INCOME TAX STATEMENT FOR THE FINANCIAL YEAR 2010-2011

ASSESSMENT YEAR 2011-2012

A. Name & Designation of the Assesses Designation

B. Office / Residential Address Pin Code No.

C. PAN GIR NO Office permanent A/C No.

1 a) Salary income with allowance excluding H.R.A.… Rs.

b) House Rent Allowance … Rs.

c) Bonus … Rs.

d) Arrear,if any Rs.

2 Any other income as stated by the Assesses

a) Income from N.S.C./Bank interest etc. Rs.

b) Income from House Property. Rs.

3 Gross Income(Col.1 + 2 ) Rs.

4 Interest paid as H.B.Loan (1.5 Lacks maximum) U/S 24(B)…. Rs.

5 Professional Tax U/S 16(iii) (For Handcpd employees are exempt from P.tax) Rs.

6 Exemption of Conveyance Allowances U/s 10(14)(i)[Max.Rs 9600/-P.A.

7 Exemption U/S 10(13A)

a) H.R.A.Received Rs.

b) House Rent paid Rs.

c) Expenditure on rent in excess of

50% of B.Pay + D.A. In Metropol City ors 40% ### Rs.

10% of B.Pay + D.A. - Rs.

e) Amount exempted (Least of a,c) - Rs. Rs.

8 Total Income(Col.3-4-5-6-7) …. Rs.

9 Deduction U/S 80 C (Maximum Rs.1,20,000/- including T.Svngs Bond)

a) Contribution to G.P.F. …. Rs.

b) Contribution to New Flexible Bond Rs.

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 c) Group Insurance Savings Scheme …. Rs.

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 d) L.I.C./P.L.I./U.Lip Premiam paid(including Notified
Pension Scheme for maximum Rs.10,000/- Rs.
e)Purchase of N.S.C. . Rs.
f) Amount paid as excluisively tuition fees to any
University/College/School for maximum of two Rs.
Children( 2 )Maximum Rs.75000/-
g) Payment of H.B.Loan (Principal) Rs.

h) Equity linked savings scheme/tax savings bond etc.{Max-20000/-) Rs.

j) Others, if any as notified 80DDB 0

i) 80U 0 ii)80DD 0 iii)80D 0 80E 0 Rs.

k) Total Amount Deducted (a to j) …. Rs. Rs.

10 Taxable Income (7-8) …. Rs.

i) Upto Rs.1,60,000/- Tax Nil, (ii)Rs.1,60,001/-to 5,00,000/-Tax
11
10%
iii) Rs.5,00,0001/- to 8,00,000/- Tax 20%, iv)Rs.8,00,001/-to Onwards
Tax 30%

v) For Women employee upto Rs.1,90,000/- Tax Nil

12 Total Tax . Rs.

13 3% Educational cess on tax Rs.

14 Tax Payable including educational cess(Col.11 + 12) … Rs.

15 Relief U/S 89(1)[Arrears Relief from Salary] Rs.

16 Net Tax Payable ( 13-14) Rs.

17 Tax already deducted from source . Rs.

18 Balance Tax Payable / Refundable Rs.

Signature of the employee

Designation

Date

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