INCOME TAX STATEMENT FOR ASSESSMENT YEAR 2011-12

NAME OF EMPLOYEE WITH PLACE OF POSTING

1 CATEGORY (CLICK ON BLUE BOX) 2 WHETHER YOU LIVE IN OWN HOUSE 3 GROSS SALARY(INCLUDING HOUSE RENT) 4 INCOME FROM OTHER SOURCES 5 INCOME FROM HOUSE PROPERTY 6 TOTAL SALARY 7 NET AGRICULTURE INCOME ( FOR RATE PURPOSE ONLY) 8 36
EMPLOYER'S CONTRIBUTION TO PENSION SCHEME U/S

GENERAL

PLEASE FILL SHADED AFTER 01/01/2004 CELLS ONLY.

DATE OF JOINING SERVICE

PAN
ABLPK0949G

NO

Income from other sources

3000 500 0 20 3520

Rs. 457,000 1a Dividends Rs. 520 1b Interest 1c nts, -Rs. 370

Rentalincomefrommachinery,pla buildings Others,Gross(excludingincomefr

Rs. 457,150 1d omowning racehorses) Rs. 3,000 1e Total

Rs. 40,000 1f Deductionsundersection57:Rs. 20,000 Rs. 400,150 i

ii

9 REBATE U/S 80G 10 BALANCE SALARY rkmangal2802@gmail.com 11 REBATE IN SEC. VI A INTEREST ON HOUSE LOAN(MAX. 1.5 LAKH) U/S 80D MAX. 15000 MEDICAL INSURANCE U/S 80L MAX. 50000 HANDICAPPED U/S 80DDB MAX. 40000 MEDICAL SPL. DISEASES U/S 80DD MAX. 50000 DEPENDENT HANDICAPPED U/S 80 E MAX. 15000 INTEREST ON EDUCATION LOAN

Expenses Depreciation

3000 2000 5000 -1480 2000 520

Rs. 15,000 iii Total Rs. 1,000 1g Balance Rs. 1,000 Rs. 10,000 Rs. 1,000 Rs. 1,000 Rs. 1,000 Rs. 385,150 Rs. 10,000 Rs. 375,150 Rs. 186,000 Rs. 20,000 Rs. 0 Rs. 0 Rs. 16,000 Rs. 0 1 2 3 4 5 SALARY
ALLOWANCES NOT EXEMPTED

2 3 4 a b c 5

Winningsfromlotteries,crossw ord puzzles,racesetc. Income from other sources (other than from owning race horses) Incomefromowningandmaint aining racehorses

Receipts
Deductionsundersection57inrela tionto(4)

12 BALANCE INCOME 13 REBATE OF HOUSE RENT 14 BALANCE INCOME 15 SAVINGS INFRASTRUCTURE BONDS PRINCIPAL OF HOUSE LOAN PAID GIS GPF PPF LIFE INSURANCE UTI ULIP ELSS TUTION FEE NSC ACCRUED INTEREST ON NSC
CONTRIBUTION TO NOTIFIED PENSION SCHEME OF GOI

Balance
Income chargeable under the head "Income from other sources"

0 520

SALARIES
500000 0 0 0 500000

VALUE OF PERQUISITES PROFIT IN LEIU OF SALARY TOTAL SALARY

ANNUAL LETABLE VALUE/RENT

INCOME FROM HOUSE PROPERTY

1000 0 100 100 900 270 Rs. 1,000 1270 -370 0 0 -370

Rs. 0 1a RECEIVED OR RECIEVABLE

AMOUNT OF RENT NOT Rs. 0 1b REALISED

Rs. 80,000 1c

TAX PAID TO LOCAL AUTHORITIES Rs. 0 1d TOTAL Rs. 0 1f 30% OF BALANCE Rs. 0 1g AMOUNT

Rs. 10,000 1e BALANCE

INTEREST PAYABLE ON BORROWED

ANY OTHER SAVING 16 REBATE IN SAVINGS U/S 80C(MAX. 1.2 LAKH) 17 TAXABLE INCOME 18 INCOME TAX
GENERAL-1.8LAKH/ LADIES-1.9 LAKH/SR. CITIZEN 2.5LAKH/SUPER SR. CITIZEN 5 LAKH

Rs. 60,000

1h TOTAL

Rs. 120,000 1i INCOME FROM HOUSE PROPERTY Rs. 255,150 2a RENT OF EARLIER YEARS REALISED 2b
AREARS OF RENT RECEIVED DURING THE CURRENT YEAR

Rs. 0 2c TOTAL INCOME Rs. 7,515 Rs. 0 Rs. 0

UPTO 5LAKH@10% UPTO 8LAKH @20% ABOVE 8 LAKH @30% 19 TAX AT SPECIAL RATES(CAPITAL GAINS ETC.) 20 TOTAL TAX 21 EDUCATION CESS @3% 22 TOTAL TAX 23 TAX PAID 24 BALANCE TAX

HRA REBATE
1 WHETHER HQ IN METROPOLIS CITY 2 3
AMT. OF HRA RECEIVED RENT ACTUALLY PAID

NO 60000 60000 500000 10000

Rs. 7,515 Rs. 225 Rs. 7,740 Rs. 0 Rs. 7,740 1 2 3 4

4 5

SALARY ( BP + DA )
EXEMPTED AMT. OF HRA

EXEMPTED INCOME
Interest income Dividend income
Long term capital gains from transactions on which STT is paid Net agricultural income/any other income for rate purpose Others including exept income of minor children

5000 5000 30000 3000

PLEASE DEDUCT

FROM MY

Feb-11 SALARY.

5 6

Total(1+2+3+4+5)

43000

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