exempted/Tax free Income
(iii) Other receipts

Tk.

1,217,000.00

(Perquisites) Tk.

246,000.00

Tk.
Total source of Fund =

Tk.

18. Difference (Between serial 16 and 17)

I solemnly declare that to the best of my knowledge and belief the information given in the IT-10B is
correct and complete.

0
Name & signature of the Assessee
Date

Assets and liabilities of self, spouse (if she/he is not an assessee), minor children and
dependant(s) to be shown in the above statements.
* If needed, please use separate sheet.

37

38

Form No. IT-10BB

FORM
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:
Seria
l No.

TIN 0

Particulars of Expenditure

0 0 - 0 0 0 - 0 0 0 0

Amount of Tk.

Comments

Personal and fooding expenses

92,000.00

Tax paid including deduction at source of the


last financial year

13,600.00

Accommodation expenses

66,000.00

Transport expenses

Electricity Bill for residence

Included With Rent

Wasa Bill for residence

Included With Rent

Gas Bill for residence

Included With Rent

Telephone Bill for residence (Mobile Bill)

Education expenses for children

10

Personal expenses for Foreign travel

11

Festival and other special expenses, if any (donation)

Living in Mother's Flat

3,600.00

25,000.00
200,200.00

Total Expenditure

I solemnly declare that to the best of my knowledge and belief the information given in the
IT-10BB is correct and complete.

0
Name and signature of the Assessee
Date:

*If needed, please use separate sheet.


"

Acknowledgement Receipt of Income Tax Return


Name of the Assessee:
UTIN/TIN: 0 0 0

Assessment Year:

0 0 0

Circle:

39

Taxes Zone:

40

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.
(2) Enclose where applicable:
(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 of house property loan interest, insurance premium for house property
income; Statement of professional income as per IT Rule-8; Copy of assessment/
income statement and balance sheet for partnership income; Documents of capital gain;
Dividend warrant for dividend income; Statement of other income; Documents in
support of investments in savings certificates, LIP, DPS, Zakat, stock/share etc.
(b) Statement of income and expenditure; Manufacturing A/C, Trading and Profit & Loss
A/C and Balance sheet;
(c) Depreciation chart claiming depreciation as per THIRD SCHEDULE of the Income Tax
Ordinance, 1984;
(d) Computation of income according to Income tax Law;
(3) Enclose separate statement for:
(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) Fulfillment of the conditions laid down in rule-38 is mandatory for submission of a return
under "Self Assessment".
(5) Documents furnished to support the declaration should be signed by the assessee or his/her
authorized representative.
(6) The assesse shall submit his/her photograph with return after every five year.
(7) Furnish the following information:
(a) Name, address and TIN of the partners if the assessee is a firm;
(b) Name of firm, address and TIN if the assessee is a partner;
(c) Name of the company, address and TIN if the assessee is a director.
(8) Assets and liabilities of self, spouse (if she/he is not an assessee), minor children and
dependant(s) to be shown in the IT-10B.
"
Total income shown in Return:

Tk.

1,217,000.00

Net Wealth of Assessee :

Tk.

2,456,400.00

Date of receipt of return :


Nature of Return :

Self

Tax paid:

Tk.

143,237.00

Serial No. in return register:


Universal Self

Normal

Signature of Receiving
41

officer with seal

42

Annexure -3

Md. Abdus Sobhan Miah


C/o. Office of the Prime Minister, Dhaka
TIN: 114005467902/Survey Circle-4
U/S-82BB

Statement of Share Income for the Year Ended 30th June,2014


Cost value of Securities :
1. LankaBangla Securities:
2. Midway Securities Ltd.
3.
a) BOID-9199:
b) BOID-9834:
Balance as on Cr./Dr.(Loan) :
1. LankaBangla Securities:
2. Midway Securities Ltd.
3.
a) BOID-9199:
b) BOID-9834:
Capital Gain :
1. LankaBangla Securities:
2. Midway Securities Ltd.
3.
a) BOID-9199:
b) BOID-9834:
Fees & Charges :
1. LankaBangla Securities:
2. Midway Securities Ltd.
3.
a) BOID-9199:
b) BOID-9834:

Divident Income :
1. LankaBangla Securities:
2. Midway Securities Ltd.
3.
a) BOID-9199:
b) BOID-9834:

8,102,896
26,035,353
46,813
34,185,062
(612,863)
181,589
2,936
(1,958,431)
2,027,550
37,899
107,018
357,817
564
500
358,881
Income
405,228

405,228

Tax
41,697

41,697

(Md. Abdus Sobhan Miah)

1/H-1/43 Mirpur, Dhaka


JASIM UDDIN BHUIYAN MONNO

TIN: 175367455472

Cost value of Securities :


1.
LankaBangla Securities:
2.
Midway Securities Ltd.
3.
a) BOID-9199:
b) BOID-9834:

6568606

###

24189953
12349
30770908

###
46,813
###