1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 PLACE GROSS SALARY INCOME RENT PAID PER MONTH HRA RECEIVED (EXCLUDING SLS HRA) 10% PAY+ DP+GR.PAY + DA PROFESSIONAL TAX INTEREST ON. HOUSING LOAN PF SUBSCIPTION FBF HEALTH INSURANCE SCHEME SUBSCRIPTION SPF 1 and 2 SCHEMES or OTHER SCHEMES HBA PRINCIPAL AMOUNT PLI PREMIUM TUITION FEES LIC PREMIUM INFRASTRUCTURE BOND (Max 20000) 80 D MEDICLAIM POLICY PREMIA 80 DD (FOR HANDICAPPED DEPENDENTS) 80 E INT. ON EDU. LOAN FOR HIGHER STUDIES 80 G DONATIONS (100% EXEMPTIONS) 80 U ( FOR SELF HANDICAPPED) INCOME TAX DEDUCTED/REMITTED UPTO JAN 2012 COIMBATORE TAX AT A GLANCE TAX ON TOTAL INCOME Education cess 2% + Higher education cess 1% INCOME TAX DEDUCTED UPTO JAN 2012 TOTAL INCOME TAX PAYABLE FOR 2011-2012 DATE MEN 0 0 0 0 WOMEN 0 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 PAN NO.
To get full HRA exemption rent paid per month should be above Rs.
Please note that all the above cells in Column C upto Sl.No. 21 to be filled up correctly. If there is Nil amount put "0" without fail. The return form in sheet 2 is generated automatically and ready for print in legal sheet (All cells in Sheet 2 is locked) Investment/Loan annexure and salary particulars to be filled up and enclosed manually. If you find any error or problem kindly feel free to advise me to correct it. R Ganapathiraman, Coop.Audit Officer, Coimbatore rganapathiraman@gmail.com
INCOME TAX STATEMENT FOR THE YEAR 2011-2012 1 2 3 NAME DESIGNATION PAN NUMBER 0 0 0
GROSS INCOME-I (Total Salary including HRA, Taxable Allowances, Perquisite (Excluding Cash allowance, if any) LESS: WHICHEVER IS LESS HRA EXEMPTION u/s 10 Actual Rent Paid 10% of Pay + DP/DA/GR.PAY Difference of (a) & (b) 50% of Salary (Pay+DA) for chennai city and 40% of Salary (Pay+DA) for other place GROSS INCOME- II (4-5) LESS: PROFESSIONAL TAX GROSS INCOME -III (a) ADD:ANY OTHER INCOME (b) LESS: LOSS ON HOUSE PROPERTY NET INCOME LOSS GROSS INCOME - 1V SAVINGS UNDER CHAPTER VI A (Under Sec.80C) GPF FBF HF SPF and other schemes (Pl.mention) HBA PRINCIPAL 80 CCC PLI TUITION FEES LIC INFRASTRUCTURE BOND TOTAL Aggregate of 11(a) to (i) ((@) - limited to Rs.100000/-) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
0.00
5 a) b) c) d) 6 7 8 9
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 11 a) b) c) d) e) f) g) h) i)
0.00 0.00
j) k) l) m) n)
80 D Mediclaim 80 DD ( for dependents) 80 E (Int. on Edn. Loan) 80G Donation 80 U (for self) Aggregate of 11 (j) to (n)
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0 0.00 PAGE 1
12 13
MEN 1) Where the total Income taxable does not exceed Rs.1,80,000 2) Where the total Income exceeds Rs.1,80,000/- but does not exceed Rs.5,00,000/3) Where the total Income exceeds Rs.5,00,000/- but does not exceed Rs.8,00,000/4) When the total Income exceeds Rs.8,00,000/TOTAL WOMEN 1) Where the total Income taxable does not exceed Rs.1,90,000 2) Where the total Income exceeds Rs.1,90,000/- but does not exceed Rs.5,00,000/3) Where the total Income exceeds Rs.5,00,000/- but does not exceed Rs.8,00,000/4) When the total Income exceeds Rs.8,00,000/TOTAL
1 0.00 NIL
0.00 0.00
0.00
10%
0.00
0.00
0.00
10%
0.00
0.00
TAX ON TOTAL INCOME 15 16 17 18 Education cess 2% + Higher education cess 1% TOTAL INCOME TAX PAYABLE FOR 2009-2010 SO FAR RECOVERED TO BE RECOVERED
0 0 0 0 0.00
0 0 0 0 0.00
CERTIFICATES 1 2 3 4 Place Certified that I am occupying a Government Quarters at No. Certified that I am residing in a rental house and paying a monthly rent of Rs Certified that I am having following LIC PLI policies and are in alive Certified that a sum of Rs. For 10/15 years 0.00
Date
NOTE: Xerox copies of all investments made and the last payment copies of the insurance premium paid towards which tax rebate is sought for may be enclosed along with I.T statement. Relevant Certificates in originals are to be enclosed for the deductions claimed under Chap.VI A In respect of the salary drawn in other Offices, necessary pay drawn particulars are to be obtained from the Drawing Officers concerned and enclosed with IT stt. Without fail
By: rganapathiraman@gmail.com
PAGE 2
INCOME TAX STATEMENT SAVINGS DETAILS FOR THE YEAR 2011-2012 NAME DESIGNATION 0 0 DETAILS OF PLI/LIC POLICIES AND PREMIUM PAID
LIC/PLI/ MEDICLAIM POLICY NO Name of the Insured Sum Assured Total Premium paid Remarks
DETAILS OF HBA DEDUCTIONS (If loan is repaid directly, Cash receipts should be attached Amount of Loan Recovered Year of Loan Received Purpose Agency Amount Repaid Mode of Repayment
PARTICULARS OF NSC INVESTED Name of the Depositor Post Office Issue No NSC NUMBER Amount
PARTICULARS OF DEPOSITS TOWARDS NSS JEEVAN AKSHAY/JEEVAN DHARA DURING THE FINANCIAL YEAR 2010-2011 Name of the Depositor Nature of Deposit Amount Cert.No Date of Deposit Place of Deposit Remarks
Particulars of Interest accrued on NSC (VI Issue) and VIII Issue Name of the Depositor NSC Name of the Post Office Cert.No Date of Deposit Rate of Int Amount
PARTICULARS OF INFRASTRUCTURE BONDS INVESTED Name of the Depositor Bond No Date Details of Bond Amount
NOTE If any investments/Loans as above are paid directly attach cash receipts accordingly
PLACE DATE
COIMBATORE 0
0 0
STATEMENT SHOWING THE SALARY, HONORARIUM FEES ETC., RECEIVED DURING THE PERIOD FROM 01.03.2011 TO 28.02.2012 (INCLUDING ARREARS OF SALARY AND ALLOWANCES) NAME; Months Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 DA arrears 51% DA arrears 58% Pay Com.arrears 3rd Instt Surrender Leave Salary Arrears if any Arrears if any Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Pay 0 Grade Pay DA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 DESIGNATION HRA CCA MA 0 0 0 0 0 0 0 0 0 0 0 0 OA 0 0 0 0 0 0 0 0 0 0 0 0 Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 360 0 300 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 GPF
0
0 P.Tax IT.
0 0 0
PLACE DATE
COIMBATORE 0
0 0
STATEMENT SHOWING THE SALARY, HONORARIUM FEES ETC., RECEIVED DURING THE PERIOD FROM 01.03.2011 TO 28.02.2012 (INCLUDING ARREARS OF SALARY AND ALLOWANCES) NAME; Months Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 DA arrears 51% DA arrears 58% Pay Com.arrears 3rd Instt Surrender Leave Salary Arrears if any Arrears if any Total 0 0 0 0 0 0 0 Pay 0 Grade Pay DA DESIGNATION HRA CCA MA OA Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 GPF
0
0 P.Tax IT.
PLACE DATE
COIMBATORE 0
0 0