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Form
FORMAT FOR THE PREPARATION OF INCOME TAX CALCULATION STATEMENT FOR 2012-13 I General Information :
Name 2 Are you a Gazetted Officer ? 3 Sex 4 Designation
1 5 6 7 8 9
Office / Department Are you residing in rented house ? (a) PAN : Name & Address of Employer Circle of filing Income Tax Return (b) TAN :
0 0 0 0 0 0 0
0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
26 Actual Rent Paid (if residing in rented house) 27 Interest on Housing Loan
If availed before 31/3/99 If availed after 31/3/99 No :
28 Public PF 29 NSC
30 Mutual funds 31 Eductional expenses of children (for 2 children) 32 Equity shares & debentures 33 Repayment of Housing loan Investment in Long term Infrastructure Bond of IDBI, ICICI etc. 34
(For claiming addition deduction of up to Rs. 20000)
0 0 0 0 0 0
0 0
35 Any other deductions 36 Pension Fund (LIC/UTI etc.) 37 Contribution to Pension scheme of Central Govt. Employees
IV Other Deductions :
38
Medical Insurance Premium u/s 80 D : (Max. Rs. 15000/- or 20000/- as the case may be) Maintenance and Medical treatment of Handicapped
0 0 0 0 0 0 0 0
39 Dependent u/s 80 DD :
(Max. Rs. 50000/- or 100000/- as the case may be) Medical treatment for certain specified disease or ailment u/s 80 DDB : (Maximum of Rs. 40000/40 and Rs. 60000/- as the case may be)
41 Repayment of Interest on loan taken for higher education u/s 80 E : 42 Contribution toPolitical Parties u/s 80GGC 43 44
Donation to certain funds, charitable institutions etc. : (100% in the case of Special Funds & 50%in other cases) Deduction inrespect of persons with disability : (Rs. 50000/- or Rs. 100000/- as the case may be)
Pattambi
Date: 25.12.2013
SUBMIT
30000
100000
30000
Title Page
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 0 0 0 0 25.12.2013
. . .
3 Balance Gross Income (1 - 2) 4 Less Profession Tax u/s 16(iii) 5 Deduct : Interest on Housing Loan (Maximum Rs. 30000/- or
Rs. 150000/- as the case may be)
0 0 0 0 0 0
.. .. .. .. .. .. .. .. .. .. .. .. .. . 0 0 0 0 0 0 0 0 0
(e) 80D (f) 80DD (g) 80DDB (h) 80E (i) 80G (j) 80GGC (k) 80U
.. .. .. .. .. .. .. 0 0 0
Maintenance and Medical treatment of Handicapped Dependent (Max. Rs. 50000/- or 100000/- as the case may be) Medical treatment for certain specified disease or ailment (Maximum of Rs. 40000/- and Rs. 60000/- as the case may be) Repayment of interest on loan taken for higher education Donation to certain funds, charitable institutions etc.: Contribution to Political Parties : Deduction inrespect of persons with disability : (Rs. 50000/- or Rs. 100000/-
8 9
Upto Rs. 200000/200001 to 500000/500001/- to 1000000/Above Rs. 1000000/-
Total Net Taxable Income (Rounded to nearest ten) Income Tax on Total Income :
: Nil
: 10% of total income exceeding Rs. 200000/: 20% of total income exceeding Rs. 500000/: 30% of total income exceeding Rs. 1000000/-
10 11 12 13 14 15
Total Add Educational Cess (3% of tax ) Total Tax Less Relief u/s 89(i) Balance Tax Less Tax deducted from the salary bill Tax Payable
0 0 0 0
0 0 0 .. 0 0 0
Signature of the Head of Office in case of NGO Signature of the Officer in the case of Gazetted Officer.
FORM 16
[See Rule 31(1)(a)]
CERTIFICATE UNDER SECTION 203 OF THE INCOME TAX, 1961 FOR TAX DEDUCTED AT SOURCE FROM INCOME CHARGEABLE UNDER THE HEAD "SALARIES"
Name and address of the Employer : Name and Designation of the Employee :
0 0
PAN : TDS Circle where Annual Return / Statement under section 206 is to be filed
0 0 0 0
0
TAN : Period From 01/04/12 To 31/03/13
0
Assessment Year
0
1 2 3 4
2013-2014 0 0
5 6
0 0 0 0 0 .. .. .. .. .. .. .. .. .. .. .. .. .. . 0
7 8 9
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
Under section 80 - D Under section 80 - DD Under section 80 - DDB Under section 80 - E Under section 80 - G Under section 80 - U Under section 80 - GGC Total of item 12-17 Total deduction admissible (13+21)
Taxable Income (8-22) (Rounded to nearest ten rupee)
0 0 0 0 .. .. .. .. .. .. .. 0 0
0 0 0 0 0 .. 0 0 Nil
Income taxpayable Educational Cess @ 3% Total Tax Payable (24+25) Less Relief u/s 89(i) Balance Tax Tax already paid / deducted Balance Tax to be paid / refunded DETAILS OF TAX DEDUCTED AT DEPOSITED INTO CENTRAL GOVERNMENT ACCOUNT Amount Date of Payment
0
I ..............................................................................................Son of ............................................................................... working in the capacityy of .................................................................................................(Designation) do hereby certifying that a sum of Rs......................................(Rupees..................................................................................... .........................................(in words) has been deducted at source and paid to the credit of the Central Government. I further certify that the information given above is true and correct based on the book of accounts, documents and other available records. Signature of the person responsible for deduction of tax Name...................................................................... Designation ...........................................................
Place : Date :
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