VANDE MATRAM

I WELCOME YOU IN THIS I.T. PROGRAMME General Information for Calculation & Submission of I.T. Data to be filled in cell forms YELLOW colour only in with "INFO1", sheet. cc .gOMcc XL8GF 5L/F ;[,DF\ H~ZL 0[8FGL V[g8=L SZMP In one worksheet you can enter 250 entries with regular pay.But if any change inbetween than make individual worksheet in that case. ;FY[ Z5_ jIlSTGF 0[8F T{IFZ Y. XS[ V[S H JS"XL8DF\ V[SL K[P5Z\T] HM SM.G[ 5|DMXG S[ prRTZ 5UFZ S[ VgI SM. ,FE D/TF JrR[YL SM. O[ZOFZ SZJFGM YTM CMI TM T[G[ DF8[ V,UYLCell No. EZJLP IU1, CODE No. 1 to 250 is given. In From JS"XL8 F1 to each column, fill data of each person and than in cell No. D1 give CODE and print all necessary forms of that person. F1 to IU1, ! YL Z5_ G\AZ GF SM0 VF5[,F K[P VF ;[, G\AZ NZ[S SM0GL GLR[ pEL SM,DDF\ 0[8F V[g8=L SZLG[ ;[, G\AZ D1 DF\ H[ T[GM SM0 VF5JFYL H[GM SM0 VF5[, CX[ T[GFprinting of INCO, INCOTAX-P,FORM-16 and SAHAJ For NZ[S OMD"G]\ 5|Lg8L\U SZL XSFX[P etc , select paper size as per your requirement and than adjust it. INCO, INCOTAX-P,FORM-16 and SAHAJ JU[Z[GF 5|Lg8L\U DF8[ TDFZL H~lZIFT D]HA ;[8L\U SZMP

GENERAL INFORMATION
1 2 3 4 5

1
VALIYA ROHITKUMAR KARSANDAS RAMJIBHAI SUPERVISOR INSTRUCTOR 2-MARUTINAGAR AIRPORT ROAD RAJKOT RAJKOT GUJARAT 360001 0 0 9426438678

Surname First Name Father's Name Grand Father's Name Designation Flat/Door/Block No Road/Street/Post Office Area/Locality Town/City/District State Pin code E Mail Address Residential Telephone No.

V8S 5MTFG]\ GFD INFORMATION l5TFG]\ GFD NFNFG]\ GFD CMNMP O,[8 q a,MS G\AZ q DSFG ZM0 q X[ZL q 5M:8G]\ GFD V[ZLIF q ,MSF,L8LG]\ GFD XC[Z q <,FG]\ GFD ZFHIG]\ GFD 5LGSM0 . D[, V[0=[; ZC[9F6GM 8[,LOMG G\AZ s V[;P0LP8LP SM0 ;FY[ f DMAF., G\AZ

9 10 11 12 13

13

13

13

14 15

16

17

18

19

Mobile No. Employer Category (Write "G"" for Govt. Employee, "P" GMSZLIFTGL S[8[UZL4 for semi government ;ZSFZL4 HFC[Z ;FC; S[ employee and "O" for Other VgI H[ ,FU] 50T]\ CMI T[ 5;\N SZMP employee, whichever applicable ) D[, S[ OLD[, DF\YL ,FU] Sex 50T]\ ,BMP Birth date HgD TFZLBP V[;P8LP0LP G\AZ ;FY[ Telephone No. with STD No. / OMG G\AZ VYJF DMAF., Mobile No. G\AZP H[ A[\SDF\ BFT] CMI T[ Name of the Bank A[\SG]\ GFDP H[ A[\SDF\ BFT] CMI T[ MICR Code of the Bank A[\SGF V[DVF.;LVFZ SM0 H[ A[\SDF\ BFT] CMI T[ Address of the Bank A[\SG]\ ;ZGFD]\\P Type of Account Account Number Details of Credit Card : Credit Card Number : Issued by :

Male 22-01-1957 0 State Bank of India 360002005 JAGNATH PLOT

20 21 22 23 24

A[\SDF\ BFTFGM 5|SFZP SAVING A[\SGF BFTFGF G\AZP 30731854391 S|[0L8 SF0"GL lJUTP S|[0L8 SF0"GF G\AZP S|[0L8 SF0" .:I] SZGFZGL lJUT AAWPV4274D

25

Parmanant Account No. (PAN 5FG G\AZP No.) Head of Office ( first ) Name of Office ( first ) Address of Office ( first ) City of Office ( first ) Pin code PAN NO.of Officer ( first )

26

SR[ZL q BFTFGF J0FGM PRINCIPAL CMNMP s 5C[,L SR[ZL f SR[ZL q BFTFG]\ GFDP s 5C[,L SR[ZL f SR[ZL q BFTFG]\ ;ZGFD]P s 5C[,L SR[ZL f SR[ZL q BFT]\ HIF VFJ[, K[ T[ UFD S[ ;L8LP s 5C[,L SR[ZL f 5LGSM0 SR[ZLGF VlWSFZL GF 5FG G\AZ s 5C[,L SR[ZL f SR[ZLGF 5FG q 8L0LV[; G\AZ VYJF SR[ZLGF 8FG G\AZ P s 5C[,L SR[ZL f SR[ZL q BFTFGF J0FGM CMNMP s AL SR[ZL f SR[ZL q BFTFG]\ GFDP s AL SR[ZL f SR[ZL q BFTFG]\ ;ZGFD]P s AL SR[ZL f SR[ZL q BFT]\ HIF VFJ[, K[ T[ UFD S[ ;L8LP s AL SR[ZL f 5LGSM0 INDUSTRIAL TRAINING INSTITUTE BHAVNAGAR ROAD,RAJKOT RAJKOT 360003 0

27

28

29

30

31

32

TAN NO.:- (of Office) ( first )

33

Head of Office ( second ) Name of Office ( second ) Address of Office ( first ) City of Office ( second ) Pin code

0 0 0 0 0 0

34

35

36

37

38

SR[ZLGF VlWSFZL GF PAN NO.of Officer ( second ) 5FG G\AZ s AL SR[ZL f SR[ZLGF 5FG q 8L0LV[; TAN NO.:- (of Office) ( G\AZ VYJF SR[ZLGF second ) 8FG G\AZ P s AL SR[ZL f SR[ZLGF p5F0 Name of Drawing Officer VlWSFZLG]\ GFD SR[ZLGF p5F0 Name of Drawing Officer's VlWSFZLGF l5TFG]\ father GFD Designation of Drawing SR[ZLGF p5F0 Officer VlWSFZLGM CMNM Date Of Issuing of Form No. OMD" G\AZ .:I] SIF"GL 16 TFZLB VF5 XFZLZLS ZLT[ BM0 Are you P.H.? Than write here BF\56 WZFJTL jIlST s5LPV[RPf KM m TM VlC YES V\U|[DF\ cI;c ,BMP XFZLZLS ZLT[ BM0 BF\56 WZFJTL jIlSTG[ Special Deduction for P.H. ( D/T]\ :5[P0L0SXG s~FP upto Rs. 50000/-) 5____qv GL DIF"NFDF\fP HM TD[ ;LGLIZ ;L8LhG If you are Senior Citizen CM TM VCL V\U|[DF\ I; than,write "YES" here,(If you ,BMPsTFP#!v_#vZ_!! are 65 year old on 31-3;]WLDF\ &5 JQF"GL 2011) p\DZf

39

40

RAVAL P L RAVAL P L PRINCIPAL 4/30/2012

41

42

43

36

No

37

0.00

38

No

INFORMATION ABOUT INCOME ( FROM PAY)

39

Band Pay of March-2012 Grade Pay of March-2012

40

DFR"vZ_!Z GM A[g0 5[ VCL ,BMP DFR"vZ_!Z GM U|[0 5[ VCL ,BMP

March/2012 April/2012 May/2012 June/2012 July/2012 August/2012 September/2012 October/2012 November/2012 December/2012 January/2013 February/2013 :5[XLI, 5UFZ D/TM CMI TM T[GM NZP 3ZEF0FGM NZ H[D S[ #_4 Z_4 !_ VYJF _ sX}gIfsNZ[S V\U|[DF\f D[0LS, EyYFGM NZP D[0LS, EyYFGM NZP sVMS8MAZvZ_!Z YL f WM,F. E\yY] D/T]\ CMI TM T[GM NZP JFCG EyYFGM NZP s 8LPV[Pf JFCG EyYFGM NZP s 8LPV[Pf sVMS8MAZvZ_!Z YL f ;L8L V[,Fpg; D/T]\ CMI TM T[GM NZP TDG[ NZ DF;[ D/TF :5[xI, S[ VgI EyYFGL ZSD VlC ,BMP

15570 2800 58 65 65 65 65 65 65 72 72 72 72 72 0 20 100 300 0 400 800 240 0

41

Rate of D.A. ( % , Percentage) Monthwise

VCL AFH]GF SMQ8SD\F\ 0LPV[PGF 8SF s@f 5|lT DF;GF ,BM\P

42

Rate of Special Pay H.R.A. %, 30 OR 20 OR 10 OR 0 (If living in Qtr.) Medical Allowance Medical Allowance (Oct-12 ) Washing Allowance Vehicle Allowance (T.A.) Vehicle Allowance (T.A.) (Oct-12) City Allowance Any Other OR Special allowance if any

43

44 44

45

46

46

47

48

1 ST D.A. CALCULATION
49A

49B

49C

49D

5|YD K DF; NZdIFG D/[, Amount of D.A. Arrears (Total DM\3JFZL E\yYFGF from First 6 Month ) TOFJTGL ZSDP 5|YD K DF; NZdIFG D/[, Amount deducted of DM\3JFZL E\yYFGF "Proffetional Tax" from First TOFJTGL ZSDDF\YL D.A. Arrears jIJ;FIJ[ZFGL YI[, S5FTP 5|YD K DF; NZdIFG JQF" NZdIFG D/[, DM\3JFZL Amount Paid in Cash from E\yYFGF TOFJTGL First D.A. Arrears ZSDDF\YL S[XDF\ R]SJFI[, ZSDP 5|YD K DF; NZdIFG D/[, DM\3JFZL E\yYFGF Amount credited to "GPF" TOFJTGL ZSDDF\YL from First D.A. Arrears P5LPV[OPDF\ HDF SZJF5F+ ZSDP

3858

3858

2 ND D.A. CALCULATION
50A

50B

50C

49D

ALHF K DF; NZdIFG D/[, Amount of D.A. Arrears (Total DM\3JFZL E\yYFGF from Second 6 Month ) TOFJTGL ZSDP ALHF K DF; NZdIFG D/[, Amount deducted of DM\3JFZL E\yYFGF "Proffetional Tax" from TOFJTGL ZSDDF\YL Second D.A. Arrears jIJ;FIJ[ZFGL YI[, S5FTP ALHF K DF; NZdIFG JQF" NZdIFG D/[, Amount Paid in Cash from DM\3JFZL E\yYFGF Second D.A. Arrears TOFJTGL ZSDDF\YL S[XDF\ R]SJFI[, ZSDP ALHF K DF; NZdIFG D/[, DM\3JFZL E\yYFGF Amount credited to "GPF" TOFJTGL ZSDDF\YL from Second D.A. Arrears P5LPV[OPDF\ HDF SZJF5F+ ZSDP

3975

3975

Other Arears if any give detail below

51A

Other Arrears (Total of all other Arrears) Amount deducted of "Proffetional Tax" from Other Arrears (Total of all other Arrears) Amount deducted of "Group Insurance" from Other Arrears (Total of all other Arrears) Amount deducted of "Income Tax" from Other Arrears (Total of all other Arrears) Amount Paid in Cash from Other Arrears (Total of all other Arrears)

51B

51C

51D

51E

49D

Amount credited to "GPF" from ALL . Arrears

52

Bonus Amount of Bonus Credited to G.P.F. (If any)

53

JQF" NZdIFG D//, VgI V[ZLI;" q TOFJTGM ;ZJF/M VCL ,BM\P JQF" NZdIFG D/[, VgI V[ZLI;" q TOFJTGL ZSDDF\YL jIJ;FIJ[ZFGL YI[, S5FTP JQF" NZdIFG D/[, VgI V[ZLI;" q TOFJTGL ZSDDF\YL ;ZSFZL lJDFGL GL YI[, S5FTP JQF" NZdIFG D/[, VgI V[ZLI;" q TOFJTGL ZSDDF\YL VFJSJ[ZFGL YI[, S5FTP JQF" NZdIFG D/[, VgI V[ZLI;" q TOFJTGL ZSDDF\YL S[XDF\ R]SJFI[, ZSDP JQF" NZdIFG D/[, VgI V[ZLI;" q TOFJTGL ZSDDF\YL S5FT AFN P5LPV[OPDF\ HDF SZFJJF5F+ ZSDP AMG; D/T]\ CMI TM T[GL ZSDP D/[, AMG; 5{SLGL P5LPV[OPDF\ HDF SZJF5F+ ZSDP
Page 3 of 37

24587

24587

0 0

54

Remunration(Total of all Remunrations) Leave Surrendar

55

5ZL1FF S[ VgI SM. JWFZFGL SFDULZL ;AA DC[GTF6]\ D/[, CMI TM T[GM S], ;ZJF/MP ZHF ZMS0 EyY]\ ,LW[, CMI TM T[GL ZSDP
INFORMATION

56

L.T.C.( if actually enjoyed)

ZHF 5|JF; ZFCTGL H[ ZSD D/[, CMI T[ s HM BZ[BZ 5|JF; SZ[, CMI VG[ D/[, CMI TM HfP

INFORMATION ABOUT INCOME ( FROM OTHER SOURCES)

57

58

59

60 61

62

63

64

65

66

67

68

A[\SG]\ jIFH D/[, CMI TM T[GL ZSDP VUFpGF JQFM"DF\ ZFQ8=LI ART 5+MDF\ ZMSF6 SZ[, CMI TM T[GF D/JF5F+ jIFHGL U6TZL SZL T[GL S], ZSDP V[GPV[;PV[;Ps:SLDv!)(*f N.S.S.( Scheme-1987) GL D/[, ZSDP N.S.S. Interest ( SchemeV[GPV[;PV[;Ps:SLDv!))Zf 1992) G]\ D/[, jIFH Income from Minor Children ;ULZ AF/SGL VFJSP JGWFZF 5[gXG Jivansuraksha Pension Fund O\0DF\YL 5M,L;L ;Zg0ZGL D/[, ZSDP _!v_!vZ__$ 5KL S[g Contribution of Central ;ZSFZGF SD"RFZL Government to New TZLS[ HM0FI[, CMI VG[ Employee join in new Pension GJL 5[gXG IMHGFDF\ H[ Scheme of Central S5FT YTL CMI T[DF\ Government after 01-01-2004 S[g ;ZSFZ FZF and join in . pD[ZJFDF\ VFJ[, OF/FGL ZSDP V[,PVF.P;LP L.I.C. Jivandhara JGWFZFGL D/[, ZSDP V[,PVF.P;LP JGV1FIGL L.I.C. Jivanakshay D/[, ZSDP .PV[,PV[;PV[;PGL D/[, E.L.S.S. ZSDP 8I]XGGL VFJSGL D/[, Tution Income ZSDP VgI SM. ;ZSFZL VFJSGL Any other Income D/[, ZSDP Bank Intrest N.S.C. Interest ( Series-8)

3769

0 0 0 0

0 0 0 0 0

INFORMATION ABOUT INVESTMENT G.P.F. deducted per month

In the table given beside , enter the amount of G.P.F. deducted per month. Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 5000 5000 5000 5000 5000 5000 5000 5000 5000 5000 15000 15000

AFH]DF\ VF5[,F SMQ8SDF\ 5|lT DF;GL P5LPV[OPGL S5FTGL ZSD NXF"JMP

Incom-tax deducted per month

In the table given beside , enter the amount of Incometax deducted per month. Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 1200 1200 1200 1200 1200 1200 1200 1200 1200 1200 2500 2013

AFH]DF\ VF5[,F SMQ8SDF\ 5|lT DF;GL VFJS J[ZFGL S5FT ZSD NXF"JMP

Summary of tax deducted at source

Quarter 1 Quarter 2 Quarter 3 Quarter 4

Acknowledgement no. of all Quarterly statement of TDS under sub-section (3) of section 200 House Rent Actually paid (Yearly) H.B.A. Interest as per Rule 24(2),100% Upto Rs.30,000/, (Loan Senction before 1-499) and after 1-4-99,100 % Upto Rs. 1,50,000/- (Enter as per condition ) Investment in Jivansuraksha Pension Fund Investment any Pension Scheme of Central Government ( Concerned with new employee employed after 01-01-2004) Medi Claim Primium If parents are Senior Citizen than,write "YES" here, Medi Claim Primium for parents Medical Expenses done for P.H. Dipendable Person

69

70

71

72

VCL NZ +6 DF;[ ;[SXG s#fGF ;[SXG Z__ V\TU"T VMOL; FZF EZJFDF\ VFJ[, 8LP0LPV[;PGF :8[8D[g8GF 5CM\R G\AZ EF0FGF DSFGDF\ ZC[TF CMI TM R}SJ[, S], JFlQF"S EF0FGL ZSDP DSFG 5[XULGL ,MGG]\ JQF" NZdIFG EZ[, jIFHGL ZSD sTFP_!q_$q!))) 5C[,FGL CMI TM ~FP #____qv VG[ TFP_!q_$q!))) 5KLGL CMI TM ~FP !5____qv ;]WL !__ @ f JGWFZF 5[gXG O\0DF\ SZ[, ZMSF6P S[g ;ZSFZGL SM.56 5[gXG :SLDDF\ SZ[, ZMSF6P s _!v_!vZ__$ 5KL ;ZSFZL GMSZLDF\ GJL :SLD C[9/ NFB, YI[, SD"RFZLVM DF8[ GL f JQF" NZdIFG D[0L S,[DDF\ SZ[, S], ZMSF6P HM TDFZF DFTFl5TF ;LGLIZ ;L8LhG CMI TM No VCL V\U|[DF\ I; ,BMP JQF" NZdIFG D[0L S,[D DFTF l5TF DF8[ SZ[, S], ZMSF6P JQF" NZdIFG lJS,F\U VFlzT DF8[ SZ[, TALAL BR"GL ZSDP

0 0 0 0 0

73 A

73 B

73 C

74

75

JQF" NZdIFG S[g;Z H[JF Medical Expenses done for U\ELZ ZMUM DF8[ SZ[, Dangerous Deases like TALAL BR" s~FP Cancer (pto limit Rs. 40000/- ) $____qvGL DIF"NFDF\fP GF6FSLI ;\\:YF S[ DFgI WDF"NF ;BFJTL ;\:YF 5F;[YL prRTZ S[/J6LGF C[T];Z ,LW[, ,MGGF jIFHGL SZ[, R]SJ6LGL ZSD JQF" NZdIFG ;[SXG (_v C[9/ ;LPV[DP S[ 5LPV[DP O\0DF\ VF5[, NFGGM S], ;ZJF/FGL ZSDP JQF" NZdIFG ;[SXG (_v C[9/ ;LPV[DP S[ 5LPV[DP O\0DF\ VF5[, NFG l;JFIGL VgI ;\:YFG[ VF5[, NFGGL S], ZSDP JQF" NZdIFG 5LP5LPV[OPDF\ SZ[, S], ZMSF6P JQF" NZdIFG JG JLDFs V[,PVF.P;LPfDF\ SZ[, S], ZMSF6GL ZSDP JQF" NZdIFG5M:8, JG JLDF DF\ SZ[, S], ZMSF6GL ZSDP 5UFZDF\YL S5FT YTF U|]5 .g:I]Zg;GF 5|lTDF;GF NZGL ZSDP JQF" NZdIFG I]PV[,PVF.P5LPDF\ SZ[, S], ZMSF6GL ZSDP JQF" NZdIFG 5MQ8 VMOL;GL ;LP8LP0LPDF\ SZ[, S], ZMSF6GL ZSDP

76

Intrest of loan taken for Higher Education

77

Deduction under Section 80G for C.M. Fund,P.M.Fund

78

Deduction under Section 80G otherthan C.M. Fund,P.M.Fund (other donation) P.P.F.

79

80

L.I.C. Primium

6774

81

P.L.I. Primium

82

Group Insurance

100

83

Investment done in U.L.I.P.

84

Post office CTD ( 10 OR 15 Year )

85

86

87

88

89

90

92

JQF" NZdIFG ZFQ8=LI ART 5+M sV[GPV[;P;LPf DF\ SZ[, S], ZMSF6GL ZSDP VUFpGF JQFM"DF\ ZFQ8=LI ART 5+MDF\ N.S.C. Interest as ZMSF6 SZ[, CMI TM reinvestment T[GF D/JF5F+ jIFH ( Series-8) 5{SLGL 5]Go ZMSF6DF\ U6TZL SZJF5F+ ZSDP DSFG 5[XUL ,LW[, CMI H.B.A.Principal TM T[GL JQF" NZdIFG EZ[, D}/ sS],f ZSDP JQF" NZdIFG V[GPV[;PV[;P GL !))ZGL N.S.S. (Scheme-1992) :SLDDF\ SZ[, S], ZMSF6GL ZSDP JQF" NZdIFG V[,PVF.P;LPGL L.I.C. JIivandhara Premium JGWFZF :SLDDF\ SZ[, S], ZMSF6GL ZSDP JQF" NZdIFG V[,PVF.P;LPGL JGV1FI L.I.C. Jivanakshay Premium :SLDDF\ SZ[, S], ZMSF6GL ZSDP JQF" NZdIFG Investment in units of E.L.S.S. .PV[,PV[;PV[;PGF (Limit upto Rs. 10000/-) I]GL8DF\ SZ[, S], ZMSF6GL ZSDP N.S.C. ( Series-8) Investment in Share or .gO|F:8=SRZ4 5FJZ S[ Debenture 8[,L SMdI]GLS[XGGF X[Z of Infrastructure, Power or S[ 0LA[gRZDF\ SZ[, S], Teli Communication Company ZMSF6GL ZSDP Investment in Home Loan Ssheme Children's tution fee for one child or two Children JQF" NZdIFG CMD ,MG :SLDDF\ SZ[, S], ZMSF6GL ZSDP JQF" NZdIFG V[S S[ A[ AF/S DF8[ EZ[, lX1F6 OLGL ZSDP JQF" NZdIFG VgI SM. ZMSF6 SZ[, CMI TM T[GL S], ZMSF6GL ZSDP S[g ;ZSFZ FZF GM8LOF. SZJFDF\ VFJ[, ZFJ UF\WL ;[JL\U .Gj[:8d[G8 GF .g[O|F:8=SRZ AMg0DF\ ;[SXG () C[9/ D/JF5F+ K]8KF8GL lJUT

93

94

95

18000

96

Other investment if any Rajiv Gandhi Saving Investment in Infrastructure bond notified by central government

97

Relief Under section 89

SOME OTHER DETAILS AND CALCULATIONS Details for ANNEXURE - A of form no. 16
Write Detail information about RECEIPT Number of from no. 24 G. in the table beside monthwise { for form No. 16 ( Details of Tax Deducted and Deposited into Central Government Account . )}

ANNEXURE - A

AFH]GF SMQ8SDF\ NZ[S DF;JF.h OMD" G\AZ Z$ GF 5CM\R G\AZ ,BJF s OMD" G\AZ !& DF8[ VF lJUT EZJL H~ZL K[Pf

Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Page 4 of 37

INFORMATION

ANNEXURE - A

AFH]GF SMQ8SDF\ NZ[S DF;JF.h OMD" G\AZ Z$ GF 5CM\R G\AZ ,BJF s OMD" G\AZ !& DF8[ VF lJUT EZJL H~ZL K[Pf
Write Detail information about DDO Sequence Number in the Book Adjustment Mini Statement in the table beside monthwise { for form No. 16 ( Details of Tax Deducted and Deposited into Central Government Account . )}

AFH]GF SMQ8SDF\ NZ[S DF;JF.h DLGL :8[8D[g8DF\ VF5[, A]SGF 0LP0LPVMP ;LSJg; G\AZ ,BJF s OMD" G\AZ !& DF8[ VF lJUT EZJL H~ZL K[Pf
Write Detail information about Date on which tax Deposited in the table beside monthwise { for form No. 16 ( Details of Tax Deducted and Deposited into Central Government Account . )}

AFH]GF SMQ8SDF\ NZ[S DF;JF.h VFJSJ[ZM S[g ;ZSFZDF\ EIF"GL TFZLB ,BJL s OMD" G\AZ !& DF8[ VF lJUT EZJL H~ZL K[Pf

Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13

Details for ANNEXURE - B of form no. 16 Challan Identification Number (CIN)

ANNEXURE - B ANNEXURE - B ANNEXURE - B ANNEXURE - B
Write Detail information about Tax Deposited in respect on of the employee (Rs.) in the table beside monthwise { for form No. 16 ( Details of Tax Deducted and Deposited into Central Government Account . )}

ANNEXURE - A

ANNEXURE - A

AFH]GF SMQ8SDF\ NZ[S A[\SDF\ VFJSJ[ZM

EIF"

CMI T[ ZSD ,BJL s OMD" G\AZ !& DF8[ VF lJUT

Write Detail information about BSR Code of the Bank Branch in the table beside monthwise { for form No. 16 ( Details of Tax Deducted and Deposited into Central Government Account . )}

0 0 0 0 0

AFH]GF SMQ8SDF\ H[ A[\SDF\ VFJSJ[ZM EIF" CMI T[

A[\SGL XFBFGF ALPV[;PVFZP SM0

,BJF

Write Detail information about Date on which tax Deposited in the table beside monthwise { for form No. 16 ( Details of Tax Deducted and Deposited into Central Government Account . )}

AFH]GF SMQ8SDF\ NZ[S DF;JF.h A[\SDF\ H[ TFZLB[ VFJSJ[ZM EIM" CMI T[ TFZLB ,BJL s OMD"
Write Detail information about Challan Serial Number in the table beside monthwise { for form No. 16 ( Details of Tax Deducted and Deposited into Central Government Account . )}

AFH]GF SMQ8SDF\ NZ[S DF;JF.h A[\SDF\ VFJSJ[ZM

Details of income from House Property

100

Address of property 1 Town / City 1 State 1 PIN code 1 If let out ? Than write here YES 1

DSFG q 5|M58L" G]\ ;ZGFD]\ DSFG q 5|M58L" G]\ UFD DSFG q 5|M58L" H[ ZFHIDF\ CMI T[ ZFHIG]\ GFD 5LGSM0 HM DSFG q 5|M58L" EF0[ VF5[, CMI TM VCL V\U|[DF\ cI;c ,BMP HM DSFG q 5|M58L" EF0[ VF5[, CMI TM VCL EF0[ ZFBGFZG]\ GFD ,BMP HM DSFG q 5|M58L" EF0[ VF5[, CMI TM VCL EF0[ ZFBGFZGF 5FG G\AZ ,BMP HM DSFG q 5|M58L" EF0[ VF5[, CMI TM VCL JFlQF"S EF0FGL VFJS ,BMP

0 0 0 0 No

101

102

103

104

105

Name of Tenant 1

106

PAN of Tenant (optional ) 1 Annual letable value / rent received or receivable ( Higher if let out for whole of the year, lower if let out for part of the year. ) 1 The amount of rent which cannot be realized 1 Tax paid to local authorities. 1 Write Ward No.of Incomtax Office here where you submitt Income Tax Return . Name of Incomtax Office here where you submitt Income Tax Return . Write Address of Incomtax Office where you submitt Income Tax Return . Write Name of City of Incomtax Office where you submitt Income Tax Return .

107

108

0 0 VlC H[ .gSD 8[1F VMOL;DF\ ZM8G" EZJFG]\ YT] CMI T[GF JM0" G\AZ ,BJF VlC H[ .gSD 8[1F VMOL;DF\ ZM8G" EZJFG]\ YT] CMI T[G]\ GFD ,BJ]\P VlC H[ .gSD 8[1F VMOL;DF\ ZM8G" EZJFG]\ YT] CMI T[G]\ ;ZGFD]\ ,BJ]\P VlC H[ .gSD 8[1F VMOL;DF\ ZM8G" EZJFG]\ YT] CMI T[ UFD q XC[ZG]\ GFD ,BJ]\P VlC H[ .gSD 8[1F VMOL;DF\ ZM8G" EZJFG]\ YT] CMI T[ UFD q XC[ZGF 5LG SM0 G\AZ ,BJFP

109

IT OFFICE WARD - 3

110

OFFICE OF INCOMETAX

111

RACE COURCE ROAD

112

MUMBAI

113

Write Pin Code of City of Incomtax Office where you submitt Income Tax Return .

400012

Page 5 of 37

In D.A. Arrears Calculation, first select "Yes" or "No" for concerned mon "GPF" or "Cash" whichever applicable.

DM\3JFZL EyYFGL TOFJTGL ZSDGL U6TZL DF8[ H[ T[ DlCGFD SZJFGL CMI T[DF\ V\U|[DF\ cc I; cc S[ cc GM c tYF TOFJTGL DlCGFDF\ cc5LV[Occ DF\ S[ ccZMS0cc DF\ U6TZL SZJFGL CM 5;\NUL SZMP
VALIYA ROHITKUMAR KARSANDAS
INDUSTRIAL TRAINING INSTITUTE RAJKOT

D. A. Calculation First
To be Calculate ? Rate of D.A. "YES" or "NO"

1/1/2012

to

31/06/2012

Period

Band Pay

Grade Pay

N.P.P.A.

Total of 2 & 3

3 2800 2800 2800 2800 2800 2800 16800

4 0 0 0 0 0 0 0

5 18370 18370 18370 18370 18370 18370 110220

Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12

Yes Yes Yes No No No

15570 15570 15570 15570 15570 15570 93420

D. A. Calculation Second

Rate of D.A. To be Calculate ? "YES" or "NO" 1

7/1/2012

to

12/31/2012

Period

Band Pay

Grade Pay

N.P.P.A.

Total of 2 & 3

3 2800 2800 2800 2800 2800 2800 16800

4 0 0 0 0 0 0 0

5 18930 18930 18930 18930 18930 18930 113580

Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12

Yes Yes Yes No No No

16130 16130 16130 16130 16130 16130 96780

Yes No

F8[ H[ T[ DlCGFDF\ U6TZL c tYF TOFJTGL ZSD H[ T[ 6TZL SZJFGL CMI T[ 5|DF6[

or concerned month.Also select plicable.

R KARSANDAS

INSTITUTE

on First

New

65

Old

58

D.A To be pay D.A paid

Diff to be "GPF" or Amount Amount pay "Cash" in in Cash

6 11941 11941 11941 0 0 0 35823

7 10655 10655 10655 0 0 0 31965

8 1286 1286 1286 0 0 0 3858 Cash Cash Cash Cash GPF GPF

9 0 0 0 0 0 0 0

10 1286 1286 1286 0 0 0 3858

n Second

New

72 Old

65
Amount Amount in in Cash G.P.F.

Diff to be "GPF" or D.A To be pay D.A paid pay "Cash"

6 13630 13630 13630 0 0 0 40890

7 12305 12305 12305 0 0 0 36915

8 1325 1325 1325 0 0 0 3975 Cash Cash Cash Cash Cash Cash

9 0 0 0 0 0 0 0

10 1325 1325 1325 0 0 0 3975

GPF Cash

INDUSTRIAL TRAINING INSTITUTE, RAJKOT INCOME YEAR :- 2012-2013 NAME:- VALIYA ROHITKUMAR KARSANDAS
Sr.No. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Name of the Month Mar-2012 Apr-2012 May-2012 Jun-2012 Jul-2012 Aug-2012 Sep-2012 Oct-2012 Nov-2012 Dec-2012 Jan-2013 Feb-2013 Description Pay Pay Pay Pay Pay Pay Pay Pay Pay Pay Pay Pay D.A. Arrears 1 D.A. Arrears 2 Other Arrears Bonus Remunretion Leave Surrender L.T.C. TOTAL Bank Intrest N.S.C. Interest ( Series-8) N.S.S.( Scheme-1987) N.S.S. Interest ( Scheme-1992) Income from Minor Children Jivansuraksha Pension Fund Contribution of Central Government Basic Pay 15570.00 15570.00 15570.00 15570.00 16130.00 16130.00 16130.00 16130.00 16130.00 16130.00 16130.00 16130.00 Grade Pay 2800.00 2800.00 2800.00 2800.00 2800.00 2800.00 2800.00 2800.00 2800.00 2800.00 2800.00 2800.00 N.P.P.A. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Total 18370.00 18370.00 18370.00 18370.00 18930.00 18930.00 18930.00 18930.00 18930.00 18930.00 18930.00 18930.00 Sp. Pay 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 D.A. 10655.00 11941.00 11941.00 11941.00 12305.00 12305.00 12305.00 13630.00 13630.00 13630.00 13630.00 13630.00 3858.00 3975.00 H.R.A. 3674.00 3674.00 3674.00 3674.00 3786.00 3786.00 3786.00 3786.00 3786.00 3786.00 3786.00 3786.00 M.A. 100.00 100.00 100.00 100.00 100.00 100.00 100.00 300.00 300.00 300.00 300.00 300.00

ASSESSMENT YEAR:- 2013-2014 DESIGNATION :- SUPERVISOR INSTRUCTOR

W.A. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 T.A. 400.00 400.00 400.00 400.00 400.00 400.00 400.00 800.00 800.00 800.00 800.00 800.00 C.L.A 240.00 240.00 240.00 240.00 240.00 240.00 240.00 240.00 240.00 240.00 240.00 240.00 Other allowance 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Total 33439.00 34725.00 34725.00 34725.00 35761.00 35761.00 35761.00 37686.00 37686.00 37686.00 37686.00 37686.00 3858.00 3975.00 24587.00 0.00 0.00 0.00 0.00 P.T. 200.00 200.00 200.00 200.00 200.00 200.00 200.00 200.00 200.00 200.00 200.00 200.00 0.00 0.00 0.00 G.I. 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00 0.00 0.00 0.00 G.P.F. 5000.00 5000.00 5000.00 5000.00 5000.00 5000.00 5000.00 5000.00 5000.00 5000.00 15000.00 15000.00 0.00 0.00 0.00 0.00 I.T.DED 1200.00 1200.00 1200.00 1200.00 1200.00 1200.00 1200.00 1200.00 1200.00 1200.00 2500.00 2013.00 0.00 0.00 0.00

24587.00 0.00 0.00 0.00 0.00 191320.00 33600.00 0.00 224920.00 0.00 3769.00 0.00 0.00 0.00 0.00 0.00 0.00 159376.00 44984.00 2200.00 0.00 6800.00 2880.00 24587.00 0.00 0.00 0.00 0.00 0.00 0.00

465747.00

2400.00

1200.00

80000.00

16513.00

ANY OTHER INCOME (ACCEPT SALARIES TO BE DECLARED SHOW HERE ( LIKE INTEREST,DIVIDEND, ETC)
L.I.C. Jivandhara L.I.C. Jivanakshay E.L.S.S. Tution Income Any other Income Income from House Property.

( VALIYA ROHITKUMAR KARSANDAS )

Total other Income

3769.00

GROSS INCOME

469516.00

SIGNATURE OF GOVT.SERVANT

STATEMENT OF INCOME TAX INDUSTRIAL TRAINING INSTITUTE, RAJKOT INCOME YEAR : NAME :
DESIGNATION :

2012-2013

ASSESSMENT YEAR :

2013-2014

VALIYA ROHITKUMAR KARSANDAS

SUPERVISOR INSTRUCTOR

PAN NO. :
"(1) "(2)

AAWPV4274D Divison ( A ) Income from Salary : Gross income from salary : as per rule 17

SEX :
Rs.

Male
465747.00

Deduction of allowances under section (10) (a) House rent allowance as per rule 10 (13-A) Rs. ( i ) H.R.A. Actually paid as per Bill ( Annualy) Rs. ( ii ) If the amount actually paid as a rent is > 10 % Amount of Basic + D.A. Than ( A - B ) ( A ) Actual Paid H.R.A. Rs. 0.00 ( B ) 10 % of ( Pay + D.A. ) Rs. 0.00 Rs. ( iii ) 40 % of ( Pay + D.A. ) ( iv ) Net elligible deduction of H.R.A.(Out of 1,2 OR 3 whichever is Minimum) (b) Under Rule 10(14)(i)Rule 2,BB(i),Dress WASHING ALLOWNCE Paid (100 %) (c) (d) Under Rule 10(14)(ii)Rule 2,BB(ii)TRANS.ALLOWANCE,( 1->100 % Upto limit of Monthly Rs. 800/-) And ( 2->100 % Upto limit of Monthly Rs. 1600/- For P.H. Employee) Total of (a)+(b)+(c) ( Allowances to be deducted Under Rule 10)

0.00 0.00

0.00 Rs. Rs. Rs. Rs. Rs. Rs. Rs. 0.00 0.00 6800.00 6800.00 2400.00 0.00 456547.00

"(3) "(4)

Deduction under rule As per Rule 16(3), PROFESSIONAL TAX ( 100 % ) Deduction under rule As per Rule 16(5), L.T.C. Remaining Salary Income (Column : 1-2(d)-(3)

A
"(1) "(2) "(3) "(4) "(5) "(6) "(7) "(8) "(9) "(10) "(11) "(12) "(13) "(14)

Division ( B ) Income from other sources :

Bank Intrest N.S.C. Interest ( Series-8) N.S.S.( Scheme-1987) N.S.S. Interest ( Scheme-1992) Income from Minor Children Jivansuraksha Pension Fund Contribution of Central Government L.I.C. Jivandhara L.I.C. Jivanakshay E.L.S.S. Tution Income Any other Income Income from House Property. Total Other Income [ Column (1) to (12) Total gross income ( Salary + Other Income [ A + DIV. B( 14 )]) Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. 3769.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3769.00

460316.00

Division ( C ) deduction admissible from total gross income Description Invesment

"(1) LESS : H.B.A. Interest as per Rule 24(2), 100% Upto Rs.30,000/-,( If Loan senction before 1-4-99) and after 1-4-99, if House purchased or Completed Construction within three years of senctioin of loan, than 100 % Upto Rs. 1,50,000/-. As per Rule 80-CCC. Jivansuraksha Pension Fund ( Limit Upto Rs. 100000.00) As per Rule 80-CCD. Investment in any Pension Scheme of Central Government ( Concerned with new employee employed after 01-01-2004) As per Rule 80-C ( Limit Upto Rs. 110000.00) but less of 80-CCC & 80-CCD (i) General Provident Fund / Common Provident Fund . (ii) Public Provident Fund (iii) Life Insurance Premium (iv) Postal Life Insurance Premium (v) Group Insurance (vi) Investment in Unit Linked Iinsurance Plan (ULIP). (vii) Post Office C.T.D. ( 10 Or 15 Year ) (viii) National Saving Certificate ( Series - 8 ) Rs. 0.00 Rs.

Eligible
0.00

"(2) "(3) "(4)

Rs. Rs.

0.00 Rs. 0.00 Rs.

0.00 0.00

Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs.

80000.00 0.00 6774.00 0.00 1200.00 0.00 0.00 0.00

Page 12 of 37

STATEMENT OF INCOME TAX

(ix) National Saving Certificate Interest as Reinvestment (x) House Building Advance Principal (xi) National Saving Scheme (Scheme-1992) (xii) L.I.C. Jivandhara Premium (xiii) L.I.C. Jivanakshay Premium (xiv) Investment in Equity Linked Saving Scheme Unit (ELSS) (xv) Investment in Share or Debenture of Infrastructure,Power or Teli Communication Company. (xvi) Investment in Home Loan Scheme (xvii) Tution fee paid for children (xviii) Other elligible if any Total of (i) TO (xviii) Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 18000.00 0.00 105974.00

Description
"(5) "(6) "(7) "(8) "(9) "(10) "(11) "(12) "(13) "(14) Total of ( 80-C ) + ( 80-CCC ) + ( 80-CCD ) Net Deduction under section 80-CCE Under section 80-D, Mediclaim Premium ( Upto Rs. 15,000.00, but Rs.20,000.00 for ceniyor citizen ) Under section 80-D, Mediclaim Premium for parents ( Upto Rs. 15,000.00 but Rs.20,000.00 If they are ceniyor citizen) Under section 80-DD, Medical Expenses done for P.H. dipendable personal relative Under section 80-DDB,Medical Expense done for Dangerous deases like Cancer (Upto Rs. 40000.00). If the person is senior citizen, than upto Rs. 60000.00. Under section 80-E,Intrest of loan taken for higher Education for 7 year from starting Under section 80-CCG, Rajiv Gandhi Saving Investment in Infrastructure

Invesment
Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. 105974.00 Rs. 0.00 Rs. 0.00 Rs. 0.00 Rs. 0.00 Rs.

Eligible
100000.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 100000.00 360316.00 360320.00 Tax Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. 0.00 16032.00 0.00 0.00

0.00 Rs. 0.00 Rs. 0.00 Rs. 0.00 Rs. Rs. Rs. Rs. Amount 200000.00 160320.00 0.00 0.00

bond notified by central government

Under section 80-G,Donation like C.M. Fund, P.M. Fund or other Donations As Per Rule 80-U,Special Deduction to P.H. & Blind employee ( Upto Rs. 50,000/- ) Total of amount to be deducted of Division (C) [(1)+(5)+(6)+(7)+(8)+(9)+(10)+(11) Less Income [ Division : B - Division : C(12) ] Remaining Amount Rounded to Rs.10/- ( Ten) DIivision : E Calculation of Income Tax General Women Ciniyer Citizen Upto Rs. 2,00,000/Upto Rs. 2,00,000/Upto Rs. 2,50,000/2,00,001 TO 5,00,000/- 2,00,001 TO 5,00,000/2,50,001 TO 5,00,000/5,00,001 TO 10,00,000/- 5,00,001 TO 10,00,000/5,00,001 TO 10,00,000/10,00,001/- to onward 10,00,001/- to onward 10,00,001/- to onward

"(1) "(2) "(3) "(4)

Tax 0% 10% 20% 30%

Total amount of Tax : Adjustment of Income Tax

Amount of Income Tax 2 % education surcharge + 1 % SEC & HSEC surcharge Less Relief Under section 89 Net amount of Income Tax Total Income-Tax paid Income tax to be paid / refund

16032.00
16032.00 481.00 0.00 16513.00 16513.00 0.00

Certificate by employee This is to certify that the information given in this statement is true and mistake less.

( VALIYA ROHITKUMAR KARSANDAS )

Signature of Govt. Servant

Certificate by office This is to certify that the information given in this statement compared with office record as well as documents presented by employee and found correct.

Signature and seal of Head of Office

Page 13 of 37

FORM NO.:-16
[See Rule 31(1)(a)] PART-A Certificate under Section 203 of the Income-Tax act,1961 for the tax deducted at source on "SALARIES". Name and Address of the Employer 0 0 0 0 0 PAN of the Deductor 0 CIT (TDS) OFFICE OF INCOMETAX Address RACE COURCE ROAD City MUMBAI Pin Code 400012 TAN of the Deductor 0 Assessment Year FROM Name & Designation of the Employee VALIYA ROHITKUMAR KARSANDAS SUPERVISOR INSTRUCTOR INDUSTRIAL TRAINING INSTITUTE, PAN of the Employee AAWPV4274D PERIOD TO RAJKOT

2013-2014
Summary of tax deducted at source
Amount of tax deduction in respect of the employee 3600.00 3600.00 3600.00 5713.00 PART-B ( Refer Note 1 )

4/1/2012

3/31/2013

Quarter Quarter 1 Quarter 2 Quarter 3 Quarter 4

Recipt Numbers of original statement of TDS under sub-section (3) of section 200 0 0 0 0

Amount of tax deposited remitted in respect of the employee 3600.00 3600.00 3600.00 5713.00

Details of salary paid and any other income and tax deducted. 1 (a) (b) (c) (d) 2 Gross Salary Salary as per provisions contained in section 17(1)
Value of perquisites under section 17(2) ( as per Form No. 12BB, whereever applicable Profits in lieu of salary under section 17(3) ( as per Form No. 12BB, whereever applicable

Rs. Rs. Rs. Rs. Rs. 465747.00 465747.00

Total Less Allowances to the extent exempt under section 10, House rent allowance Washing allowance Transport allowance Rs. Rs. Rs. 0.00 0.00 6800.00 Rs. 6800.00

3 4

Balance (1-2) Deductions :(a)Entertainment allowance (b)Tax on Employment Rs. Rs. 2400.00

Rs.

458947.00

5 6 7

Aggregate of 4 (a ) and 4 ( b ) Income chargeble under the head "salaries"(3-5) ADD : Any other income reported by the employee Income Intrest Rs. 3769.00 0.00

Rs.

2400.00 Rs. 456547.00

Rs.

3769.00 Rs. 460316.00

8 9

Gross Total Income(6+7) Deduction under Chapter VI-A (A) Section 80C,80CCC and 80CCD (a) Section-80 C (i) ( ii ) ( iii ) Section 80 C Rs. Rs. Rs. Rs. Rs. Rs. 0.00 0.00 105974.00 Rs. 100000.00 Gross Amount Rs. Deductible Amount

Note:1 Aggregate amount deductible under Section 80 C shall not be exceed One Lakh rupees. Note:2 Aggregate amount deductible under the three Section i.e.80 C, 80CCC and Section 80 CCD shall not be exceed One Lakh rupees.

"FORM-16"

Page 14 of 37

( B ) Other Section ( e.g. 80 E, 80 G etc) under chapter VI-A (i) ( ii ) ( iii ) ( iv ) (v) ( vi ) ( vii ) ( viii ) 10 11 Section - 80 D Section - 80 DD Section - 80 DDB Section 80-E Section-80-G Section-80-U Section 24 ( 2 ) HBA intrest Section 80 CCG Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs.

Gross Amount 0.00 Rs. 0.00 Rs. 0.00 Rs. 0.00 Rs. 0.00 Rs. 0.00 Rs. 0.00 Rs. 0.00 Rs.

Qulifting Amount 0.00 Rs. 0.00 Rs. 0.00 Rs. 0.00 Rs. 0.00 Rs. 0.00 Rs. 0.00 Rs. 0.00 Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs.

Deductible Amount 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 100000.00 360316.00 360320.00 16032.00 481.00 16513.00 0.00

Aggregate of deductible amount under chapter VI-A Total Income (8-10) Remaining Amount Rounded to Rs.10/- ( Ten)

12 13 14 15 16

Tax on Total Income Education cess @ 3 % ( on tax computed at S.No.12) Tax Payable ( 12 + 13 ) Less Relief Under Section 89 (attach details) Tax Payable (14-15)

16513.00

Verification
I RAVAL P L capacity of son / daughter of

RAVAL P L

Working in the

PRINCIPAL

(designation ) do hereby certify that a sum of Rs.

16513.00

( in words ) ] has been deducted and deposited to the credit of the [ Rs Sixteen Thousand,Five HundredThirteen Central Government,. I further certify that the information given above is true, complete and correct and is based on the books of account documents ,TDS statement, TDS deposited and other available records. Place : 0 Dated: Designation :

4/30/2012 PRINCIPAL

Signature of the person responsible for deduction of Tax. (RAVAL P L RAVAL P L)

ANNEXURE - A Details of Tax Deducted and Deposited in the Central Government Account through book entry.
( The Employer to provide payment wise details of tax Deducted and Deposited withrespect to the employee ). Sr. No. 1 2 3 4 5 6 7 8 9 10 11 12 13 15 1 In the column for TDS, give total amount for TDS,Surcherge ( if applicable) and education cess. Tax Deposited in respect on of the employee (Rs.) 1200.00 1200.00 1200.00 1200.00 1200.00 1200.00 1200.00 1200.00 1200.00 1200.00 2500.00 2013.00 Book Identification number (BIN) DDO Sequence Number in the Book Adjustment Mini Statement

Receipt numbers of form no. 24 G

Date on which tax Deposited

ANNEXURE - B Details of Tax Deducted and Deposited in the Central Government Account through Challan.
( The Employer to provide payment wise details of tax Deducted and Deposited withrespect to the employee ). Sr. No. 1 2 3 4 5 Tax Deposited in respect on of the employee (Rs.) 0 0 0 0 0 Challan Identification Number (CIN) BSR Code of the Bank Branch Date on which tax Deposited Challan Serial Number

Note :

In the column for TDS, give total amount for TDS,Surcherge ( if applicable) and education cess.

"FORM-16"

Page 15 of 37

S12
2013-14 ITR-1, PAGE 1

ITR - 1

A1
FIRST NAME

SAHAJ INDIAN INDIVIDUAL INCOME INCOME TAX RETURN

A2
MIDDAL NAME

AY 2013-14

R O H I
A3
LAST NAME

T K U M A R

K A R S A N D A S
A4
PARMANENT A/C. No.

V A L
A5
SEX

I Y A
A6
DATE OF BIRTH

A A W P V 4 2 7 4 D
A7
INCOME TAX WARD/CIRCLEME

MALE
A8

FEMALE

## ## ## ## ## ## ## ##
A9

IT OFFICE WARD - 3
ROAD/STREET

FLAT/DOOR/BUILDING

- M A R U T

I N A G A R

A I R P O R T
A11 TOWN/CITY/DISTRICT

R O A D

A10 AREA/LOCALITY

R A J K O T
A12 STATE

R A J K O T
A13 PINCODE

G U J A R A T
A14 EMAIL ADDRESS

0
A15
RESIDENTIAL PHONE NO. WITH STD COC\DE

A16 MOBILE NO.

0
A18 Fill one4 A20 Fill only one filled4 A21 if revised4
Tax refundable Tax Payable

9 4 2 6 4 3 8 6 7 8
Non Tax Bal.

A17 Fill One

Resident

Government. Non Resident

PSU

Others

A19

Fill one4

Resi. but not Ordinarly 148 153A/153C

bfre due date-139(1)

After due date139(4)4

Rvsd-139(5)res to notice4

142(1)

and4
Recept Number of Original Return Date of Filling Original Return

PART-B -GROSS TOTAL INCOME

B1 B2 B3 B4

Whole-Rupee (@) only

u u u u

Income from Salary/Pension

Note
Ensure to fill "Sch TDS1" Given in Page 2

B1

0 0 0 0 0 0 4 5 6 5 4 7 6
If showing loss mark the negative in bracket at left

Income from One House Prorerty

B2 B3 B4

(-) 0 0 0 0 0 0 0 0 0 0 0 0 (+ ) 0 0 0 0 0 0 0 0 3 7 6 9 ( )

Income from other sources

Note
Ensure to fill "Sch TDS2" Given in Page 2

Gross Total Income (B-1+B2+B3)

0 0 0 0 0 0 4 6 0 3 1 6

PART-C -DEDUCTIONS AND TAXABLE TOTAL INCOME

C1
4C1 4C4
80C 80CCF 80DDB 80GG 80U

( Refer to Instruction for limits on amount as per Tax Act )

1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

4C2 4C5 4C8

4C11

80CCC 80D 80E 80GGA

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

4C3 4C6 4C9

4C12

80CCD
80DD

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

to

4C7
4C10

80G 80GGC

C13 C14 C15

4C13

Total TCS Deduction ( Add items C1 to C3 ) Taxable Total Income ( B4-C14 )

u u

C14 C15 ( )

0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 3 6 0 3 1 6

FOR OFFICE USE ONLY

STAMP RECEIPT NO HERE

SEAL, DATE AND SIGNATURE OF RECEIVING OFFICIAL

G70
PERMANENT ACCOUNT NUMBER

2013-14 ITR-1, PAGE 2

A A W P V 4 2 7 4 D

PART-D -DEDUCTIONS AND TAXABLE TOTAL INCOME

D1 D3 D4 D6 D7 D9 D10 D12 D13 D14 Tax Payable On Total Income(C15) Secondary & Higher Education Cess Reliief u/s 90/91 Total Tax and Interest (D6+D7) Total TDS Deducted Refund ( D12-D8, if D12>D8 )

(Refer to Instruction for limits on amount as per Tax Act)

Tax Payable On Total Income( C15 )

4D1 4D4 4D7 4D10 4D13

0 0 0 0 0 1 6 0 3 2 4D2 0 0 0 0 0 0 0 0 0 0 4D5 0 0 0 0 0 0 0 0 0 0 4D8 0 0 0 0 0 0 0 0 0 0 4D11 0 0 0 0 0 0 0 0 0 0 4D14

0 0 0 0 0 0 0 4 8 1 4D3 0 0 0 0 0 0 0 0 0 0 4D6 0 0 0 0 0 1 6 5 1 3 4D9 0 0 0 0 0 1 6 5 1 3 4D12 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 1 6 5 1 3 0 0 0 0 0 1 6 5 1 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 6 5 1 3

Relief u/s 89 Total Interest u/s 234A/234/B234C Total Self Assessment Tax Paid Tax Payable CD8-D12, if D8>12)

Balance Tax After Relief ( D3-D4-D5 ) Tax Advance Tax Paid Tax Pripaid Taxes ( D9+D10+D11)

Bank Account Detaails 4D15 4D17 4D19

Account No.

( Mandatory in all acses irrespective of refund due or not)

3 0 7 3 1 8 5 4 3 9 1
Current4

4D16
Fill Only One: Refund by4

MICR CODE

3 6 0 0 0 2 0 0 5
deposited into bank A/C.

Type Of Account4

P Saving

4D18

Cheque or4

Exempt income only for reporting purpose (From Dividends, Agricultural Income < Rs.5000/-

VERIFICATION
I, RAVAL P L Son / Daughter of RAVAL P L solemnly declare that to the best my knowladge and belief, the information given in the return ts correct and complete and the amount of total income and other particulars shown there in are truly stateed and are in accordance with the provisions of the Income-tax Act.1967. in respect of income chargeable to Income-tax for the previous year relevant to the Assessment Year 2013-14

Place4

RAJKOT

Date4

3 0 0 4 2 0 1 2 SIGN HERE
Amount to be paid to TRP TRP Signature

If the return has been prepare by a tax Rerturn Prdeparer (TRP) give further details as bellow Name of the TRP

TRP PIN [ 10 Digit ] 4 4

Sch IT -DETAILS OF ADVANCE TAX AND SELF ASSESSMENT TAX PAYMENTS

BSR CODE (col.i) DATE OF DEPOSIT (col.ii) CHALLAN NO (col.iii) TAX PAID (col.iV)

R1 R2 R3 R4 R5

u u u u u Note u u u
u u u u u u

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

(1) Enter the totals of Advance Tax Sell Assessment Tax in D9 and D10 (2) Continue in Supplementary IT if you cannot fill within Sch IT

Sch IT -DETAILS OF TAX DEDCTED AT SOURCE FROM SALARY

TAN (col.i) 4 NAME OF THE EMPLOYER (col.ii) 4

[As per Form 16 issued by Employer(s)]

(col.iii) 4 TAX DEDUCTED (col.iV)

INCOME UN. SALARY

S1 4 0 S2 4 0 S3 4

PRINCIPAL INDUSTRIAL TRAINING INSTITUTE RAJKOT 0 0 0

0 0 4 5 6 5 4 7

0 0 0 1 6 5 1 3

Note

(1) Enter the totals column (iv) of Sch TDS1 and Sch TDS2 in D11 (2) Continue in Supplementary Schedule TDS1 if you cannot fill within Sch TDS1

Sch IT -DETAILS OF TAX DEDCTED AT SOURCE FROM INCOME OTHER THAN SALARY [As Form 16A by Deductor(s)]
TAN (col.i) 4 4 4 4 NAME OF THE DEDUCTOR (col.ii) 4 4 4 4 TAX DEDUCTED (col.iii) 4 4 4 4
AMT OUT OF(iii) CLMD YERA(col.iv)

T1 4 T2 4 T3 4 T4 4

Note

(1) Enter the totals column (iv) of Sch TDS1 and Sch TDS2 in D11 (2) Continue in Supplementary Schedule TDS2 if you cannot fill within Sch TDS2

ITR - V

A5 A3
Received with tanks from TR No. u

ACNOWLEDGEMENT
VALIYA ROHITKUMAR KARSANDAS
1(SAHAJ)
u 4S(SUGAM)u 4 u 5u 6 for assesment year 2011-12, having the folloving Particulars 2 3

AY 20 13-14
a return of income in

A1

FIRST NAME

A2

MIDDAL NAME

R O H I
LAST NAME

T K U M A R

K A R S A N D A S
A4
PARMANENT A/C. No.

V A L
SEX

I Y A
A6
DATE OF BIRTH

A A W P V 4 2 7 4 D
A7
INCOME TAX WARD/CIRCLEME

MALE
A8

FEMALE

## ## ## ## ## ## ## ##
A9

IT OFFICE WARD - 3
ROAD/STREET

FLAT/DOOR/BUILDING

2 -

M A R U T I

N A G A R

A I R P O R T
A11 TOWN/CITY/DISTRICT

R O A D

A10 AREA/LOCALITY

R A J K O T
A12 STATE

R A J K O T
A13 PINCODE

G U J A R A T
A14 Fill only one filled4

bfr. due date-139(1)

After due date139(4)4

Rvsd-139(5)res to notice4

142(1)

148

153A/153C

COMPUTATION OF INCOME AND TAX RETURN

6

Whole-Rupee (@ ) only

if showing loss, mark the negative sign in bracket at left

B1 B2 B3 B4 B5 B6 B7 B8 B9 B10 B11 B12 B13 B14

Gross Total Income Deduction Under Chapter VI-A Total Income Current Loss if any Net Tax Payable Interest Payable Total Tax and Interest Payable Total Advance Tax Paid Total Self Assessment Tax Paid Total TDS Deducted Total TCS Deducted Total Prepaid Taxes (B8+B9+B10+B11) Total Payable (B7-B12, IF B7>B12) Refund (B12-B7, if B12>B7)

u u u u u u u u u u u u u u

B1 B2 B3 B4 B5 B6 B7 B8 B9 B10 B11 B12 B13 B14

0 0 0 0 0 0 4 5 6 5 4 7 0 0 0 0 0 0 1 0 0 0 0 0

0 0

0 0 0 0 0 0 3 6 0 3 1 6

0 0 0 0 0 0 0 1 6 0 3 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 6 5 1 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 6 5 1 3

0 0 0 0 0 0 0 1 6 5 1 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

FOR OFFICE USE ONLY

STAMP RECEIPT NO HERE

SEAL, DATE AND SIGNATURE OF RECEIVING OFFICIAL

SAR AL-II [For Individuals having Income from Salary / Pension / Income from One House Property ( exluding loss brought forward from previous years ) / (ITR2 0 1 3 - 1 4 Income from other Sources ( Excluding Winning from Lottery and Income From Race Horses)] 1)
(Please see Rule 12 of the Income-tax Rules,1962)(Also see attached instructions) First name Middle name Last name PAN A A W P V 4 2 7 4 D

INDIAN INCOME TAX RETURN

Assessment Year

FORM

PERSONAL INFORMATION

VALIYA
Flat/Door/Block No 2-MARUTINAGAR Road/Street/Post Office AIRPORT ROAD Town/City/District RAJKOT Email Address

ROHITKUMAR

KARSANDAS

Name Of Premises/Building/Village

Date of Birth (DD/MM/YYYY)

22-01-1957
Area/Locality RAJKOT State GUJARAT Pin code 3 6 0 0 0 0 1 Employer Category (Tick)

Govt

PSU

Other

Sex (Tick)

Male

Female

(STD code)-Phone Number

Designation of Assessing Officer (Ward/Circle) FILING STATUS

Return filed under Section [Please see instruction number-9(i)]

Whether original or Revised return? (Tick) If revised, enter Receipt No and Date of filing original return Residential Status (Tick)

Original

Revised

DD/MM/YYYY
Resident Non-Resident Resident but Not Ordinarily Resident

1 2 3 INCOME & DEDUCTIONS 3 5

Income chargeable under the Head Salaries ( Salary / Pension ) Income chargeable under the Head House Property' ( enter -ve sign in case of loss if any ) Income chargeable under the Head Other Sources ( enter -ve sign in case of loss if any ) Gross Total Income ( 1 + 2 + 3 ) Deductions under chapter VI A (Section) a b c d 80CCE 80D 80DD 80DDB

1 2 3 4

456547.00 0.00 3769.00 460316.00

100000.00 0.00 0.00 0.00

e f g h

80E 80CCG 80G 80U

0.00 0.00

i j

80GG 80GGA

0.00 0.00 0.00

0.00 k 80GGC 0.00

l

6 7 8 9 TAX COMPUTATION

Deductions ( Total of 5a to 5l ) Total Income ( 4-6m ) Tax Payable on Total Income Secondary and Higher education cess on ( 8 )

6 7 8 9 10 11 12 13 14 15

100000.00 360316.00 16032.00 481.00 16513.00 0.00 0.00 16513.00 0.00 16513.00

10 Total Tax, Surcharge and Education Cess Payable ( 8 + 9 ) 11 12 13 Relief under Section 89 Relief under Section 90/91 Balance Tax Payable (10-11-12)

14 Interest Payable u / s 234A / 234B / 234 C 15 Total Tax and Interest Payable (13+14) Do not write or stamp in this area For Office Use Only

Seal and Signature of receiving official

Receiiptt No Date

TAXES PAID

16 Taxes Paid a Advance Tax (from item 25) b TDS (column 7 of item 23 +column 7 of item 24) c Self Assessment Tax (from item 25) 17 Total Taxes Paid (16a+16b+16c) 18 Tax Payable (15-17) (Enter if 15 is greater than 17, else leave blank) 19 Refund (17-16) (enter if 17 is greater than 16, also give Bank Account details below) 20 Enter your bank account number (mandatory in case of refund) 3 21 Do you want your refund by 22 Give additional details of your bank account MICR Code 23 3 6 0 0 0 cheque, or 2 0 0 5

16a 16b 16c 17 16 17 1

0.00 16513.00 16513.00 0.00 0.00

REFUND

0 7 3 1 8 5 4 3 9 deposited directly into your bank account? (tick as applicable) Type of Account (tick as applicable)

Savings

Current

Details of Tax Deducted at Source from Salary [As per Form 16 issued by Employer(s)] Tax Deduction Account Number (TAN) of the Employer (2) Name and address of the Employer (3)
PRINCIPAL, INDUSTRIAL TRAINING INSTITUTE, RAJKOT 0, 0, 0 Income chargeable under the head Salaries Deduction under Chapter VI-A Tax payable ( Incl. education cess) Total tax deducted Tax payable /refundable

TDS ON SALARY

Sr No.

(1)
i

(4) 460316

(5) 100000

(6) 16513

(7) 16513 0

(8) 0

0
ii

0
24 Sr No. TDS ON INTEREST Details of Tax Deducted at Source other than salary Tax Deduction Account Number (TAN) of the Deductor (2)

Name and address of the Deductor (3)

Amount paid / Credit

1
i ii iii Note

(4)

Date of Payment / Credit (5)

Amount out Total tax deducted of (6) claimed for this year (6) (7)

Enter the totals of column (7) of 23 and column (7) of 24 in Sl No. 17 of TAXES PAID

TAX PAYMENTS

25 Details of Advance Tax and Self Assessment Tax Payments Sl Name of Bank & Branch BSR Code No. i ii iii iv v Note 26

Date of Deposit (DD/MM/YYYY)

Serial Number of Challan

Amount (Rs) 0.00 0.00 0.00 0.00 0.00

Enter the totals of Advance tax and Self Assessment tax in Sl No. 17 a and 15c of TAXES PAID

Sr. A B C 27

Other Information (transactions reported through Annual Information Return) (Please see instruction number-9(ii) for code) Code Amount (Rs) Code Amount (Rs) Code Sr. Sr. 001 002 003 D E F 004 005 006 27 G H 007 008

Amount (Rs)

Exempt income any for reporting purposes ( from Dividend, Capital gains etc)

VERIFICATION VALIYA ROHITKUMAR KARSANDAS VALIYA KARSANDAS RAMJIBHAI son / daughter of I, solemniy declare that to the best of my knowledge and belief, the information given in the return thereto is correct and complete and that the
2013-2014

Place

RAJKOT

Date

Sign here -->

28 If the return has been prepared by a Tax Return Preparer (TRP) give further details as below: Identification No. of TRP Name of TRP

Counter Signature of TRP 29

29 If TRP is entitled for any reimbursement from the Government, amount thereof (to be filled by TRP)

Government of India

INCOME TAX - DEPARTMENT ACKNOWLEDGEMENT

Received with thanks from

VALIYA ROHITKUMAR KARSANDAS

SARAL - II for the assessment year

a return of income

and / or return of fridge benefits in Form No.

2013-2014

having the following particulars

Name
PERSONAL INFORMATION

PAN

VALIYA

ROHITKUMAR

KARSANDAS
Name Of Premises/Building/Village 0 Area/Locality RAJKOT State GUJARAT

Flat/Door/Block No 2-MARUTINAGAR Road/Street/Post Office AIRPORT ROAD Town/City/District RAJKOT

1 Gross Total Income COMPUTATION OF INCOME AND TAX THEREON 2 Deductions under chapter VI A (Section) 3 Total Income 4 Net tax payable 5 Interest payable 6 Total tax and Interest payable 7 Taxes Paid a Advance Tax b TDS c TCS d Self Assessment Tax d Total Taxex Paid (7a + 7b + 7c + 7d ) 8 Tax Payable ( 6 - 7d ) 9 Refund ( 7e - 6 ) 7a 7b 7c 7d

1 2 3 6 7 6

460316.00 100000.00 360316.00 16513.00 16513.00

0.00 16513.00 0.00 16513.00

7e 8 9

COMPUTATION OF FRINGE BENEFITS AND TAX THEREON

10 Value of Fridge benefits 11 Total Fridge benefit tax liability 12 Total interest payable 13 Total tax and Interest payable 14 Taxes Paid a Advance Tax b Self Assessment Tax c Total Taxes Paid (14a+14b) 15 Tax Payable (13-14c) 16 Refund (14c-13) 14a 14b

10 11 12 13

14c 15 16

Receiiptt No

Seal and Signature of receiving official

Date

FORM

INDIAN INCOME TAX RETURN

ITR-1
[For Individuals having Income from Salary / Pension / Family Pension & Interest]
(Please see Rule 12 of the Income-tax Rules,1962) (Also see attached instructions) First name Middle name Last name PAN A A W P V

Assessment Year

2 0 1

3 - 1 4

PERSONAL INFORMATION

VALIYA
Flat/Door/Block No 2-MARUTINAGAR Road/Street/Post Office AIRPORT ROAD Town/City/District RAJKOT Email Address

ROHITKUMAR
#REF! Area/Locality RAJKOT State GUJARAT

KARSANDAS

Name Of Premises/Building/Village

Date of Birth (DD/MM/YYYY)

22-01-1957
Employer Category (Tick)

Pin code 3 6 0 0 0 0 1

Govt

PSU

Other

Sex (Tick)

Male

Female

(STD code)-Phone Number

Designation of Assessing Officer (Ward/Circle) FILING STATUS

Return filed under Section [Please see instruction number-9(i)]

Whether original or Revised return? (Tick) If revised, enter Receipt No and Date of filing original return (DD/MM/YYYY) Residential Status (Tick) 1 2

Original

Revised

Resident

Non-Resident 1

Resident but Not Ordinarily Resident

Income chargeable under the Head Salaries ( Salary / Pension ) Income chargeable under the Head Other Sources a b Family Pension Interest Total ( 2a + 2b ) 2a 2b

456547.00

3769.00
2c 3

INCOME & DEDUCTIONS

c 3 4

Gross Total Income ( 1 + 2c ) Deductions under chapter VI A (Section) a b c d 80C 80CCC 80CCD 80D

3769.00 460316.00

100000.00 0.00 0.00 0.00

e f g h

80DD 80DDB 80E 80G

0.00 0.00 0.00 0.00

i j k l

80GG 80GGA 80GGC 80U

0.00 0.00 0.00 0.00

4m 5 6 7 8a 8b

m Deductions ( Total of a to l ) 5 6 7 8 TAX COMPUTATION Total Income ( 3-4m ) Net Agricultural Income (Enter only if greater than Rs 5,000) Aggregate Income (5+6) a b 9 a b c d 10 11 12 Tax Payable on Aggregate Income Rebate in respect of Net Agricultural income Tax Payable on Total Income ( 8a-8b ) Surcharge on 9a 9a 9b

100000.00 360316.00 360316.00 16032.00 0.00

16032.00 0.00 481.00

9d

Education Cess,including secondary and higher education cess on 9c ( 9a+9b ) Total Tax, Surcharge and Education Cess Payable ( 9a + 9b + 9c ) 10 11

16513.00

Relief under Section 89 Relief under Section 90/91 Balance Tax Payable (9d-10-11) Do not write or stamp in this area (Space for bar code) 13

0.00 0.00
12

16513.00

a b c

Interest Payable U/s 234A 13a Interest Payable U/s 234B 13b Interest Payable U/s 234C 13c 13d 14

Total Interest Payable d (13a+13b+13c) Total Tax and Interest Payable 14 (12+13d) For Office Use Only

0.00 16513.00

Seal and Signature of receiving official

Receiiptt No

Date

TAXES PAID

15 Taxes Paid a Advance Tax (from item 23) b c TDS (column 7 of item 21 +column 7 of item 22) Self Assessment Tax (from item 23)

15a 15b 15c

0.00 16513.00 16513.00

d Total Taxes Paid (15a+15b+15c) 15d 16 Tax Payable (14-15d) (Enter if 14 is greater than 15d, else leave blank) 16 17 Refund (15d-14) (enter if 15d is greater than 14, also give Bank Account details below) 17 18 Enter your bank account number (mandatory in case of refund) 3 0 7 3 1 8 5 4 3 9 1 cheque, or deposited directly into your bank account? (tick as applicable) 19 Do you want your refund by 20 In case of direct deposit to your bank account give additional details MICR Code 3 Savings 6 0 0 0 2 0 0 5 Type of Account (tick as applicable) Details of Tax Deducted at Source from Salary [As per Form 16 issued by Employer(s)] Tax Deduction Account Number (TAN) of the Employer (2) Name and address of the Employer (3) PRINCIPAL, INDUSTRIAL TRAINING INSTITUTE, RAJKOT 0, 0, 0
Income Tax payable( Deduction under chargeable under Incl. surch. and Chapter VI-A the head Salaries edu. cess)

REFUND

Current

21 Sr No. TDS ON SALARY

Total tax deposited

Tax payable /refundable

(1)
i

(4)

(5)

(6)

(7)

(8)

460316

100000

16513

16513

0
ii

22 Sr No. TDS ON INTEREST

Details of Tax Deducted at Source on Interest [As per Form 16 A issued by Deductor(s)] Tax Deduction Account Number (TAN) of the Deductor (2) Name and address of the Deductor (3) Date of Payment / Credit (5) Total tax deposited Amount out of (6) claimed for this year (7)

Amount paid / Credit

1
i ii iii Note

(4)

(6)

Enter the totals of column (7) of 21 and column (7) of 22 in Sl No. 15b of TAXES PAID

23 TAX PAYMENTS Sl No.

Details of Advance Tax and Self Assessment Tax Payments Name of Bank & Branch BSR Code
Date of Deposit (DD/MM/YYYY)

Serial Number of Challan

Amount (Rs) 0.00 0.00 0.00 0.00 0.00

i 0.00 ii 0.00 iii 0.00 iv 0.00 v 0.00 Note Enter the totals of Advance tax and Self Assessment tax in Sl No. 15 a and 15c of TAXES PAID

24 Sr. a b c 25

Other Information (transactions reported through Annual Information Return) (Please see instruction number-9(ii) for code) Code Amount (Rs) Code Amount (Rs) Amount (Rs) Sr. Sr. Code 001 004 007 d g 002 005 008 e h 003 006 f

Tax-exempt interest income (for reporting purposes only) VERIFICATION

25

I,

VALIYA ROHITKUMAR KARSANDAS

son / daughter of

VALIYA KARSANDAS RAMJIBHAI

solemniy declare that to the best of my knowledge and belief, the information given in the return thereto is correct and complete and that the amount of total income and other particulars shown therein are truly stated and are in accordance with the provisions of the Incometax Act, 1961, in respect of income chargeable to Income-tax for the previous year relevant to the
Assessment Year 2013-2014 Date Sign here -->

Place RAJKOT

26 If the return has been prepared by a Tax Return Preparer (TRP) give further details as below: Identification No. of TRP Name of TRP If TRP is entitled for any reimbursement from the Government, amount thereof (to be filled by TRP)

Counter Signature of TRP 28

Government of India

INCOME TAX - DEPARTMENT ACKNOWLEDGEMENT

Received with thanks from VALIYA and / or return of fridge benefits in Form No.

ROHITKUMAR KARSANDAS ITR - 1 for the assessment year

a return of income

2013-2014

having the following particulars

Name
PERSONAL INFORMATION

PAN A Name Of Premises/Building/Village #REF! Area/Locality RAJKOT State GUJARAT A W P V 4 2 7 4 D

VALIYA ROHITKUMAR KARSANDAS

Flat/Door/Block No 2-MARUTINAGAR Road/Street/Post Office AIRPORT ROAD Town/City/District RAJKOT

1 Gross Total Income COMPUTATION OF INCOME AND TAX THEREON 2 Deductions under chapter VI A (Section) 3 Total Income 4 Net tax payable 5 Interest payable 6 Total tax and Interest payable 7 Taxes Paid a Advance Tax b TDS c TCS d Self Assessment Tax d Total Taxex Paid (7a + 7b + 7c + 7d ) 8 Tax Payable ( 6 - 7d ) 9 Refund ( 7e - 6 ) 7a 7b 7c 7d

1 2 3 6 7 6

460316.00 100000.00 360316.00 16513.00 0.00 16513.00

0.00 16513.00 0.00

7e 8 9

16513.00

COMPUTATION OF FRINGE BENEFITS AND TAX THEREON

10 Value of Fridge benefits 11 Total Fridge benefit tax liability 12 Total interest payable 13 Total tax and Interest payable 14 Taxes Paid a Advance Tax b Self Assessment Tax c Total Taxes Paid (14a+14b) 15 Tax Payable (13-14c) 16 Refund (14c-13) 14a 14b

10 11 12 13

14c 15 16

Receiiptt No

Seal and Signature of receiving official

Date

FORM

INDIAN INCOME TAX RETURN

ITR-2
[For Individuals and HUFs not having Income from Bussiness or Profession]
(Please see Rule 12 of the Income-tax Rules,1962) (Also see attached instructions)

Assessment Year

2 0 1 3 - 1 4

Part A Gen
First name

GENERAL
Middle name Last name PAN A A W P V 4 2 7 4 D

VALIYA
PERSONAL INFORMATION Flat/Door/Block No 2-MARUTINAGAR Road/Street/Post Office AIRPORT ROAD Town/City/District RAJKOT Email Address

ROHITKUMAR
#REF! Area/Locality RAJKOT State GUJARAT

KARSANDAS

Name Of Premises/Building/Village

Status ( Tick ) Individual

Date of Birth (DD/MM/YYYY) ( in case of individual )

HUF

22-01-1957
Pin code 3 6 0 0 0 1 Sex (Tick)

Male

Female

(STD code)-Phone Number 0

Employer Category ( if in empoyment ) (Tick) Govt PSU Other

Designation of Assessing Officer (Ward/Circle)

Return filed under Section [Please see instruction number-9(i)]

Whether original or Revised return? (Tick) FILING STATUS If revised, enter Receipt No and Date of filing original return (DD/MM/YYYY) Residential Status (Tick)

Original

Revised

Resident

Non-Resident

Resident but Not Ordinarily Resident

Whether this return is being filed by a representative assesseem ? ( tick ) If yes, please furnish following information ( a ) Name of representative ( b ) Address of representative ( c ) Permanent Account Number ( PAN ) of the representative

Yes

No

Part B Part B - TI
1 Salaries ( 6 of Schedule S ) 2 TOTAL INCOME Income from house property ( 3c of scedule HP ) ( enter nil if loss )

Computation of total income

1 2

456547.00 0.00

3 Capital gains a Short term I Short - term ( u/s 111 A ( A5 of schedule CG ) II Short - term ( others ) ( A6 of schedule CG )
3ai 3aii

0.00 0.00 0.00 0.00

3c

III Total Short - term ( 3ai + 3aii ) (A4 of schedule CG ) 3aiii b Long term ( B5 of schedule CG ) ( enter nil if loss ) c Total capital gains ( 3aiii + 3b ) For Office Use Only
3b

0.00

Do not write or stamp in this area (Space for bar code)

Receiiptt No

Date

Seal and Signature of receiving official

Page 25

4 Income from other sources a from sources other than from owning race horses ( 3 of Schedule OS) b from owning race horses ( 4c of Schedule OS ) ( enter nil if loss) c total ( a + b ) ( enter nil if 4c is a loss) 5 Total ( 1 + 2 + 3c + 4c ) 6 Losses of current year set off against 5 ( total of 2vi and 3 vi of schedule CYLA ) 7 Balance after set off current year losses ( 5 - 6 ) ( also total of column of 4 of schedule CYLA ) 8 Brought forward losses set off against 7 ( 2vi of shedule BFLA ) 9 Gross Total income ( 7 - 8 ) ( also 3vii of shedule BFLA ) 10 Deduction under chapter VI - A ( n of shedule VIA ) 11 Total income ( 9 - 10 ) 12 Net agricultural income / any other income for rate purpose ( 4 of schedule El ) 13 Aggregate income ( 11 +- 12 ) 14 Losses of current year to be carried forward ( total of row xi of schedule CFL )

4a 4b 4c 5 6 7 8 9 10 11 12 13 14

3769.00 0.00 3769.00 460316.00 0.00 460316.00 0.00 460316.00 100000.00 360316.00 0.00 360316.00 0.00

Part B - TTI
1

Computation of tax liability on total income 16032.00

1c 2 3 4

2 3 4 5

6 7

8 9 TAXES PAID

Tax Payable on Total Income a Tax at normal rates 1a b Tax at special rates ( 11 of schedule SI ) 1b c Tax Payable on Total Income ( 1a + 1b ) Surcharge on 1c Education Cess, including secondary and higher education cess on ( 1c + 2 ) Gross tax liability ( 1c + 2 + 3 ) Tax relief a Section 89 5a b Section 90 5b c Section 91 5c d Total ( 5a + 5b + 5c ) Net tax liability ( 4 - 5d ) Interest payable a For default in furnishing the return ( section 234A ) 7a b For default in payment of advance tax ( section 234B ) 7b c For deferment of advance tax ( section 234AC ) 7c d Total Interest Payable ( 7a + 7b + 7c ) Aggregate liability ( 6 + 7d ) Taxes Paid a Advance Tax (from schedule - IT ) 9a TDS (total of column 7 of schedule - TDS1 and b 9b column 7 of schedule - TDS-2)

COMPUTATION OF TAX LIABILITY

16032.00 0.00 481.00 16513.00

0.00

5d 6

0.00 16513.00

7d 8

0.00 16513.00

0.00 16513.00 16513.00

0.00

10 11 12 13 14

c Self Assessment Tax (from schedule-IT ) 9c d Total Taxes Paid ( 9a+9b+9c) 9d Amount Payable (Enter if 8 is greater than 9d, else enter 0 ) 10 Refund ( if 9d is greater than 8, also give Bank Account details below) 11 Enter your bank account number (mandatory in case of refund) 3 0 7 3 1 8 5 4 3 9 1 Do you want your refund by deposited directly into your bank account? (tick as applicable) cheque, or In case of direct deposit to your bank account give additional details MICR Code 3 6 Savings 0 0 0 2 0 0 5 Type of Account (tick as applicable)

REFUND

Current

I,

VALIYA ROHITKUMAR KARSANDAS

VERIFICATION son / daughter of

VALIYA KARSANDAS RAMJIBHAI

solemniy declare that to the best of my knowledge and belief, the information given in the return and shedules thereto is correct and complete and that the amount of total income and other particulars shown therein are truly stated and are in accordance with the provision of the Income-tax Act, 1961, in respect of income chargeble to Income-tax for the previous year relevent to the
Assessment Year 2013-2014 Date Sign here -->

Place

Page 26

15 If the return has been prepared by a Tax Return Preparer (TRP) give further details as below: Identification No. of TRP Name of TRP If TRP is entitled for any reimbursement from the Government, amount thereof

Counter Signature of TRP 16 PAN of employer (optional ) 0

Schedule - S
Name of Employer

Details of income from salary

PRINCIPAL
Town / City Address of employer RAJKOT INDUSTRIAL TRAINING INSTITUTE 1 Salary ( Excluding all allowanse, prequisites & profit in lieu of salary ) 2 Allowances exempt under section 10 2 3 Allowances not exempt 4 Value of perquisites 5 Profit in lieu of salary 6 Income chargeble under the Head "Salaries" ( 1+3+4+5 ) Address of property 1 1 Tick Town / City SALARIES State GUJARAT

PIN code 3 6 0 1

456547.00

9200.00
3 4 5 6 State PIN code

456547.00

Schedule - HP

Details of income from House Property ( Please refer to instructions. )

if let out

Name of Tenant

PAN of Tenant (optional )

HPUSE PROPERTY

Annual letable value / rent received or receivable ( Higher if let out for whole of the year, 1a lower if let out for part of the year. ) b The amount of rent which cannot be realized 1b c Tax paid to local authorities. 1c 0.00 d Total ( 1b + 1c ) 1d 1e e Balance ( 1a - 1d ) 0.00 f 30 % of 1e 1f 0.00 g Interest payable on borrowed capital 1g 1h h Total ( 1f + 1g ) 1i i Income from house property 1 ( 1e - 1h ) Town / City State Address of property 2 a Tick

0.00

0.00

0.00 0.00
PIN code

if let out

Name of Tenant

PAN of Tenant (optional )

Annual letable value / rent received or receivable ( Higher if let out for whole of the year, lower if let out for part of the year. ) b The amount of rent which cannot be realized 2b c Tax paid to local authorities. 2c d Total ( 2b + 2c ) 2d e Balance ( 2a - 2d ) f 30 % of 2e 2f g Interest payable on borrowed capital 2g h Total ( 2f + 2g ) i Income from house property 2 ( 2e - 2h ) 3 Income under the head " Income from house property " a Rent of earlier years realized under section 25 A / AA b Arrears of rent received during the year under section 25 B after deducting 30 % c Total ( 3a + 3b + 1i + 2i ) Please include the income of the specified person referred to in Schedule SPI while computing the income under this head. NOTE > a

2a

2e

2h 2i 3a 3b 3c

0.00

Schedule - CG
CAPITAL GAINS

Capital Gains
1

A Short term capital gains 1 From assets in case of non-resident to which first proviso to section 48 applicable 2 From other assets a Full value of consideration 2a b Deduction under section 48 i Cost of acquisition bi ii Cost of Improvement bii iii Expenditure of transfer biii

Page 27

CAPITAL GAINS

iv Total ( i +ii + iii ) c Balance ( 2a - biv ) Loss if any, to be ignored under section 94(7) or d 94(8) ( enter positive values only. )

biv 2c 2d

e Exemption under section 54B/54D 2e f Short term capital gain ( 2c - 2d - 2e ) 3 Amount deemed to be short term capital gains under section 54B/54D/54EC/54ED/54G/54GA 4 Total short term capital gain ( 1 + 2f + A3 ) 5 Short term capital gain under section 111A included in 4 6 Short term capital gain other than referred to in secion 111A (A4 - A5 ) B Long term capital gains 1 Assets in case of non-resident to which first proviso to section 48 applicable 2 Other assets where proviso to section 112 (1) not applicable a Full value consideration 2a b Deduction under section 48 i Cost of acquisition after indexation bi ii Cost of Improvement after indexation bii iii Expenditure on transfer biii iv Total ( bi +bii + biii ) biv c Balance ( 2a - biv ) 2c d 54/54B/54D/54EC/54F/54G/54GA 2d Net balance ( 2c - 2d ) e 3 Other assets where proviso to section 112 (1) is applicable a Full value consideration 3a b Deduction under section 48 i Cost of acquisition without indexation bi ii Cost of Improvement without indexation bii iii Expenditure on transfer biii iv Total ( bi +bii + biii ) biv c Balance ( 3a - biv ) 3c d Exemption under sections 54/54B/54D/54EC/54F 3d
Exemption under sections

2f A3 A4 A5 A6 1

2e

3e e Net balance ( 3c - 3d ) B4 4 Amount deemed to be long term capital gains under section 54/54B/54D/54EC/54ED/54F 5 Total long term capital gain 1 + 2e [ (enter 2e as nil if loss) + 3e (enter 3e as nil if loss )+ 4 )] B5 C C Income chargeable under the head " CAPITAL GAINS " ( A4 + B5 ) (enter B5 as nil, if loss) D Information about actual / receipt of capital gain Upto 15/9 16/9 to 15/12 16/12 to 15/3 Date (i) ( ii ) ( iii ) 1 Long - term 2 Short - term Please include the income of the specified persons referred to in Schedule SPI while computing the income under this head. NOTE >

CAPITAL GAINS

16/3 to 31/3 ( iv )

Schedule - OS

Income from other sources

1 Income 0.00 a Dividends, Gross 1a 3769.00 b Interest Gross 1b c Rental income from machinery, plants, buildings, 1c 0.00 d Other, Gross ( excluding income from owning race horses ) 1d 1e e Total ( 1a + 1b + 1c + 1d ) f Deduction under section 57 :i Expenses fi ii Depreciation fii 0.00 iii Total fiii 1g g Balance ( 1e - fiii ) 2 2 Winning from lotteries, crossword puzzles, races, etc. 3 3 Income from other sources ( other than owning race horses ) ( 1g + 2 ) (enter 1g as nil, if loss) 4 Income from owning and maintaining race horses. a Receipts 4a b Deduction under section 57 in relation to ( 4 ) :4b 4c c Balance ( 4a - 4b ) Income chargeable under the head " Income from other sources" ( 3 + 4c ) (enter 4c as nil if loss 5 5 and take 4c loss figure to schedule CFL) Please include the income of the specified persons referred to in Schedule SPI while computing the income under this head. NOTE > OTHER SOURCES

3769.00

3769.00 3769.00

0 3769.00

Page 28

Schedule - CYLA
Sr.No. BROUGHT FORWARD LOSS ADJUSTMENT CURRENT YEAR LOSS ADJUSTMENT
Head / Sources of Income

Details of Income after Set off of current year losses.

Income of current year ( Fill this column only if income is zero or positive ) House property loss of the current year set off Total loss ( 3c of Schedule HP ) 1 2 Other sources loss ( other Current year's Income than loss from race horses ) of remaining after set off the current year set off Total loss ( 3 of Schedule OS ) 3 4=1-2-3

Lose to be adjusted

i ii iii iv v vi vii

Salaries House Property Short term capital gain Long term capital gain Other sources ( including profit from owning race horses ) Total loss set off Loss remaining after set-off out of 2 & 3

456547.00

0.00

456547.00

0.00

Schedule - BFLA
Sr.No.
Head / Sources of Income

Details of Income after Set off of Brought Forward losses of earlier years.
Income after set off, if any, of current year's losses as per 4 of schedule CYLA 1 Brought forward loss set off Current year's Income remaining after set off 3

i ii iii iv v vi vii Sr.No.

Salaries House Property Short term capital gain Long term capital gain Other sources ( including profit from owning race horses ) Total of brought forward loss set off Current year's income remaining after set-off Total ( i3 + ii3 + iii3 + iv3 + v3 )

Schedule - CFL
Assessment year 2000-01 2001-02 2002-03 2003-04 2004-05 2005-06 2006-07 2007-08 Total of earliar year losses

Details of Losses to be carried Forward to future years.

Data of filing (DD/MM/YYYY) House property loss Short term capital loss Long term capital loss Other sources loss ( from owning race horses )

CARRY FORWARD OF LOSS

i ii iii iv v vi vii viii ix x xi xii

Adjustment of above losses in Schedule BFLA year losses ) 2008-09 ( Current Total loss Carried Foraward to future years

Schedule - VIA
a TOTAL DEDUCTIONS b c d e f g n 80C 80CCC 80CCD 80D 80DD 80DDB 80E

Deductions under chapter VI A (Section)

100000.00 0.00 0.00 0.00 0.00 0.00 0.00

h i j k l m

80G 80GG 80GGA 80GGC 80RRB 80U

0.00

0.00
n 100000.00

Total deductions ( total a toi m )

Page 29

Schedule - SPI
Sr.No. 1 2 3 Name of person

Income of specified persons(spouse, minor child etc) includable of the assessee ( income of the minor child to be included after Rs. 1,500 per child)
PAN of person (optional) Relationship Nature of Income Amount(Rs.)

Schedule - SI
SPECIAL RATE Sr. Section code No. 1 2 3 4 5 11

Income chargeble to Income tax at special rates [ Please see instruction No.9(iii) for section code and rate of tax]
Special rate (%) Income i Tax thereon ii Sr. Section code No. 6 7 8 9 10 Total ( 1ii to 10 ii ) Special rate (%) Income i Tax thereon ii

EXEMPT INCOME

Schedule - EI
1 2 3 4 5 6

Details of Exempt Income ( Income not to be included in Total Income )

1 2 3 4 5 6

Interest income Dividend income Long term capital gains from transaction on which Securities Transaction Tax is paid Neat Agriculture income / any other income for rate purpose Others, including exempt income of minor children Total ( 1 + 2 + 3 + 4 + 5 )

Schedule - AIR
SI 1 2 3 4 Code of transaction 001 002 003 004

Other Information (transactions reported through Annual Information Return) [ Please see instruction No.9(ii) for code ] Amount ( Rs. ) Code of transaction Amount ( Rs. ) SI
5 6 7 8 005 006 007 008

Schedule - IT
TAX PAYMENTS Sl No. Name of Bank & Branch

Details of Advance Tax and Self Assessment Tax Payments of Income - tax.
BSR Code
Date of Deposit (DD/MM/YYYY)

Serial Number of Challan

Amount (Rs) 0.00 0.00 0.00 0.00 0.00

i 0.00 ii 0.00 iii 0.00 iv 0.00 v 0.00 NOTE > Enter the totals of Advance tax and Self Assessment tax in Sl No. 9a and 9c of Part-B TTI.

Schedule - TDS1
TDS ON SALARY

Details of Tax Deducted at Source from Salary [As per Form 16 issued by Employer(s)]
Name and address of the Employer (3) PRINCIPAL, INDUSTRIAL TRAINING INSTITUTE, 0, 0, 0
Income chargeable under the head Salaries

Sr Tax Deduction Account Number (TAN) of the Employer No.

Deduction Tax payable( Total under Incl. surch. tax Tax payable Chapter VIand edu. deposite /refundable A cess) d (5) 100000 (6) 16513 (7) 16513 (8) 0

(1)
i

(2)

(4) 460316

ii 0 0 0

Schedule - TDS2
TDS ON OTHER INCOME

Details of Tax Deducted at Source on Income [As per Form 16 A issued by Deductor(s)]
Name and address of the Deductor (3) Date of Payment / Credit (5) Total tax deposited (6) Amount out of (6) claimed for this year (7)

Sr Tax Deduction Account Number (TAN) of the Deductor No.

Amount paid / Credit

(1)
i ii

(2)

(4)

NOTE > Enter the total of column (7) of Schedule TDS-1 and column (7) of Schedule-TDS-2 in 9 (b) of Part B - TTI.

Page 30

Government of India

Received with thanks from VALIYA ROHITKUMAR KARSANDAS and / or return of fridge benefits in Form No.ITR - 2 for the assessment year Name
PERSONAL INFORMATION

INCOME TAX - DEPARTMENT ACKNOWLEDGEMENT

2013-2014
a return of income having the following particulars PAN A Name Of Premises/Building/Village #REF! Area/Locality RAJKOT State GUJARAT 1 2 3 6 7 6 A W P V 4 2 7 4 D

VALIYA ROHITKUMAR KARSANDAS

Flat/Door/Block No 2-MARUTINAGAR Road/Street/Post Office AIRPORT ROAD Town/City/District RAJKOT 1 Gross Total Income

456547.00 100000.00 356547.00 16513.00 0.00 16513.00

COMPUTATION OF INCOME AND TAX THEREON

2 Deductions under chapter VI A (Section) 3 Total Income 4 Net tax payable 5 Interest payable 6 Total tax and Interest payable 7 Taxes Paid a Advance Tax b TDS c TCS d Self Assessment Tax d Total Taxex Paid (7a + 7b + 7c + 7d ) 8 Tax Payable ( 6 - 7d ) 9 Refund ( 7e - 6 ) 7a 7b 7c 7d

0.00 16513.00

7e 8 9 10 11 12 13

16513.00

COMPUTATION OF FRINGE BENEFITS AND TAX THEREON

10 Value of Fridge benefits 11 Total Fridge benefit tax liability 12 Total interest payable 13 Total tax and Interest payable 14 Taxes Paid a Advance Tax b Self Assessment Tax c Total Taxes Paid (14a+14b) 15 Tax Payable (13-14c) 16 Refund (14c-13) 14a 14b

14c 15 16 Seal and Signature of receiving official

Receiiptt No

Date

Page 31

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08-5-1989 TO 31-12-1998 01-01-1999 TO 14-01-2000 15-01-2000 TO 28-02-2001 01-03-2001 TO 28-02-2002 01-03-2002 TO 28-02-2003 01-03-2003 TO ONWARDS A B C D E F A1 A2 A3 A4 A5 A6 B4 C3 D2 E1

SZ[, ~FP !____qvGL lS\DTGF V[GPV[;P;LP TFZLB TFP_(q_5q!)() YL TFP#!q!Zq!))( JrR[ P TM 5L/F S,ZGF ;[,DF\ ccV[cc ;FY[ ccKcc 5ZL6FD[ HF\A,L S,ZGF ;[,DF\ V[GPV[;P;LP /X[P VF ZLT[ H]NF H]NF S], !_ [ SZLG[ jIFHGL S], ZSD GLR[ VF5[, 5M58L
10000.00 10000.00 15000.00 20000.00 25000.00 30000.00 35000.00 40000.00 45000.00 50000.00 1240.00 1390.00 2340.00 3500.00 4925.00 6720.00 5789.00 5600.00 4801.50
12.4 13.9 23.4 35 49.25 67.2

40905.50

4600.00

A1 A2 A3 A4 A5 A6 B1 B2 B3 B4 B5

124.00 139.00 156.00 175.00 197.00 224.00 118.30 132.30 148.00 165.40 185.10

B6 C1 C2 C3 C4 C5 C6 D1 D2 D3 D4 D5 D6 E1 E2 E3 E4 E5 E6 F1 F2 F3 F4 F5 F6

206.90 113.00 125.80 140.00 155.80 173.50 193.10 97.20 106.70 117.10 128.50 141.00 154.70 92.00 100.50 109.70 119.80 130.90 142.90 81.60 88.30 95.50 103.30 111.70 120.80