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Put the Total Deposit filled,
Amount through 80 C & The Amount is Actual
Deduction under chapter VI-A Taxable Income for
Ors.
1 (LIC,PF,Tuition Fees,H.B.Principal):80C this Year(Col.no.9 of
Salary statement of
2 Pention fund(Max.100000/-) 80CCC this year.)
c Total (2a+2b) 2c
3 Gross Total Income (1+2c) 3 0
4 Deductions under chapter VIA (Section
a 80C 0 e 80DD 0 I 80GG 0
b 80CCC 0 f 80DDB 0 j 80GGA 0
c 80CCD 0 g 80E 0 k 80GGC 0
d 80D 0 h 80G 0 l 80U 0
m Deductions (Total of a to i) 4m 0
5 Total Income (3-4m) 5 0
6 Net Agricultural Income (Enter only if greater than Rs.5,000) 6
7 Aggregate Income' (5+6) 7 0
8 a Tax Payable on 'Aggregate Income' 8a 0
b Rebate in respect of Net Agricultural income 8b 0
TAX COMPUTATION
Receipt No.
Date
### Taxes Paid
a Advance Tax (from item 23) 0
TAXES PAID
15a
b TDS (column 7 of item21+column 7 of item
15b22) 0
c Self Assessment Tax (from item 23) 15c
d Total Taxes paid (15a+15b+15c) 15d 0
### Tax payable(14-15d)(enter if 14 is greater than 15d, else leave blank) 16 0
### Refund (15d-14) (enter if 15d is greater than 14, also give Bank account details below) 17 0
### Enter your bank account number (mandatory in case of refund) 0
REFUND
### Do you want your refund by Cheque, or deposited directly into your bank account? (tick as applicable
√
### In case of direct deposit to your bank account give additional details
Deduc
Tax Deduction Income Tax payable Total Tax
tion
TDS ON SALARY
22 Details of Tax Deducted at Source on Interest [As per Form 16 A issued by Deductor(s)]
Tax Deduction Amount
Date of
Sl Account Namee and address of Amount paid/ Total tax out of (6)
Payment
TDS ON INTEREST
Sl
No Name of Bank & Branch BSR Code
(DD/MM/YYYY) Challan (Rs.)
(i) 0
(iii) 0
NOTE Enter the total of Advance tax and Self Assessmen tax in Sl.No.15a and 15c of TAXES0PAID
24 Other Information (Transactions reported through Annual Information Return) (Please see instruction number-9(ii) for
Sl. Code Amount (Rs.) Sl. Code Amount (Rs.) Sl. Code Amount (Rs.)
a 001 e 004 h 007
b 002 f 005 i 008
c 003 g 006 j
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 Counter Signature of TRP
If TRP is entitled for any reimbursement from the Government, amount thereof (to be filled
27 by TRP)
YYY)
rs
ving official
(ii) for code)
ly
Government of India
Name PAN NO
PERSONAL INFORMATION
0 00 0
Flat/Door/Block No: Name of Premises/Building/Village:
0
Road/Street/Post Office: Area/Locality:
0 0
Town/City/District: State: Status(fill the code)
0 0
Designation of Assessing Officer Original/Revised
1 Gross total income 1 0
COMPUTATION OF INCOME & TAX THEREON
Date:
FORM NO.10 E
[See rule 21AA]
Form for furnishing particulars of income under section 192(2A) for the year ending 31 st March, 2010 for claiming
relief under section 89(1) by a Government servant or an employee in a 2[company,co-operative society,local
authority ,university, instituty
1 Name and address of the employee 0 0
2 Permanent account number 0
Particulars of income referred to in rule 21A of the Income-tax Rules, 1962,during the previous year relevant to
assessment year 2010-11
1 (a) Salary received in arrears or in advance in accordance with the provisions of sub-rule (2)
of rule 21A. 0
(b)
Payment in the nature of gratuity in respect of past services, extending over a period of not
less than 5 years in accordance with the provisions of sub-rule (3) of rule 21A. Not Applicable
(c)
Payment in the nature of compensation from the employer or former employer at or in
connection with termination of employment after continuous service of not less than 3 Not Applicable
years or where the unexpired portion of term of employment is also not less than 3 ye
(d) Payment in commutation of pension in accordance with the provisions of sub-rule (5) of
rule 21A Not Applicable
2 Detailed particulars of payments referred to above may be given in Annexure I,II,IIA,III,
or IV as the case may be. ANNEX-I
…………………………………………..
Signature of the employee
Verification
I, _______,do hereby declare that what is stated above
is true to the best of my knowledge and belief.
Verified today, the Day of
Place: …………………….
………………………………………
Date:…………………… Signature of the employee
ANNEXURE-I
[See item 2 of Form No.10E]
Arrears or advance salary
Sl No. Particulars Amount (Rs.)
1 Total income (excluding salary received in arrears or advance) 0
2 Salary received in arrears or advance 0
Total income (as increased by salary received in arrears or advance)
3
[Add item 1 and item 2] 0
4 Tax on total income [as per item 3] 0
5 Tax on total income [as per item 1] 0
Tax on salary received in arrears or advance
6
[Difference of item 4 and item 5] 0
Tax computed in accordance with Table "A"
7
[Brought from column 7 of Table A] 0
Relief under Section 89(1) [Indicate difference between the amounts mentioned
8
against item 6 and item 7] 0
TABLE "A"
[See item 7 of Annexure 1]
Total income Salary received Total income (as Tax on total Tax on total Difference in tax
of the in arrears or increased by income [as per income[as per [Amount under
relevent advance salary received in column (2)-After column (4) column (6) minus
previous year relating to the arrears or Rebate and After Rebate amount under
(Rs.) relevent advance) of the including Edn and including column (5)]
previous year relevent previous Cess and Edn Cess and (Rs.)
Previous as mentioned year mentioned in Surcharge] Surcharge]
year in column (1) column (1) [add (Rs.) (Rs.)
(Rs.) colmn 2 & 3]
(Rs.)
2008-09 0 0 0 0 0 0
Signature:
Place: Name:
Date: Designation:
Dept: