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2. You see 6 Fields (1.Personal Details, 2.Pay Particulars, 3.Deductions, 4.Other Deductions, 5. DDO Particulars,

3. Enter your Particulars in 1 to 5 Fields (Only in yellow colour cells)

4. See your Tax Details in 6th Field

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Yours..
RAMESH KOORA, Karimnagar
email: ramesh.koora@gmail.com
visit: www.rameshkoora.8m.com
Mobile No. 9948841000

This Programme Run in MS Office 2003/2007 only

 Basic Pay on Jan-08 is 8385 190130

rotection Password contact me on my mobile

eductions, 5. DDO Particulars, 6. Tax Details)

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 PARTICULARS FOR INCOME TAX ASSESSME
This is Only for our State Govt Teachers
1.PERSONAL DETAILS 2.PAY PARTICULARS
Basic Pay on
NAME K.RAMESH 8385
Jan-2009

DESIGNATION SA(M) Increment Month Nov-09

WORKING PLACE GHS SAPTHAGIRI COLONY PP/FP/Spl Pay

MANDAL KARIMNAGAR Allowances

Surrender Leave
PAN NUMBER Not Claimed
Claimed Month

Surrender Leave
Post Type Non Vacation Post Not Applicable
Claimed Days

HRA 10% Pension Service Pensionable

GPF Monthly
CCA Other Corporations
Deduction 500

SEX Male GPF A/C No 13054/EDN

APGLIF Monthly
PHC No
Deduction 250

Reader Allowance Not Applicable APGLIF A/C No

LIVING HOUSE Rented House GIS 60

H.NO. 9-6-342 Edn Consession 0

Sainik Welfare
Res. Address Ramnagar, Karimnagar Fund
0

Employee Welfare
Cell No.9948841000 20
Fund

8385 10 House Rent Paid 20216

5.DDO PARTICULARS
(for Form 16 only)

DDO NAME CH.SRIKANTHA 8600 8600

FATHER'S NAME Designed by…
DESIGNATION GHM Gr-II

OFFICE GHS SAPTHAGIRI COLONY

PAN NUMBER

TAN NUMBER

6.TAX DETAILS

TAXABLE INCOME 154080

a) TAX PAYBLE 0 RAMESH KOORA

KARIMNAGAR
b)Surcharge 0 994 884 1000

NET TAX PAYBLE 0

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E TAX ASSESSMENT 2009-2010
ur State Govt Teachers
3.DEDUCTIONS Under Chapter VI A..U/s. 80C

a) GPF Deductions 10131

b) APGLI Deductions 3000

c) Group Insurance 720

d) LIC Policies Premium (Yearly)

e) Subscription to NSC VIII issue

f) Tution fee for 2 children 10000

g) Repayment of HBA instalments.

h) LIC Annuity Plan (Jeevan Dhara & Jeevan Aksay etc.)

i) UTI Retirement Benefit Pention fund.

j) ULIP 0

k) PLI

l) Public Provident fund

m) Subscriptions made to equity shares/Debentures

n) Subscription made to any Mutual fund (ELSS)

o) Subscription to Deposit Scheme of National housing Bank

p) Infrastructure Bonds (ICICI/IDBI etc)

q) Fixed Deposits in Bank More Than (5) years.

r) LIC Pension fund U/s. 80 CCC (Max. Rs. 10000)

s) Contribution to any Pension scheme U/s. 80 CCD (Max. 10% of salary)

t)

4.OTHER DEDUCTIONS UNDER CHAPTER VI A.

a) Medical Insurance premia U/S. 80-D upto 10000/- or Rs.15000/- in case of
senior citizen
b) Treatment of Handicapped Dependent U/S.80-DD
(Rs.50000 above 40% disability OR Rs.100000 above 80% disiability)
c) Expenditure on Medical Treatment of Dependent U/S.80-DDB
(Rs.40000 or Actual expenditure whichever is less OR Rs.60000 or actual
expenditure whichever is less if the dependent is above 65 years of age)
d) Donation to Charitable institution U/S.80-G

i) Approved institutions 50% of qualifying amount.

ii) Kargil,National calmaties & PM/CM Relief fund (100%)

e) Maintenance of Totally Blind or P.H. U/S.80-U

(upto Rs.50000 & Rs.75000 if the disiability is more than 80% for self)

f) Interest of House Building Advance.

g)Interest of Educational Loan

h)

f) EWF and SWF 20

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 SALARY PARTICULARS OF Sri/Smt/Kum K.RAMESH, SA(M) GHS SAPTHAGIRI COLONY, Mdl:KARIMNAGAR

PAY & ALLOWANCES DEDUCTIONS

Sl Salary & Other NET
No particulars AMOUNT
Pay EPI/PP DA IR CCA HRA AHRA Others TOTAL GPF APLIF GIS PT CMRF EWF/SWF TOTAL

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
1 Mar-09 8385 0 3554 1258 70 839 14106 500 250 60 100 20 930 13176

2 Apr-09 8385 0 4344 1845 70 839 15483 500 250 60 150 960 14523

3 May-09 8385 0 4344 1845 70 839 15483 500 250 60 150 960 14523

4 Jun-09 8385 0 4344 1845 70 839 15483 500 250 60 150 280 1240 14243

5 Jul-09 8385 0 4344 1845 70 839 15483 500 250 60 150 960 14523

6 Aug-09 8385 0 4344 1845 70 839 15483 500 250 60 150 960 14523

7 Sep-09 8385 0 4344 1845 70 839 15483 500 250 60 150 960 14523

8 Oct-09 8385 0 4344 1845 70 839 15483 500 250 60 150 960 14523

9 Nov-09 8600 0 4456 1892 70 860 15878 500 250 60 150 960 14918

10 Dec-09 8600 0 4456 1892 70 860 15878 500 250 60 150 960 14918

11 Jan-10 8600 0 4456 1892 70 860 15878 500 250 60 150 960 14918

12 Feb-10 8600 0 4456 1892 70 860 15878 500 250 60 150 960 14918

13 Surrender Leave 0 0 0 0 0 0 0

14 IR Arrears (Jan-09 to Mar-09) 1761 1761 1761 1761 0

15 DA Arrears (Jan-09 to Mar-09) 2370 2370 2370 2370 0

16 DA Arrears (July-09 To Oct-09 ) 0 0 0 0 0

Child Edn
17 0 0 0 0
Concession
TOTAL 101480 0 54156 23502 840 10152 0 0 190130 10131 3000 720 1750 280 20 15901 174229

Signature Of the Assessee Signature of the Drawing & Disbursing Officer

Prepared by Ramesh Koora, Karimnagar 9948841000
 STATEMENT OF INCOME TAX FOR THE YEAR 2009-2010
1 Name of the Government Servant & Address K.RAMESH, SA(M)

GHS SAPTHAGIRI COLONY

Mdl:KARIMNAGAR
2 Permanent Account No
3 Whether living in Own/Rented House Rented House

4 Gross Pay & Allowances as indicated in the Statement Enclosed 190130

5 Deductions towards HRA U/s. 10(13-A) (least of the following exempted)

a) Actual HRA received 10152

b) Actual Rent paid minus of 10% of salary (Rent: @20216 PM) 227028

c) 40% of salary (salary means Basic pay) 40592

6 TOTAL SALARY (4-5) 179978

7 DEDUCTIONS FROM SALARY INCOME 0

Exemption from conveyance allowance u/s.10(14)(i) 0

PROFESSIONAL TAX 1750

8 Income from Salary (6-7) 178228

9 Income from Capital Gains 0

10 Other Sources of income if any 0

11 income OR Loss from House Property (U/s.24(vi)) 0

12 Gross total income (8+9+10+11) 178228

13 DEDUCTIONS Under Chapter VI A..U/s. 80C

a) GPF Account No : 13054/EDN 10131

b) APGLIF No : 3000

c) Group Insurance 720

d) LIC Policies Premium 0

e) Subscription to NSC VIII issue 0

f) Tuition fee for 2 children 10000

g) Repayment of HBA installments. (Principle Amount) 0

h) LIC Annuity Plan (Jeevan Dhara & Jeevan Aksay etc.) 0

i) UTI Retirement Benefit Pension fund. 0

j) ULIP 0

k) PLI 0

l) Public Provident fund 0

m) Subscriptions made to equity shares/Debentures 0

n) Subscription made to any Mutual fund (ELSS) 0

o) Subscription to Deposit Scheme of National housing Bank 0

p) Infrastructure Bonds (ICICI/IDBI etc) 0

q) Fixed Deposits in Bank More Than (5) years. 0

r) LIC Pension fund U/s. 80 CCC (Max. Rs. 10000) 0

s) Contribution to any Pension scheme U/s. 80 CCD (Max. 10% of salary) 0

t) 0

TOTAL QUALIFYING AMOUNT (UP TO Rs.1,00,000/-)

23851
U/Sec. 80C,80CCC & 80CCD

14 TOTAL INCOME (12-13) 154377

 15 OTHER DEDUCTIONS UNDER CHAPTER VI A.
a) Medical Insurance premium U/S. 80-D up to 15000/- or Rs.20000/- in case of
0
senior citizen
b) Treatment of Handicapped Dependent U/S.80-DD
0
(Rs.50000 above 40% disability OR Rs.100000 above 80% disability)
c) Expenditure on Medical Treatment of Dependent U/S.80-DDB
(Rs.40000 or Actual expenditure whichever is less OR Rs.60000 or actual 0
expenditure whichever is less if the dependent is above 65 years of age)
d) Donation to Charitable institution U/S.80-G 0

i) Approved institutions 50% of qualifying amount. 0

ii) Kargil,National calmatives & PM/CM Relief fund (100%) 280

e) Maintenance of Totally Blind or P.H. U/S.80-U
(40% and above disability up to Rs.50000 & more than 80% disability up to 0
Rs.75000 for self)
f) Interest of House Building Advance. 0

g) Interest of Educational Loan 0

h) 0
i) EWF and SWF 20
16 TAXABLE INCOME (14-15) (Round off to nearest multiple of Rs.10) 154080

17 Amount of Tax (as per rates given below)

a) Male Assesses 154080
i) Up to 160000/- 0

II) Rs.160001 to 300000

0
(10% of the amount by which the total income exceeds Rs.160000)

iii) Rs.300001 to 500000

0
(Rs.15000+20% of the amount by which the total income exceeds Rs.300000)

iv) above Rs.500000

0
(Rs.55000+30% of the amount by which the total income exceeds Rs.500000)
a) Female Assesses 0
i) Up to 190000/- 0

II) Rs.190001 to 300000

0
(10% of the amount by which the total income exceeds Rs.190000)
iii) Rs.300001 to 500000
0
(Rs.12000+20% of the amount by which the total income exceeds Rs.300000)
iv) above Rs.500000
0
(Rs.52000+30% of the amount by which the total income exceeds Rs.500000)

18 a) TAX PAYABLE 0

b) Add: Education Cess @ 2% on Tax payable 0

c) Add: Secondory & Higher Education cess @ 1% on Tax payable 0

19 NET TAX PAYABLE (18 a + b ) 0

20 Relief U/S.89(I) if arrears paid

NET TAX PAYABLE (19-20) (after relief U/S.89) 0

DETAILS OF TAX DEDUCTIONS

Up to Nov-2009 :

Dec-2009 :

Jan-2010 :
Feb-2010 :
TOTAL :

Signature of the
Signature Of the Assessee
Drawing & Disbursing Officer

Prepared By Ramesh Koora, Karimnagar 9948841000

 FORM NO. 16
(Vide rule 31(1)(a) of Income Tax Rules, 1962)
Certificate under Section 203 of the Income Tax Act, 1961 for Tax Deducted at
Source from Income Chargeable under the Head "Salaries".
Name and Address of The Employer Name and Designation of the Employee
K.RAMESH, SA(M) GHS SAPTHAGIRI COLONY,
CH.SRIKANTHA, GHM Gr-II, GHS SAPTHAGIRI COLONY
Mdl:KARIMNAGAR
PAN No. of the deductor TAN No. of the deductor PAN/GIR No. of the Employee

Acknowledgement Nos. of all Quarterly Statements of TDS under sub-section(3) of section 200 as provided
by TIN Facilitation Centre of NSDL Web-site
Period
Quarter Acknowledgement No. Assessment Year
From To
01.04.2009 31.03.2010 2010-2011

DETAILS OF SALARY PAID AND ANY OTHER INCOME AND TAX DEDUCTED
1 Gross Salary
a) Salary as per provisions contained in Section 17(1) 190130.00 190130.00
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 190130.00 190130.00
2 Less: Allowance to the extent exempted under section 10 10152.00 10152.00
3 BALANCE (1-2) 179978.00 179978.00
4 DEDUCTIONS
a) Exemption conveyance allowance 0.00 0.00
a) Entertainment allowance:

b) Tax on Employment: 1750.00 1750.00

5 Aggregate of 4 (a&b) 1750.00 1750.00
INCOME CHARGEABLE UNDER THE
6 178228.00
HEAD SALARIES (3-5)
7 Add: Any other income reported by the employee. 0.00 0.00
8 GROSS TOTAL INCOME (6+7) 178228.00
9 Deductions under Chapter VI A
A, (a) Under 80CC
Gross Amt Qualifying Amt Deductible Amt
i) a) GPF Account No : 13054/EDN 10,131.00 10,131.00 10,131.00
ii) b) APGLIF No : 3,000.00 3,000.00 3,000.00
iii) c) Group Insurance 720.00 720.00 720.00
iv) d) LIC Policies Premium - - -
v) j) ULIP - - -
vi) f) Tuition fee for 2 children 10,000.00 10,000.00 10,000.00
vii) g) Repayment of HBA installments - - -
viii) h) Subscription to NSC VIII issue - - -
Aggregate amount deductible under the three sections
Note : 23,851.00 23851.00
i.e.80C,80CCC,80CCD shall not exceed One Lakh Rupees
B. Deductions under other sections (80D,80DD,80DDB,80E,80G etc.)
Under Chapter VI A Qualifying Amt Deductible Amt
Section_ _ _EWF&SWF
_______ Gross amount Rs_ _ _ _ _ _ _20.00
_ 20.00 20.00
Section U/S. 80-DD Gross amount Rs 0.00 0.00 0.00
Section U/S. 80-DDB Gross amount Rs 0.00 0.00 0.00
Section U/S. 80-U Gross amount Rs 0.00 0.00 0.00
Section U/S. 80-G Gross amount Rs 0.00 0.00 0.00
Section U/S. 80-E Gross amount Rs 0.00 0.00 0.00
CM Relief Fund Gross amount Rs 280.00 280.00 280.00
Section Interest of HBA Gross amount Rs 0.00 0.00 0.00
 Aggregate of Deductible amount under Chapter
10 24151.00
VI A (9A+9B)

11 Total Income (8-10) 154080.00

12 TAX ON TOTAL INCOME 0

13 Education Cess (on Tax at S.No.12) 0

14 Secendory&Higher Education Cess (on Tax at S.No.12) 0

15 Tax Payable (12+13+14) 0

16 Relief U/Sec.89 attach details. 0

17 Tax payable (15-16) 0

18 Less :(a) Tax deducted at Source U/S.192(1)

(b) Tax paid by the employer on behalf the

employee U/Sec.192(IA) on prerequisites U/Sec.17(2)

19 Tax payable/refundable (17-18) 0

Details of Tax Deducted and Deposited into Central Government Account

Transfer
Secendory
Total Tax Date on which Voucher/
Sl. TDS Education & Higher Cheque/DD BSR Code of
Deposited tax deposited Challan
No No. Cess Rs. Education No. (if any) Bank Branch
Rs. (DD/MM/YY) Identification
Cess Rs.
No.

I, CH.SRIKANTHA working in the capacity of GHM Gr-II do here by certify that a sum of Rs.0.00 (in words Zero
rupees 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.

Place: GHS SAPTHAGIRI COLONY Signature of The person responsible for

Dated : deduction of tax

Full Name: CH.SRIKANTHA

Designation : GHM Gr-II, GHS SAPTHAGIRI COLONY

Prepared by Ramesh Koora, Karimnagar 9948841000.

HAGIRI COLONY
 ANNEXURE

Name of the Employee : K.RAMESH

Designation : SA(M)

Office/Branch : GHS SAPTHAGIRI COLONY, Mdl:KARIMNAGAR

HOUSE RENT ALLOWANCE EXEMPTION

Amount of allowance being received

:
from the Bank.

Address of the House occupied. : H.NO. 9-6-342

Ramnagar, Karimnagar

Cell No.9948841000

a) Amount of H.R.A. : 10152.00

b) Actual Rent paid Less 1/10th of Salary : 227028.00

c) 40% of Salary : 40592.00

Least of above (a),(b) and ( c ) i.e. : 10152.00

(Rupees Ten Thousand One Hundred and Fifty two only)

I here by conform that I have actually incurred expenditure/Amount incurring expenditure as payment of rent in
respect of the residential accommodation occupied by me and the amount of HRA exempted from tax as above is
calculated as per the relevant provisions of the income tax Act.

Place : GHS SAPTHAGIRI COLONY

Date : Signature

(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. 600/- per month
 INDIAN INCOME TAX RETURN Assessment Year
FORM [ For Individuals having Income from Salary/Pension/Family pension & Interest ]
ITR-1 ( Please see Rule 12 of the Income-tax Rules,1962 ) 2 0 0 9 - 1 0
( Also see attached instructions )

First Name Middle Name Last Name PAN

Flat/Door/Block No. Name of Premises/Building/Village Date of Birth ( DD/MM/YY )

PERSOSNAL INFORMATION

Road/Street/Post Office Area / Locality Employer Category ( Tick )

√ Govt. PSU Others

Town/ City / District State PIN Code Sex ( Tick )

Male Female

E-mail Address (STD Code- Phone Number

Designation of the Assessing Officer (Ward/Circle) Return filed under Section-

[Please see instruction number-9(i)]
FILING STATUS

Whether Original or Revised return?Tick Original Revised

If revised, enter Receipt No. and date of filing original return

( DD/MM/YYYY )
Residential Status ( Tick ) Resident Non-Resident Resident but Not Originally Resident.

1
Income chargeable under the Head "Salaries" (Salary/Pension)
2
Income chargeable under the Head "Other Sources"
a Family Pension 2a 0.00
b Interest 2b 0.00
INCOME & DEDUCTIONS

c Total ( 2a + 2b ) 0.00 2c 0.00

3 Gross Total Income ( 1 + 3c ) 3 0.00
4 Deductions under Chapter VI A ( Section )
a 80C e 80DD i 80GG
b 80CCC f 80DDB j 80GGA
c 80CCD g 80E k 80GGC
d 80D h 80G l 80U
m Deductions (Total of a to i) 4m 0.00
5 Total Income ( 3 - 4m ) 5 0.00
6 Net Agricultural Income(Enter only if greater than Rs.5000) 6 0.00
7 "Aggregate Income" ( 5 + 6 ) 7 0.00
8 a Tax Payble on "Aggregate Income" 8a
b Rebate in respect of Net Agricultural Income 8b
TAX COPUTATION

9 a Net Tax payable 9a 0.00

b Surcharge on 9a 9b 0.00
c Education Cess on (9a+9b) 9c
d Total Tax, Surcharge and Education Cess Payable(9a+9b+9c) 9d 0.00
10 Relief under Section 89 10
11 Relief under Section 90/91 11 0.00
12 Balance Tax Payable (9d-10-11) 12 0.00
Do not write or stamp in this area (Space for bar code) 13 a Interest Payable U/s 234 A 13a
b Interest Payable U/s 234 B 13b
c Interest Payable U/s 234 C 13c
d Total Interest Payable
13d 0.00
( 13a+13b+13c )
14 Total Tax and Interest Payble
14 0.00
(12+13d)
For Office Use Only Seal and Signature of the Receiving Official

Receipt No.

Date:
 15 Taxes Paid
TAXES PAID a Advance Tax ( from item 23 ) 15a
b TDS (column 7 of item 21+column 7 of item 22) 15b
c Self Assessment Tax (from item 23) 15c
d Total Taxes Paid ( 15a+15b+15c) 15d 0.00
16 Tax Payable(14-15d)(Enter if 14 is greater than 15d, else leave blank) 16 0.00
17 Refund (15d-14)(Enter if 15d is greater than 14, also give Bank Account details below) 17
REFUND

18 Enter your Bank Account number(mandatory in case of refund)

19 Do you want your refund by cheque, or deposited directly into your bank account?(tick as applicable )
20 In case of direct deposit to your bank account give additional details;
MICR Code: Type of Account(tick as applicable ) Savings Current

21 Details of Tax Deducted at Source from Salary[ As per Form 16 issued by Employer(s)]
Tax Deduction Account Name and Address of Income Deduction
Number (TAN) of the the Employer Chargeable Under Tax payable
Sl. Total Tax Tax Payble/
(Incl.surch.and
TDS ON SALARY

No. Employer under the Chapter deposited refundable

edu.Cess
head "Salaries VI-A
1 2 3 4 5 6 7 8

I 0.00 0.00 0.00 0.00

II

22 Details of Tax Deducted at Source on Interest [ As per Form 16 A issued by Deductor(s)]

Tax Deduction Account Name and address of Date of Amount out of (6)
Sl.N Number (TAN) of the the Deductor Amount
Payment/C Total Tax Deposited claimed for this
o. Deductor Paid/Credited
redit year
TDS ON INTEREST

1 2 3 4 5 6 7

ii

iii

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

23 Details of Advance Tax and Self Assessment Tax Payments

Sl.N Date of Despatch ( Serial Number of
Name of the Bank & Branch BSR CODE Amount (Rs.)
o. DD/MM/YY ) Challan
TAX PAYMENTS

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

24 Other information ( Transactions reported through Annual Information Return ) ( Please see instruction number-9(ii) for code)
Sl. Code Amount ( Rs ) Sl. Code Amount ( Rs. ) Sl. Code Amount ( Rs. )
a 001 d 004 g 007
b 002 e 005 h 008
c 003 f 006

25 Tax-exempt interest income ( for reporting purpose only ) 25

26 E-filing Acknowledgement Number Date (DD/MM/YY)

VERIFICATION
I, son/daughter of solemnly
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 Income Tax
Act, 1961, inrespect of income chargeable to Income Tax for the previous year relevant to the Assessment Year 2007-08.

Place: Date: Sign here --->

27 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

If TRP is entitled for any reimbursement from the Government, amount thereof (to be filled by TRP) 28
3850 7200 14600
3950 7385 15025
4050 7570 15500
4150 7770 15975
4260 7970 16450
4370 8170 16925
4480 8385 17475
4595 8600 18025
4710 8815 18575
4825 9050 19125
4950 9285 19675
5075 9520 20300
5200 9775 20925
5335 10030 21550
5470 10285 22175
5605 10565 22800
5750 10845 23500
5895 11125 24200
6040 11440 24900
6195 11755 25600
6350 12070 26300
6505 12385 27000
6675 12700 27750
6845 13030 28500
7015 13390 29250
13750 30000
14175 30765