Income Statement for the year 2010-11 Sex

Name: Satish Pal B/PAY 14740+4350 Designation Jr. Engineer M=1/F=2 1

Office CC DIVN,BBMB,NANGAL Employee No. 231741 PAN NO ANBPP7754J
Month Gross G.P.F. Arrear LOTA Elect. F.T.A. GIS HRD HBA LIC I.Tax
Pay in GPF Allow.
Mar-10 33474 2353 300 42 3462 600
Apr-10 28181 2424 300 42 3462 600
May-10 28181 2424 300 42 3462 600
Jun-10 28181 2577 300 42 3462 600
Jul-10 28181 2577 300 42 3462 600
Aug-10 28181 2577 300 42 3462 600
Sep-10 28181 2577 300 42 3462 1000
Oct-10 28181 2577 300 42 3462 1000
Nov-10 28181 2577 300 42 3462 1000
Dec-10 28181 2577 300 42 3462 1100
Jan-11 28181 2577 300 42 3462 1100
Feb-11 28181 2577 300 42 3462 1100
Total 343465 30394 0 3600 0 0 504 0 0 0 41544 9900
Others
B.P. 14740+4350
Add: 1.Cash Award Rs. 12000
2.Total Salary Rs. 355465 NOTE:
3.Benefit of Rent Free Accommodation 110 12 Rs. 1320 Pl.check up interest on HBA
4.Value of Electricity Concession 155 27% 12 Rs. 502 taken from Deptt.
5.Value of Privilege Pass Rs.
6.Total Value of Perquisites (3+4+5) Rs. 1822
DIRECT SAVINGS/PAYMENTS
a) G.P.F. Rs. 30394
b) LIC/GIS Premiums: Rs. 12388 ii) 80D Medical Insurance Rs
c) NSCs Rs. 7000 iii) 80DD Handicapped Treatment Rs
d) PLI Rs. 11400 iv) 80DDB Medical Treatment Rs.
e) PPF Rs. 5000 vi) 80G Donation 50% to 100% Rs.
c) Reinvestment of NSCs interest Rs. 2020 vii) 80U Phy. Handicapped Ass. Rs
Rs. viii)Tax Rebate u/s 89 Rs.
Rs.
Rs.
Rs. Any Other Income:
U/s 80CCC Pension Scheme Rs. i) Withdrawl from NSS including interest
ii) Income from interest Rs.
**Income from House Property (Rent) Rs. iii) Any other income Rs.
Less Interest on HBA (accrued) Rs.
Net Income from House Property: Rs. 0
** Interest on IDBI Bonds
Certificates: Other

1. I undertake to supply the documentaryproof in support of Savings and Deductions claimed.

2. I shall be personally responsible to file Income Tax Department return with the Income Tax Deptt.as required
under law and shall also be liable to face consequences for the (i) wrong information supplied,(ii)Income
concealed, if any, and (iii) For non-submission of documents/copies of proofs
or non-compliance of undertaking given, as may be imposed by the Income Tax Authorities.
3. Certified that deductions claimed under Section 80DD and 80DDB do not exceed the respectively
and a certificate issued by the competent authority to the effect of admissibility is attached.
4. Certified that I have not been provided, exclusively, with Motor Vehicles by the BBMB.
5. Certified that the in come of minor children has been included/clubbed in the statement.
6. Certified that the amount of special allowance/LOTA/FTA claimd and drawn during the year is less than the expdr
actually incurred by me on local official touring (within 8 KM) and the amount has been spent to meet the expen-
-ses actually incurred wholly, necessarily and exclusively in the performance of my official duties.
7. Certified that construction of house for which the rebate on account of refund of House Building
Advance/Interest is being claimed has been claimed.
 Year of Purchase NSC No. Date Amount Rate Interest

2008-09 60DD 445635 6/3/2009 5000 95.5 478

2009-10 61DD 57824 27/05/2009 11000 88.3 971

& 69CC 265895 to 265900 & 09/02/2010
20010-11 65DD 546315 28/06/2010 7000 81.6 571
& 35BB 548702

nterest on HBA
Total: 2020

**
 Proforma for Calculation of Income Tax for the year 2008-09
Name: Satish Pal Designation Jr. Engineer Sex 1
Office: CC DIVN,BBMB,NANGAL PAN ANBPP7754J
1 Total Income from Salary as per Annexure - A Rs. 355465
2 Value of perquisites Rs. 1822
3 Total Income from Salary as per Annexure - A Rs. 357287
4 Allowances exempt: LOTA 3600 FTA: 0 W.A. Rs. 3600
5 Balance:(3-4) Rs. 353687
6 Rs.
7 Income chargeable under Head Salary: Rs. 353687
8 Add any other Income
i) Income from Properties: Direct: Rs 0 Rs. 0
ii) Withdrawl from NSS including interest Rs. 0
iii) Income from Interest: Rs. 2020 2020
iv) Any other Income Rs. 0
9 Total 8(i) to (iv) Rs. 2020
10 Gross Total Income (7+8) Rs. 355707
11 Savings & Deductions under Chapter VI-A
80-C Savings under specified schemes(Max 100000)
a) G.P.F. 30394
b) LIC/GIS Premiums: Salary 42048 Direct 12388 54436
c) NSCs 7000
d) PLI 11400
e) PPF 5000
c) Reinvestment of NSCs interest 2020
0 0
0 0
0 0
Under Section 80 CCC Pension Plan 0
12 Total: 11(a) to 11(j) Max. 100000 110250 100000
13 i) 80-D Medical Insurance (Max.Rs.10000) Rs. 0 0
ii) 80-DD(Handicapped dependent Rs.50000) Rs. 0 0
iii) 80-DDB(Deduction in respect of Medical treatment,40000/- Rs. 0 0
v) 80-G Donation 50% or 100% Rs. 0 0
vi) 80-U(Physically Handicapped Assessee Max upto 50000/- Rs. 0 0

14 Total: 13(i) to 13(vi) 0 0

15 Total Savings & Deductions: 100000
16 Total Income (10-15) Rs. 255707
17 Total Income Rounded to Rs.10 Rs. 255710
18 Calculation of Tax
For Men 1 to 160000 Rs. Nil
For women 1 to 190000 Rs. Nil
For Men 160001 to 500000 10% Rs. 9571
For women 180001 to 500000 10% 0
For Both 500001 to 800000 20% 0
For Both 800001 to onward 30% 0
19 Tax Payable: 9571
20 Surcharge (If Income > 1000000) 10 % Rs. 0
21 Education Cess @ 2% onTax Payable (Col.19+20) 3% Rs. 287
22 Total Tax Payable (19+20+21) 9858
23 Tax Relief under Section 89 attach details & Form 10E Rs.
24 Net Tax Payble(20-21) Rs. 9858
25 Tax already deducted from Salary 9900 Others 0 Rs. 9900
26 Balance tax to be paid Rs. -42

Signatures