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FORM NO. 10E [See rule 21AA] Form for furnishing particulars of income under section 192(2A) for the year ending 31st March,2010 for claiming relief under section 89(1) by a Government servant or an employee in a company, co-operative society, local authority, university, institution, association or body 1. Name 2.Address 3. PAN 4. Status
Manoj Pahu House no 6 AIQPP9903

Indian Resident

Particulars of income referred to in rule 21A of the Income tax Rules, 1962, relevant to 200506, 2006-07, 2007-08, and 2008-2009 received during 2009-10 [second installment of 6CPC Arrears] 1. (a) Salary received in arrears or in advance during 2009-10 in accordance with the 195680 provisions of sub-rule (2) of rule 21A (b) Payment in the nature of gratuity in respect of past services, extending over a period Not of not less than 5 years in accordance with the provisions of sub-rule (3) of rule 21A 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 Not 3 years or where the unexpired portion of term of employment is also not less than 3 applicable years in accordance with the provisions of sub-rule (4) of rule 21A (d) Payment in commutation of pension in accordance with the provisions of sub-rule Not (5) of rule 21A 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 Annexure-I Verification I do hereby declare that what is statedabove is true to the best of my knowledge and belief. Verified

today Date : Signature of the employee ANNEXURE -I 1. Total net taxable Income excluding Salary received in Arrears or advance 2. Salary received in arrears or advance 3. Total income (as increased by salary received in arrears or advance)[Add item 1 and item 2] 4. Tax on total income (as per item 3) 5. Tax on total income (as per item 1) 6. Tax on salary received in arrears or advance [Difference of item 4 and item 5] 7. Tax computed in accordance with Table "A" [Brought from column 7 of Table "A"] 8. Relief under section 89(1) [Indicate the difference

271067

195680

466747

48769

11440

37329

18481

18848

between the amounts mentioned against items 6 and 7] TABLE "A" [See item 7 of Annexure I] Previous Year(s) Total Net Taxable income of the relevant previous year Salary received in arrears or advance relating to the relevant previous year as mentioned in col.(1). Total income Tax on total Tax on total (as increased income [ As income [ As by salary per Col.(2)] per Col.(4)] received in arrears or advance) of the relevant previous year mentioned in col.(1) [Add Col.(2) and (3) 4
129100 152209 164243 197920 0 0 0 2028

Difference in tax [Amount under col.(6) minus amount under col.(5)]

1 2005-06 2006-07 2007-08 2008-09 Total

2
89932 88023 100143 169694

3
39168 64186 64100 28226

5
2968 5551 7054 4936

6
2968 5551 7054 2908

18481