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p) Fixed Deposits in Bank More Than (5) years. h) EWF and SWF 40
q) LIC Pension fund U/S 80 CCC (Max. Rs. 10000) i) Others if any
r) Contribution to any Pension Scheme U/S 80 CCD (Max. 10% of
salary) 0
Prepared by: G. ASHOK ,SA(M)
s) Infrastructure Bonds (ICICI/IDBI etc)U/s 80CCF (Up to
ZPHS DURSHED, Mdl&Dt: KARIMNAGAR, A.P. 505001
Rs.20000)
Note: Savings (a) to(r) Max.Rs 1,00,000 and (s) Rs.20,000 Total
Mail: aputfknr@gmail.com; Ph: 9490300725
Rs.1,20,000
INSTRUCTIONS: 1.Fill up the data in the light pink colour only. 3. Send your valuable suggesions and modifications.
2.verify with experts before submission. 4.You may change in the STATEMENT using password 12345.
19 Notional
arrears
Inc
0 0 0 0 0
20 Step up Arrears 0 0 0
21 Edu.Concession 0 0 0 0
22 Other Arrears 0 0 0
TOTAL 236446 625 54388 48581 0 0 0 1750 0 0 0 341790 31428 0 720 2400 40 0 0 34588 307202
with best compliments from APUTFKNR Copy available at www.utfknr.9f.com Signature of the Assessee
STATEMENT OF INCOME TAX for the Financial Year 2011-12
G. ASHOK
1 Name of the Government Servant & Address
ZPHS DURSHED
2 Permanent Account Number AQTPP2949L
3 Whether living in Own / Rented house (Address) Rented House at Karimnagar
4 Gross Pay & Allowences as indicated in the Statement enclosed Rs 341,790
5 Deductions towards H.R.A. U/s 10 (13-A) (Least of the following exempted) Rs 48,581
a) Actual H.R.A. received 48,581
b) Actual rent paid minus 10% of salary(PAY+DA) Rs 6,500 X 12 -- 10%S 48,917
c) 40% of salary (Salary means Basic Pay+DA) 116,334
6 Total Salary (4-5) Rs 293,209
7 Deductions from Salary Income Rs 2,400
a) Exemption from Conveyance Allowance U/s. 10(14) (i) 0
b) Profession Tax U/s 16 (3) B 2,400
8 Income from Salary(6-7) Rs 290,809
9 Income from Capital Gains ----
10 Other sources of income if any ----
11 Income OR Loss from house Property (U/s.24L(vi)) ----
12 Gross Total Income (8+9+10+11) Rs 290,809
13 Deductions Under Chapter VI A., U/s. 80C, 80CCC, 80CCD
a 1 GPF A/C No. 6968 31,428
2 APGLI No. ---- 0
3 Group Insurance 720
4 Lic Policies Premium ----
5 Subscription to NSC VIII Issue ----
6 Tution Fee for 2 Children ----
7 Repayment of HBA instalments Rs ----
8 UTI Retirement Benefit Pension Fund. ----
9 ULIP ----
10 PLI ----
11 Public Provident Fund ----
12 Subscriptions made to Equity shares/Debentures. ----
13 Subscriptions made to any Mutual Fund (ELSS) ----
14 Subscription to Deposit Scheme of National Housing Bank ----
15 Fixed Deposites in Banks for morethan 5 years ----
16 LIC Annuity Plan (Jeevan Dhara etc.) ----
b 17 LIC Pension fund U/s. 80CCC (Max. Rs. 10,000), LIC Annuity Plans ----
c 18 Contribution to any Pension Scheme U/s. 80 CCD (Max. 10% of Salary) ----
d 19 Infraustructure Bonds (ICICI/IDBI etc)U/s 80CCF 0
TOTAL QUALIFYING AMOUNT (upto Rs. 1,20,000/-) U/Sec. 80C, 80CCC & 80CCD Rs 32,148
16 TAXABLE INCOME (14-15) (Round of to nearest multiple of Rs. 10.) Rs 258,621 Rs 258,620
17 Amount of Tax (as per rates given below)
a a) MALE ASSESSES
i) Up to 160000/- Nil
II) Rs.1,60,001 to 5,00,000 Rs 9,862
(10% of the amount by which the total income exceeds Rs.160000)
UNDERTAKING CERTIFICATE
Certify that I have paid an amount of Rs. 78000 (Rupees seventy-eight thousands Only )
towards House Rent for the year 2010-11 @ Rs.6500.
DETAILS OF SALARY PAID AND ANY OTHER INCOME AND TAX DEDUCTED
1 Gross Salary
a) Salary as per provisions contained in Section 17(1) 341790.00 341790.00
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 341790.00 341790.00
2 Less: Allowance to the extent exempted under section 10 48581.00 48581.00
3 BALANCE (1-2) 293209.00 293209.00
4 DEDUCTIONS
a) Exemption conveyance allowance 0.00
a) Entertainment allowance:
b) Tax on Employment: 2400.00 2400.00
5 Aggregate of 4 (a&b) 2400.00 2400.00
INCOME CHARGEABLE UNDER THE
6 290809.00
HEAD SALARIES (3-5)
7 Add: Any other income reported by the employee. 0.00 0.00
8 GROSS TOTAL INCOME (6+7) 290809.00
9 Deductions under Chapter VI A
A, (a) Under 80C 32148.00
Gross Amount Qualifying Amount Deductible Amount
1 GPF A/C No. 6,968 31,428.00 31,428.00 31,428.00
2 APGLI No. ---- - - -
3 Group Insurance 720.00 720.00 720.00
4 Lic Policies Premium ---- ---- ----
5 Subscription to NSC VIII Issue ---- ---- ----
6 Tution Fee for 2 Children ---- ---- ----
7 Repayment of HBA instalments Rs ---- ---- ----
8 UTI Retirement Benefit Pension Fund. ---- ---- ----
9 ULIP ---- ---- ----
10 PLI ---- ---- ----
11 Public Provident Fund ---- ---- ----
12 Subscriptions made to Equity shares/Debentures. ---- ---- ----
13 Subscriptions made to any Mutual Fund (ELSS) ---- ---- ----
14 Subscription to Deposit Scheme of National Housing Bank ---- ---- ----
15 Fixed Deposites in Banks for morethan 5 years ---- ---- ----
16 LIC Annuity Plan (Jeevan Dhara etc.) ---- ---- ----
b 17LIC Pension fund U/s. 80CCC (Max. Rs. 10,000), LIC Annuity Plans ---- ---- ----
c 18Contribution to any Pension Scheme U/s. 80 CCD (Max. 10% of Salary) ---- ---- ----
I J.GOPAL RAO working in the capacity of HEAD MASTER do here by certify that a sum of Rs 10158
of IT (in words Rupees ten thousands, one hundred fifty-eight 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)
(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. 3000/- per month