Name: S.SAMUEL SELVARAJ B.SC,M.A.B.Ed I.T.calc.

p3
Particulars of LIC / ULIP / PLI
Annual
Policy Name of the Name of the insured & Amount
S.No Name of Policy Premium
Number Company Relationship Insured
Paid
1 767699929 LIC J.Premalatha Princess New Bima Gold 200000 10728

2 Wife

3 766050951 LIC S.Jashua Vijay Pradheep Jeevan Rakshak 200000 6858

4 Son

7
8
9
10
Total 17586

Particulars of N.S.C
S.No Name of Post Office Issue No N.S.C No Amount

Total 0
Details of Interest Accrued of N.S.C
Date of Purchase of Rate of
S.No N.S.C & Name of Post Office the NSC Interest Amount

Total 0
Particulars about the Payment of Tution Fees

Name of the Child Name of the school Date of Amount

S.No
and the course or college Payment Paid

Total 0
Details of Fixed Deposits

Period /
S.No Date Bank Receipt No Amount
years
Total 0
 INCOME TAX CALCULATION STATEMENT
FOR THE PERIOD FROM MARCH 2019 TO FEBRUARY 2020
ASSESSMENT YEAR 2020 - 2021
Name, Designation & Address of the Employee Name, Designation & Address of the Employer

PAN GPF/TPF No: TAN

1. SALARY INCOME : Including HRA, Honorarium Taxable allowances, Taxable Perquisities (Excluding cash
allowance if any Rs. 799223
2. LESS : House Rent Allowance (Sec. 10(13A & Rule 2A)
A. Rent Paid RS. 12 X = 0
B. 10% of pay +DA RS. 72070
C. (A - B) RS. 0
D. Actual HRA Received RS. 0
E. 40% of Pay +DA RS. 288280
Least of the above C, D or E Rs. 0
3 GROSS SALARY INCOME 1-2= Rs. 799223
STANDARD DEDUCTION RS. 50000/=(all members elegible) Rs. 50000
4 LESS :
PROFESSIONAL TAX (u/s 16 (iii) Rs. 2500
SALARY INCOME : (Salary after allowing relief U/S 16) 3-4= (i.e.
5 Rs. 746723
6A. Less : Deduction upto Rs. 2,00,000 for Home Loan Interest on U/S 24(b) and Rs. 30,000 for home 103,380
improvement loan interest Rs.
6B. Net Salary Income 5 - 6A = Rs. 643,343
7 ADD : Any other income (if any)., Bank Interest, NSC Interest etc., Rs.
GROSS TOTAL INCOME 6B + 7 =
8 Rs. 643,343
9 LESS : Deductions under chapter VI A U/S 80 C : As per details attached. (Note 4)
A. L.I.C. Premium (Note 3) / Postal Life insurance premium (PLI) Rs. 10250
B. G.P.F / T.P.F Rs. 84750
C. P.P.F Rs.
D. S.P.F 2K + F.B.F. Rs. 1560
E. Sukanya Samriddhi Scheme (சசசசச சசசச, சசசச சசசசசசச) Rs.
F. R.P.F. Rs.
G. R.P.L.I. / NSC VIII Issue Rs. 0
H. Stamp duty and Registration Charges (on New House Purchasing) Rs.
I. Repayment of Housing Loan (Principal) Rs. 44628
J. Tuition fess (Please Refer Note No.2 in page No.3.) Rs. 0
K. Equity Linked Savings Scheme (ELSS) Rs.
L. Subscription to Equity Shares / Debentures or / Units Rs.
M. Investments in term Deposits (of min 5 years) with a scheduled bank. Rs. 0
N. Subscription to notified bonds of Nabard Rs.
O. 5 years time deposit an a/c under Post office time deposit rules 1981 Rs.
P. deposit in an a/c under senior citizens savings scheme Rules 2004 Rs.
Q. U/s 80 CCC : Premium for Annuity Plans (OR) PENSION PLAN Rs.
R. U/s 80 CCD (1) : Contribution to Pension scheme of Employees (CPS subs + CPS Arrer Rs.
TOTAL QUALIFIYING AMOUNT 9 (A to R)
Maximum amount of Deduction Rs. 1,50,000/- Rs. 141188
 U/s 80 CCE : Aggricate amount of Deduction u/s 80 C. 80 CCC and 80 CCD(1) is restricted to
9(I) Rs. 1,50,000 by sec. 80 CCE Rs. 141188

U/s 80 EE : (OR) U/s 80EEA : For 80 EE - First Time home buyers (FY-2016-17) can claim tax
deduction of Rs. 50000 on home loan interest payments till repayment. (OR) For 80EEA - First
9(II) Rs.
Time home buyers (FY-2019-20) can claim tax deduction of Rs. 1,50,000 on home loan interest
payments till repayment. (Either 80 EE or 80 EEA only can claim).

U/s 80 D : Medical Insurance premium +NHIS health fund Max Rs. 25,000 for employee or his
9(III) family and Max. Rs. 25,000 for employees's parents (Senior citizen 50,000) (Max Rs. 5000 for Rs. 2160
Pre health check up.

U/s 80 DD : Expenses on Medical treatment etc. and deposit made for maintanenance of
9(IV) Rs.
handicapped dependents (Max Rs. 75,000) in case of severe disabilities Rs. 1,25,000/-.

U/s 80 DDB : medical Expenses towards treatment of himself, or a dependent relative for
9(V) specified diseases and ailments (amount actualy paid or Rs. 1,00000 whichever is less, ( senior Rs.
citizen Rs. 100000. )

U/s 80 E : Repayment of interest on loan taken for higher Education (For self or for relatives
9(VI) Rs.
(spouse & children)

9(VII) U/s 80 G : Donation to approved funds and charitable institutions. Rs.

9(VIII) U/s 80 CCD (1B) : deduction up to Rs. 50,000/- for investment in NPS (National Pension Schene) Rs.

9(IX) U/S 80U DISABLITY/ HANDICAP (BELOW 80 % MIN 75,000 ABOVE 80% MAX 125000)

9(X) U/s 80 TTA : Deduction in respect of interest on deposit in savings Account (Max. 10,000) Rs.
9(XI) SUM OF 9(I) TO 9(X) Rs. 143348

10 TAXABLE INCOME (Rounded off to nearest ten rupees) 8-9(X) = Note: All DEDUCTIONS
UNDER COLUMN 9(I) TO 9(X) CANNOT EXCEED THE GROSS TOTAL INCOME Rs. 499,995

COMPUTATION OF TAX : Rounded off to nearest ten rupees. The basic exemption limit is Rs. 2,50,000/-
Table 1, Upto Rs.500000/- 100% Tax Rebate can claim (Rs.12500). Rs. 500000

Taxable Income Income Tax Tax Working

Upto Rs. 2,50,000 NIL Rs. Nil
Rs. 2,50,001 - Rs. 500,000 5% of (total Income minus 2,50,000)+4%Cess Rs. 12500 (Rebate)
Rs. 5,00,001 - Rs. 10,00,000 Rs. 12,500 + 20% of (Total Income minus 5,00,000)+4%Cess Rs.

Exceeding Rs. 10,00,001 Rs.1,12,500 + 30% of (Total Income minus 10,00,000)+4%Cess Rs.

TOTAL Rs. 12500

11. Tax payable on Taxable Income (as per table 1 as above) Rs. 12500

12. Less : REBATE of Rs.12500 for individuals having taxable income upto 5 lakhs (sec 87A) (In this form if
serial number 10 is less than Rs. 5 lakhs then you can less Rs. 12500 or the amount of tax payable Rs. 12500
whichever is lower)

13. Tax payable on Taxable Income after rebate Rs. 12500 11-12 = Rs. 0
14. ADD : Education cess @ 2% on the payable 2% of 13 Rs. 0
15. ADD : Secondary and Higher Education cess @ 2% on tax payable 2%of 13 Rs. 0
16. Total TAX Payable 13 + 14 +15 = Rs. 0
17. LESS : Rebate u/s 86, 89, 90 or 91 Rs.
18. LESS : Pre paid taxes (Advance tax TDS) Rs.
19. Balance of Income Tax to be deducted 16 - 17 -18 = Rs. 0
CERTIFICATE
1. Certified that I am occupying the house allotted by the accommodation controller /PWD/TNHB on
payment of rent of Rs. per month.
2. Certified that I am occupying rental house and paying monthly rent of Rs.
per month.
3. Certified that I am paying sum of Rs. 10250 towards L.I.C. premium and the policies alive.
4. Certified that I am paying sum of Rs. is being by me towards a C.T.D. and the
Cumulative Time is for 10/15 years.

Station : Signature :
Date : Designation : 0
Page 1

Step 1 : ENTER Name Details

Step 2 : Enter salary details in Enter salary pag

Step 3 : Enter Policy details in Enter Policy Deta
Step 4 : Enter Yellow boxes for extra Details i
Now your IT-Form is ready for A4 SHEET printo

S.SAMUEL SELVARAJ B.Sc, M.A, B.Ed

BT ASSISTANT SCIENCE

PUMS , SINGAIYANPUDUR,
KINATHUKADAVU, COIMBATORE - 642109
MOBILE : 8903913946
E-mail : samuelselvaraj1964@gmail.com
" TNGTF " - KOVAI
Page 2

Amount Tax
250000 Nil
250000 12500
0 0

0 0

Total 12500
etails

ails in Enter salary page

ails in Enter Policy Details page
oxes for extra Details in this page
dy for A4 SHEET printout.

AJ B.Sc, M.A, B.Ed

T SCIENCE

IYANPUDUR,
IMBATORE - 642109
903913946
aj1964@gmail.com
- KOVAI
0 Page : 3

Particulars of LIC / ULIP / PLI

Annual
Name of the Name of the insured & Amount
S.No Policy Number Name of Policy Premium
Company Relationship Insured
Paid
1 10250
2
3
4
5
6
7
8
9
10
Total 10250

Particulars of N.S.C

S.No Name of Post Office Issue No N.S.C No Amount

Total 0

Details of Interest Accrued of N.S.C

Date of Purchase of the Rate of
S.No N.S.C & Name of Post Office Amount
NSC Interest

Total 0

Particulars about the Payment of Tution Fees

Name of the Child Name of the school Date of Amount

S.No
and the course or college Payment Paid

Total 0

Details of Fixed Deposits (BANK)

Period /
S.No Date Bank Receipt No Amount
years
Total 0
Page 3

Enter Yellow boxes for LIC/ULIP/PLI

Enter Yellow boxes for N.S.C.

Enter Yellow boxes for TUTION FEES

Enter Yellow boxes for BANK DEPOSIT

I

SIT
 INCOME PARTICULARS FOR THE YEAR (2019 - 2020) ASSESSMENT YEAR (2020 - 2021)
Name 0 Designation: 0 GPF/TPF No: 0

Office: 0

Pay and allowances Official deductions from the salary

HILL
Month & SP / GPF/T SPF/ SPF CPS PROF.T
Pay GP DA HRA MA SA Bonus ALLOW TOTAL FBF NHIS PLI I.T I.T Cess
Year PP PF 2000 Arr AX
ANCE
Mar-19 48900 4401 3600 300 0 57201 6396 70 60 180
Apr-19 48900 4401 3600 300 0 57201 6396 70 60 180 0 0 0 0
May-19 48900 5868 3600 300 0 58668 6572 70 60 180 0 0 0 0
Jun-19 48900 5868 3600 300 0 58668 6572 70 60 180 0 0 0 0
Jul-19 50400 6048 3800 300 0 60548 6774 70 60 180 0 0 1250 0
Aug-19 50400 6048 3800 300 0 60548 6774 70 60 180 0 0
Sep-19 50400 6048 3800 300 0 60548 6774 70 60 180 0 0
Oct-19 62960 10703 3800 300 0 77763 8840 70 60 180 0 0
Nov-19 60000 10200 3800 300 0 74300 8424 70 60 180 0 0
Dec-19 50400 0 8568 3800 300 0 63068 7076 70 60 180 0 0
Jan-20 50400 0 8568 3800 300 0 63068 7076 70 60 180 0 1250 0
Feb-20 50400 0 8568 3800 300 0 63068 7076 70 60 180 0 0
Total 620960 0 0 85289 44800 3600 0 0 754649 84750 840 720 2160 0 0 2500 0 0
ARREARS Drawn Particulars
DA Arr 1 5490 5490
DA Arr 2 8960 8960
Incent.Ar 0 0
EL Surr. 25200 3024 1900 30124
Sel.Gr.Arr. 0 0
Pongal 0
7Th Pay Arr. 0 0
TOTAL 646160 0 0 99739 44800 3600 0 0 0 799223 84750 840 720 2160 0 0 2500 0 0

Pay,PP,SP.GP DA Total 10% of Pay +DA 40% of Pay +DA

620960 99739 720699 72070 288280
Signature of the Assessee Head of the office
Page 4