Income Tax for the Financial Year 2014-2015

Name & Designation of the Employee :

PAN No :
Department :
1)

SALARY INCOME :
a) Pay
b) Spl. Pay etc
c) D.A
d) H.R.A
e) C.C.A
f)
if any ( viz.
Honororium
Other source
of income,
if anyetc.)
(viz.
g) Agriculture etc.,)

Rs:_____________________________________
Rs:_____________________________________
Rs:_____________________________________
Rs:_____________________________________
Rs:_____________________________________
Rs:_____________________________________
Rs:_____________________________________

Total : Rs:____________________________________
2)

3)

4)

H.R.A :
a) Rent Paid
b) 10% of Salary
c) (a-b)
d) H.R.A. Received
( c or d whichever is less is Eligible )
Balance (1 - 2) :

Rs:_____________________________________
Rs:_____________________________________
Rs:_____________________________________
Rs:_____________________________________
Rs:____________________________________

DEDUCTIONS :
a) Prof. Tax
b) C.M's Relief Fund
c) Medical Expenditure (80DD & 80DD3)
d) Medical
Insurance
Int.paid on
Housing loan / Education
e) Loan interest.
f)
Other, if any
Total (a to f) :
Balance (2 - 3) :

Rs:_____________________________________
Rs:_____________________________________
Rs:_____________________________________
Rs:_____________________________________
Rs:_____________________________________
Rs:_____________________________________
Rs:____________________________________
Rs:____________________________________

SAVINGS :section 80C

a) E.P.F.
b) A.P.G.L.I.F.
c) G.I.S.
d) L.I.C.
e) P.L.I./ N.S.C.
f)
Tuition fee
g) Housing loan (Principal paid)
h) Bonds
i)
P.P.F
j)
..

Rs:_____________________________________
Rs:_____________________________________
Rs:_____________________________________
Rs:_____________________________________
Rs:_____________________________________
Rs:_____________________________________
Rs:_____________________________________
Rs:_____________________________________
Rs:_____________________________________
Rs:_____________________________________

Total (a to j) : Rs:____________________________________
(upto Rs. 1,50,000/- only shoud be taken for
the savings for of Tax Excemption)

5)
6)
7)
8)
9)
10)

Balance ( 3 - 4 ) :
Total Tax :
Education Cess 3% on Tax :
paybleshould
( 6+7 )be:
Tax alreadyTotal
paid Tax
( Detailed
given ) :
Balance to be paid :

Income Level / Slabs

Where the total income does not
exceed Rs. 2,50,000/Where the total income exceeds Rs.
2,50,001/- but does not exceed Rs.
5,00,000/Education Cess: 3% of the income -tax

Rs:____________________________________
Rs:____________________________________
Rs:_____________________________________
Rs:____________________________________
Rs:____________________________________
Rs:____________________________________
Rs:____________________________________
Rs:____________________________________

(Signature of the Assesee)

Income Tax Rate
NIL
10 % of amt. by which the total income