BIO DATA OF THE EMPLOYEE FOR FILLING UP OF ITR-1

FIRST NAME IN CAPITAL

Middle Name: DATA SHEET FOR FILLING UP I T R - I
Last Name:
Permanent A/C No ( PAN NO)
DATE OF BIRTH
EMPLOYEE'S ADDRESS
Post Office:
Area/Locality:
District: This Calculation Sheet Prepared by Sri
PIN CODE: Pranab Bandyopadhyay, Bhattapara,
Jiaganj, Murshidabad.
State: Email:-
(STD code)-Phone No: pranabLr@yahoo.com.
Gender -MALE
GENDER- MALE
FEMALE
EMPLOYEE STATUS
DESIGNATION OF EMPLOYEE
Office Address
STATUS- Govt/PSU/Others
Tan no of D.D.O.
PARTICULARS OF SALARY

Total Income from Salary Rs :(col.no 7 ) of Gross salary( including HRA,BONUS,

Salary Statemet for THIS YEAR ANY INT.PTAX,&U/S10(13A))

Auto Calculation for Relief U/S 89(1)

Taxable income of previous year (Col-9)
Form No. 16 of PREVIOUS YEAR
[ Taxable Income for this year after deduc 80 C 0
(Col-9 of Salary statement]
This Cell is Auto
filled,
The Amount is Actual
Taxable Income for
this Year(Col.no.9 of
Salary statement of
this year.)
 This Cell is Auto

←
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.)

New pension scheme (Max

3 10% of salry 80CCD
4 Donation(max.100%) 80G
5 Health Premium (Max.15000/-)80D
6 Education Loan(Max.75000/-) 80E
7 Handicapped (Max.1,00,000/-) 80DD
Medical Treatment
8 Etc.80DDB(Max.40000/-
Permanent disabbility including
9 blindnes (Max.75000/-) 80 U
Total Deduction 0
Arrear Received if any
Relief under Section 89(1) 0 AUTO FILLED CELL (DON'T PUT ANY DATA )

Advance Tax Paid

For refund enter 9 Digit MICR Code

Type of Account Savings/Current
Bank Account No
This Cell is Auto
filled,
The Amount is Actual
Taxable Income for
this Year(Col.no.9 of
Salary statement of
this year.)
This Cell is Auto
filled,
The Amount is Actual
Taxable Income for
this Year(Col.no.9 of
Salary statement of
this year.)
FORM INDIAN INCOME TAX RETURN Assessment Year
[For Individual having Income from Salary/Pension/family pension & Interest]
ITR-1
(Please see Rule 12 of the Income-tax Rules, 1962) 2 0 1 0 - 1 1
(Also see attached instructions)
First name Middle name Last name Pan No
0 0 0 0
PERSONAL INFORMATION

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

0 12/30/1899

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

√
0 0 √ Govt. PSU Others
Town/City/District State Pin code Sex (Tick) √
0 0 0 √ 0√ 0
Email Addrs. (STD Code) - Phone Number
Designation of Assessing Officer (Ward/Circle) Return Filed Under Section- 1 1
FILING STATUS

0 [Please see instruction number-9(i)]

Whether original or Revised return? (Tick)
√ √ Original Revised
If revised, enter Receipt No and Date of ORIGINAL
filing original return (DD/MM/YYYY)

Residential Status (Tick)

√ √ Resident Non-Resident Resident but not ordinarily Residen
1 Income chargeable under the Head 'Salaries',Pension 1 -
2 Income chargeable under the Head 'Other Sources' (Interest) ### 0
a Family pension 2a 0
b Interest 2b 0
0
INCOME & DEDUCTIONS

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

9 a Tax Payable on total Income (8a - 8b) 9a 0

b Surcharge on 9a 9b 0
c Education Cess on (9a + 9B) 9c 0
d Total Tax, Surcharge and Education cess payable (9a + 9b + 9c) 9d 0
### Relief under Section 89 10 0
### Relief under Section 90/91 11 0
 ### Balance Tax Payable (9d-10-11) 12 0
Do not write or stamp in this ares (Space for 13 a Interest Payable U/s 234A 13a 0
bar code) b Interest Payable U/s 234B 13b 0
c Interest Payable U/s 234C 13c 0
d Total Interest Payable 13d 0
(13a+13b+13c)
14 Total Tax and Interest Payable14 0
(12+13d)
For office Use only Seal and signature of receiving o

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

MICR Code 0 Type of Account (tick as applicable)√ SavingsCurrent

21 Details of Tax Deducted at Source from Salary [As per Form 16 issued by Employer(s)]

Deduc
Tax Deduction Income Tax payable Total Tax
tion
TDS ON SALARY

Sl Account Namee and address of chargeable (incl. surch. tax payable/

No Number(TAN) of under
the Employer under the head And edn. deposi refundabl
the Employer Chapt
salaries Cess) ted e
er VI-A

(1) (2) (3) (4) (5) (6) (7) (8)

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

No Number(TAN) of the Deductor credited deposited claim for

the Deductor /Credit
this year
(1) (2) (3) (4) (5) (6) (7)
0
0
TDS
0
NOTE Enter the total of column (7) of 22 in Sl.No.15b of TAXES PAID 0
23 Details of Advance Tax and Self Assessment Tax Payments
Date of Deposit Serial Number of Amount
TAX PAYMENTS

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

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

VERIFICATION

I, son/ daughter of solemnly

declare that to the best of my knwledge 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 in

Place Date Sign here

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

INCOME TAX DEPARTMENT

ACKNOWLEDGEMENT

Received with thanks form: 0 00 a return of income &/return

of fringe benefits in Form No ITR - 1 for assessment year 20010-2011, having the following particulars:

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

2 Deduction under Chapter-VI-A 2 0

3 Total Income 3 0
4 Net tax payable 4 0
5 Interest payable 5 0
6 Total tax and interest payable 6 0
7 Taxes paid
a Advance Tax 7a 0
b TDS 7b
c TCS 7c 0
d Self Assessment Tax 7d 0
e Total Taxes paid (7a+7b+7c+7d) 7e 0
8 Tax payable (6-7e) 8 0
9 Refund (7e-6) 9 0
10 Value of Fringe Benefits 10 NA
Fringe Benefits & Tax Thereon
Computation of Income &

11 Total fringe benefit tax liability 11 NA

12 Total interest payable 12 NA
13 Total tax and interest payable 13 NA
14 Taxes paid NA
a Advance Tax 14a
b Self Assessment Tax 14b
c Total Taxes paid (14a+14b) 14c NA
15 Tax payable (13-14c) 15 NA
16 Refund (14c-13) 16 NA
Receipt No. Seal and Signature of receiving official:

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

3 Residential status PERMANENT RESIDENT

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.)

(1) (2) (3) (4) (5) (6) (7)

2008-09 0 0 0 0 0 0

Signature:

Place: Name:

Date: Designation:
Dept: