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FORM OF RETURN OF INCOME UNDER THE INCOME-tax ORDINANCE, 19

Photograph o
(XXXVI OF 1984)
Universal Self/Normal
[Put tick () where applicable]

ONLY FOR THE SALARIED INDIVIDUAL

[to be atte
photo
Assessment Year: 2015-2016
Mr. Alam

1. Name of the Assessee:


2. TIN:

3. National ID No:

Date of Birth:
0
1
0
5
Spouses TIN or Name :
0
(a) Circle:
0
(b) Taxes Zone:
Name and address of the employer:

Email:

8. Residential Status: Resident

4.
6.
7.
9.

10. Present Address:


11. Telephone:

Serial no.
1
2
3
4
5
6
7
8
9
10

11
12

0
0

Office

Mobile:

Statement of income during the income year ended on 30/06/2015


Heads of Income
Salaries : u/s 21
Income from house property: u/s 24
Agricultural income: u/s 26
Capital Gain: u/s 31
Income from other sources: u/s 33
Total income
Tax leviable on total income
Tax rebate: u/s 44(2)(b)
Tax payable (difference between serial no.7 and 8)
As Tax payable is negative so, minimum tax liability for individual
Tax Payments:
(a) Tax deducted or paid in advance/with return Taka
(b) Adjustment of Tax Refund (if any) Taka
Net Tax Liability (Difference between serial no. 9 and 10)
Tax exempted and Tax free income Tk. ...........

3,000.00
-

(Please attach supporting documents/statements, if needed)

Verification
I,
Md. X
,
Father:
Md. Abdur Rahim, TIN: 624383329901
solemnly declare
of my knowledge and belief the information given in this return and statements and documents a
is correct and complete.
Place:
Date :

Dhaka

Enclosures:

Signature of th
(Name and sea

Name of the Assessee: Mr. Alam


Income Year: 2014-2015
Assessment Year: 2015-2016
Computation of Income Tax Liability
Particulars of Total Income

Amount in Taka

A. Income from Salary: U/S-22


1
2

Basic Salary

100,000.00

House Rent

360,000.00

Less: Exemption- Taka 25,000 per month yearly 25,000*12

300,000.00

or, 50% of basic salary

600,000.00

Whichever is lower

300,000.00

Conveyance Allowance

Less: Exemption maximum


4

Conveyance Facility (Basic Salary*5%)

Medical Allowance
Less: Exempted Max. Tk.120,000.

Leave Fare Allowance

Leave Encashment

Incentive Bonus

Festival Bonus

30,000.00
120,000.00

10 Employer's Contribution to RPF@10% of basic salary


11 Interest on RPF (Employee and Employer's interest)

Less: Exemption-interest on RPF@14.50%, or

One third of basic salary

400,000.00

Whichever is lower

Total Income from Salary


B. Income from House Property: U/S-24 (if any)
C. Agricultural Income: U/S-26 (if any)
D. Capital Gains: U/S-31
E. Income from other sources: u/s 33

TDS Rate Net Amount

Bank Interest on Savings Account (Gross)

10%

4,500.00

Bank Interest on FDR (Gross)

10%

20,250.00

Bank Interest on DPS (Gross)

10%

2,250.00

4
5

Income from Dividend (Gross)

10%

Foreign Remittance Received in 2014-2015


Less: Fully exempted (One of my brother lives in USA as a wage earner.
He sent this amount through bank)

Total income from Other Sources


Total Taxable Income
2

Signature of the A

Name of the Assessee: Mr. Alam


Calculation of Investment Allowance
Particulars of Investment
1
2
3
4
5
6
7

Amount in Taka

Own Contribution to Recognized Provident Fund


Trust Bank Contribution to Recognized Provident Fund
Donation for Charitable Institution from 01.07.14 to 30.06.15
Investment in Shares from 01.07.14 to 30.06.15
Investment in Govt. Bond/SP from 01.07.14 to 30.06.15
Life Insurance Premium Paid from 01.07.14 to 30.06.15
Allowable maximum 10% of Policy Value
-

120,000.00
120,000.00

60,000.00
100,000.00

Deposit Pension Scheme


Allowable maximum Taka 60,000.00
Purchase of a new laptop/desktop
Allowable maximum Taka

8 Other Allowable Investments (if any)


Total Actual Investment
Maximum Limit of Investment:
30% of Total Taxable Income Less Employer's Contribution to RPF Less Interest on RPF Less
U/S 82 Income
Or, Taka 15,000,000.00
Whichever is lower
Allowable Investment (actual investment or maximum limit whichever is lower)

Computation of Tax Liability


Slab of Taxable Income
1st Taka 250,000 (men) or 300,000 (women)

Tax Rate

Taxable Income

0%

250,000.00

On Next Taka 400,000.00

10%

400,000.00

On Next Taka 500,000.00


On Next Taka 600,000.00
On Next Taka 3,000,000.00
On rest of the Amount
Gross Tax Liability
Less: Investment Credit@15% on Taka
Net Tax Liability after Investment Credit
Surcharge Payable @10%, or 15% or 20%, or 25%
Total Tax Liability

15%
20%
25%
30%

500,000.00
327,000.00
1,477,000.00
240,000.00

Minimum Tax Liability


Actual Tax Liability - Higher one
Less: Tax Deducted at Source on Savings Account
3

Tax Deducted at Source on FDR


Tax Deducted at Source on DPS
Tax Deducted at Source on Dividend
Advance Income Tax Payment for Salary by the employer
AIT (Pay Order No. 0591022 Dt. 23/10/14, Trust Bank Ltd. Sylhet Br.)
Net Tax Liability / (Refund)

Signature of the Assessee

Statement of assets and liabilities for Salaried person (as on 30/06/201


1. Name of the Assessee:
2. TIN:
0
0

Mr. Alam
0
0
0

1. Non-Agricultural Property (at cost with legal expenses ) :


Land/House property (Description and location of property)
2. Agricultural Property (at cost with legal expenses) :
Land (Total land and location of land property) 2.66 decimal land
3. Investments:
(a) Shares/Debentures
(b) Saving Certificate/Unit Certificate/Bond
(c) Prize bond/Savings Scheme/FDR
(d) Loans given
(e) Other Investment
Total
4. Motor Vehicles (at cost) :
Type of motor vehicle and Registration number
5. Jewellery (quantity and cost) 80 Bori Gold Gift
6. Furniture (at cost)
7. Electronic Equipment (at cost) : Laptop
8. Cash Asset :
(a) Cash in hand
(b) Cash at bank
(c) Other deposits (PF with Interest)
Total
9. Any other assets (With details)
Total Assets
10. Less Liabilities:
(a) Mortgages secured on property or land
(b) Unsecured loans
(c) Bank loan
(d) Others
Total Liabilities
11. Net wealth as on last date of the income year
(Difference between total assets and total liabilities sl. 9-10)
12. Net wealth as on last date of previous income year
13. Accretion in wealth (Difference between sl. 11 less sl. 12)
14. Personal & Family Expenditure:
15. Total Accretion of wealth (sl. 13 add sl. 14)
16. Sources of Fund :
(i) Shown Return Income

Amount in Taka
100,000.00
500,000.00
-

Amount in Taka
750,000.00
110,000.00
-

300,000.00
-

Amount in Taka
1,477,000.00
4

(ii) Tax exempted/Tax free Income


(iii) Other receipts (Bank loan received in this income year)
Total source of Fund
17. Difference (Between serial 15 and 16)

300,000.00
-

I solemnly declare that to the best of my knowledge and belief the information given in this for
complete.
Name & signature of the A
Date:
Assets and liabilities of self, spouse (if she/he is not an assessee), minor children and dependant(s
the above statements.
*Please provide documents and use separate sheet, if needed.

Instructions to fill up the Return Form

Instructions:
(1) This return of income shall be signed and verified by the individual assessee or person as pre
the Income Tax Ordinance, 1984.
(2) Enclose where applicable:
(i) Salary statement for salary income;
(ii) Deed or rental agreement (if any) for house property income;
(iii) Documents in support of any other income or liabilities shown;
(iv) Documents in support of investments made in any form;
(v) Computation of income according to Income-tax Ordinance, 1984;
(vi) Provide evidence in support of tax payment.

(3) Documents furnished to support the declaration should be signed by the assessee or hi
representative.

(4) Assets and liabilities of self, spouse (if she/he is not an assessee), minor children and dependan
in this form.
(5) If needed, please use separate sheet.
(6) Please visit NBRs website www.nbr-bd.org for further information.

Acknowledgement Receipt of Income Tax Return


Government of the Peoples Republic of Bangladesh
Office of the Deputy Commissioner of Taxes
Taxes Circle
0
Taxes Zone
0
Name of the Assessee:
TIN:

Mr. Alam
0

Total income shown in Return:

Assessment Year: 2
0

1,477,000.00

Tax Paid:
5

Gross Wealth shown:


Date of receipt of return:

14,210,000.00

Net Wealth shown :


Serial No. in Return Register:

Return submitted under section 82BB/Normal

Signature of Receiving Officer w

IT-11UMA

ORDINANCE, 1984
Photograph of the Assessee
[to be attested on the
photograph]

Non-resident

on 30/06/2015
Amount in Taka
1,380,000.00
55,000.00
12,000.00
30,000.00
1,477,000.00
180,400.00
36,000.00
144,400.00
4,000.00
3,000.00
-

3,000.00
141,400.00
300,000.00

solemnly declare that to the best


s and documents annexed herewith

Signature of the assessee


(Name and seal)

unt in Taka

Amount in Taka
Pls input yearly basic salary.

100,000.00
360,000.00

1,200,000.00
Input yearly house rent.

300,000.00
600,000.00
300,000.00

60,000.00

30,000.00
120,000.00

120,000.00

400,000.00
-

1,380,000.00
55,000.00
12,000.00

Please input gross interest of Savings Account.

Net Amount
4,500.00

5,000.00

20,250.00

22,500.00

2,250.00

2,500.00

30,000.00
1,477,000.00
8

Signature of the Assessee

unt in Taka
120,000.00
120,000.00

60,000.00
100,000.00

Amount in Taka
240,000.00
-

Just Input Policy Value.

240,000.00

on RPF Less

is lower)

ble Income
250,000.00

407,100.00
15,000,000.00
407,100.00
240,000.00

Tax Liability
-

400,000.00

40,000.00

500,000.00
327,000.00
,477,000.00
240,000.00

75,000.00
65,400.00
180,400.00
36,000.00
144,400.00
144,400.00
4,000.00
144,400.00
500.00
9

2,250.00
250.00
141,400.00

Pls input TDS deducted by employer.

Pls input Tax paid by you through pay order + AIT on car fitness &
tax token fee+ last year Tax Refund.

the Assessee
IT-10BBB

(as on 30/06/2015 )
Amount in Taka

10,000,000.00
800,000.00

unt in Taka
100,000.00
500,000.00
600,000.00
1,200,000.00
400,000.00
200,000.00
150,000.00

unt in Taka
750,000.00
110,000.00
860,000.00
14,210,000.00
300,000.00
300,000.00
13,910,000.00
5,000,000.00
8,910,000.00
1,500,000.00
10,410,000.00

Pls input net wealth in a reasonable basis and if you regularly


submit return then you must match Net Wealth with Last
Year Income Tax Return.
Pls input family expense in a reasonable basis and increase or decrease to make
zero Serial NO. 17.

unt in Taka
1,477,000.00

1,777,000.00

10

300,000.00
1,777,000.00
8,633,000.00

on given in this form is correct and

& signature of the Assessee

en and dependant(s) to be shown in

ee or person as prescribed u/s 75 of

he assessee or his/her authorized

ldren and dependant(s) to be shown

..

Return

ladesh
es

ssessment Year: 2015-2016

3,000.00
11

shown :

13,910,000.00

n Register:

eceiving Officer with seal.

12