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1

2 PAN NO.

3 Designation4 Name of the Office

5 Basic Pay as on MAR-13

6

7 AFTER AAS/INCREMENT/STEP-UP

8

910 AI11 PP/FP12 HMA

13

14

15

16

1 ZPPF/GPF/CPS ZPPF

3 GIS 120

4 APGLI 450

5 CSS 0

0

FEB

CA(PH ALLOWANCE)

MONTH OF INCREMENT/AAS/STEP-UP

ZPHS, KARUMANCHI

MONTH OF NEW BASIC AFTER AAS/INCREMENT/STEP-UP

7000

ZPPF ENHANCEMENTMONTH(SELECT'0' IF NOT

ENHANCED)

PAY AFTER INCREMENT/AAS/STEP-UP

Name of the Employee

CCA 0

3000

RENT ACTUALLY PAID PER MONTH

0

Basic Pay as on Jan-2013(for DA calculation) 25600

TREASURY ID No: AFGPB9002G0706764

EARNINGS

26300

26300

70

12

B. SANKAR SINGH

25600

SCHOOL ASSISTANT(SS)

DEDUCTIONS

NO

ZPPF AMOUNT (MAR 12)

JAN

GIS ENHANCEMENTMONTH (SELECT '0' IF

NOT ENHANCED)

HRA %

FILL IN THE DATA

APGLI ENHANCEMENTMONTH (SELECT '0' IFNOT ENHANCED)

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6LOANS(GPF/ZPPF/APG

LI)0

7 EWFLOAN 0

8 LIC(SALARY) 0

9 LIC(BYHAND) 48063

GROSS AMOUNTDA 1(47.936% to

54.784%) 8765

DA 1(54.784% to63.344%) 8764

DA 2(63.344%) CASHMONTH NOV

PAY AI DA HRA

1342 351 850

PAY AI DA HRA

0 0 0 0

0 DAYS

1 0

2 0

3 0

SELECT THE MONTH FROCASH ALONG

Tuition Fee

Housing Loan Principle

FEES REIMBURSEMENT 0

S.L. ENCASHMENT MONTH

DA ARREARS

JUL

LIC ENHANCEMENT MONTH(SELECT '0' IF NOT

ENHANCED)

OTHER DEDUCTIONS

SURRENDER LEAVE

INFRASTRUCTURAL BONDS(max. Rs. 20000/-)

GPF/ZPPF ADJUSTMENT

6573

6/12/18/24 YEARS SCALE/INCRE

PRC ARREARS/STE

7012

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4 0

5 0

6 0

7 0

8 0

9 0

10 0

11 0

12 0

13 0

14 0

15 0

16 0

Interest on Housing loan(U/S 24(L)(VI)

P.L.I/N.S.C.

C.M.Relief Fund

Exception on PHC dependent (80DD) Rs. 50000/-

Mediclaim Insurance (80-D)

interest on Education loan

Donations (80 G)

B. SANKAR SINGH

Any other

Deduction on to PHC Employees(80 U)

Health insurance(Max. 15000/-, Rs. 20000/- for Sr. citizens)

Exp. On Medical Treatment

Name of Premises/Building/Village

EMPLOYEE INFORMATION FO

Road/Post Office/Street

NAME OF THE EMPLOYEE

DATE OF BIRTH(mm/dd/yyyy)

HOUSE NO.

Bonds

FATHER'S NAME

RAJIV GANDHI EQUITY SHARE SCHEME(80CCG) MAX 50000

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S. No Month and Year Amount of Tax Paid

1 Mar-13 0

2 Apr-13 0

3 May-13 0

4 Jun-13 0

5 Jul-13 0

6 Aug-13 1500

7 Sep-13 1500

8 Oct-13 1500

9 Nov-13 1500

10 Dec-13 1500

11 Jan-14 5000

12 Feb-14 9830

22330

Rs. 22330

DDO FATHER'S NAME M. HANUMA NAIK

TOWN/CITY/DISTRICT

DDO INFORMA

PIN CODE

nineteen thousand two hundred and forty only

9830TOTAL

Bill ID No. Issued bytreasury

STATE

TAX DEDUCTION AT SOURCE(TDS) AND ADVANCE TAX PAID BY THE EMPLOYEER

DDO DESIGNATION GAZETTED HEAD MASTER

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GAZETTEDN.G.O N.G.O.

ENHANCEMENTMONTH

TOTAL

0 0

0 0

0

1

2

0

ELOW

ANY CORRECTIONS ORSUGGESTIONS PLEASE

CALL

TO PREFIX A ZERO HIT SINGLEINVERTED COMMA(') AND ENTER

THE NUMBER

IF YOU HAVEN'T GOT ANY BENEFITUNDER AAS OR STEP UP

SELECTED THE FIRST TWO BASICPAYS AS SAME , THEN SELECT

YOUR MONTH OF INCREMENT ANDSELECT YOUR BASIC PAY.

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IR TOTAL P. TAX ZPPF CASH

161 0 0

IR TOTAL ZPPF P. TAX CASH

0 0 0

0

WHICH THE NEW DA IS DRAWN INITH REGULAR SALARY

CASH

2191

0

1753

2704

0

.KRISHNA)

ENTAL ARREARS2704

P UP ARREARS

0

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DDO NAME

DDO TAN

TAX PAID BALANCE

DATE 22330 0

HYDZ-00398-G

PRAKASAM

ION

523001

OR EMPLOYEE

Andhra pradesh

L. SAMBASADA SIVA RAO

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Jan-13 25600 14025 12272 1753Feb-13 25600 14025 12272 1753Mar-13 25600 14025 12272 1753 Apr-13 25600 14025 12272 1753 8765 877 7888May-13 25600 14025 12272 1753 8765 7012 1753

Jun-13 25600Jul-13 25600 16216 14025 2191

Aug-13 25600 16216 14025 2191

Sep-13 25600 16216 14025 2191 8764 876 7888

Oct-13 25600 16216 14025 2191 8764 6573 2191

Nov-13 25600

Dec-13 25600

Jan-14 26300

Feb-14 26300

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OCTNOV

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PAY AI PP/FP CA WANC IR HMA DA HRA TOTAL ZPPF GIS APGLI P.TAX

1 Mar-13 25600 70 0 0 0 12272 3072 41014 3000 120 450 200 20

2 Apr-13 25600 70 0 0 0 12272 3072 41014 3000 120 450 200

3 May-13 25600 70 0 0 0 12272 3072 41014 3000 120 450 200

4 Jun-13 25600 70 0 0 0 14025 3072 42767 3000 120 450 200

5 Jul-13 25600 70 0 0 0 14025 3072 42767 3000 120 450 200

6 Aug-13 25600 70 0 0 0 14025 3072 42767 3000 120 450 200

7 Sep-13 25600 70 0 0 0 14025 3072 42767 3000 120 450 200

8 Oct-13 25600 70 0 0 0 14025 3072 42767 3000 120 450 200

9 Nov-13 25600 70 0 0 0 16216 3072 44958 3000 120 450 200

10 Dec-13 25600 70 0 0 0 16216 3072 44958 3000 120 450 200 20

11 Jan-14 26300 70 0 0 7101 0 16659 3156 53286 3000 120 450 200

12 Feb-14 26300 70 0 0 7101 0 16659 3156 53286 3000 120 450 200

DA ARREARS 1 8765 8765 7012

DA ARREARS 2 8764 8764 6573

PRC ARREARS 1342 0 161 351 850 2704 0 0 scae

arrears 0 0 0 0 0 0 0 0

CSS 0 0FEES

REIMBURSEMENT0 0 0 0

Surrender Leave 0 0 0 0 0 0 0 0 0

309942 840 0 0 161 14202 0 190571 37882 553598 49585 1440 5400 2400

S.NOD

STATEMENT OF EARNINGS AND DEDUCTIONS/SAVINGS IN RESPECT OF B. SANKAR SINGH,SCHOOL ASSISTANT(SS) FOR THE YEA

TOTAL

M O R E E A R N I N G S

EARNINGSMONTH&YEAR

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SIGNATURE OF THE D.D.O.

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37224

37244

37244

38997

38584

37497

37497

37497

39688

36168

44516

39686

1753

2191

2704

0

0

0

0

468490

NET

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mployee

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PAN1 Name of the Employee :2 Designation : SCHOOL ASSISTANT(SS)3 Name of the Office : ZPHS, KARUMANCHI4 Gross salary Income : Rs 5535985 HRA Exmpted :

i) Actual HRA Received : Rs 37882

ii) Rent paid in Excess of 10% of Salary (Pay+DA) : Rs 33949

iii) 40% of Salary : Rs 124060(Deduct least of the above three) : Rs 33949

6 Net salary Income(4-5) : Rs 5196497 Deductions :

a) Profession Tax(U/S 16(iii) : Rs 2400b) Interest on Housing loan(U/S 24(L)(VI) : Rs 0Total : Rs 2400

8 Total Income(6-7) : Rs 5172499 Deductions under chapter VI -A :

A)Savings(U/S 80C) (Max.Rs.1,00,000) :i)G.P.F/Z.P.P.F/C.P.S/C.S.S : Rs 49585ii)G.I.S : Rs 1440iii)L.I.C : Rs 48063iv)P.L.I/N.S.C. : Rs 0v) A.P.G.L.I : Rs 5400vi) Tution Fee : Rs 0vii) Housing loan principle amount : Rs 0viii) Bonds : Rs 0

ix) Any other : Rs 0Total (U/S 80C) : Rs 104488

B) INFRASTRUCTURE BONDS(MAX. 20000/-) : Rs 0C) Mediclaim Insurance (80-D) : Rs 0D) Expenditure on PHC dependent (80DD) : Rs 0E) Interest on Education Loan(80-E) : Rs 0F) Exp. On Medical Treatment(80-DDB) : Rs 0G) RAJIV GANDHI EQUITY SHARE SCHEME(80 CCG) : Rs 0F) Donations (80 G) : Rs 0

i) C.M.Relief Fund : Rs 413ii) Sainic welfare fund : Rs 20iii) Employees welfare fund : Rs 20iv) Other donations if any : Rs 0

G) Deduction on to PHC Employees(80 U) : Rs 0Total(Chapter VI-A) : Rs 453 Rs 104941

Rs 10045310 Taxable Income(8-9) : Rs 41679611 Tax on total Income :

-: Rs 0 -

: Rs 21680 -

: Rs 0 -

TOTAL DEDUCTIONS( ADMISSIBLE)

MALE/FEMALE SERVANT

10 00 001/-and above-Rs 1 30 000+30% of the amount

INCOME TAX CALCULATION FOR THE YEAR 2013-14

2,00,001 to 5,00,000-10 of the amount exceeding 5 lakhs

TAN :HYDZ-00398-G

2,00,000-Nil

[Actual Rent Paid 7000X12=84000-50051[(Pay+DA)*10%]=33949]

TDS PAID

AFGPB9002G

Rs. 5,00,001/-to 10,00,000/-Rs.30000+20 of the amount exceeding

5,00,000/-

B. SANKAR SINGH ID No:0706764

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Designation

Signature

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--

-

-

PAID

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SARAL-II

PSU

1 1

2 2

3 3

4 4

5

a 80 C 100000 e 80DD 0 i 80GG

b 80 CCC 2400 f 80DDB j 80GGA

c 80 CCD g 80E k 80GGC

d 80 D 0 h 80G 453 l 80U

6 6

7 7

8 8

9 9

10 10

11 11

12 12

13 13

14 14

15 15

D i i hi

I N C O M E & D E D U C T I O N S

T A X C O M P U T A T I O N

Relief under Section 89 0

Balance Tax Payable (10-11-12) 22330

Relief under Section 90/91 0

Total Tax and Education cess Payable(8+9) ROUNDED TO NEAREST 10 22330

Total Tax and Interest Payable (13+14) 22330

416796

Tax Payable on Total Income 21680

Secondary and Higher Education cess on 8 651

Total Interest Payable U/s 234A/B/C 0

0

Deductions ( Total of 5a to 5i) 102853

Total income(4-6)

Income Chargeable under the Head 'House Property'(enter -ve sign in case ofloss, if any)

Income Chargeable under the Head ' Other Sources '(enter -ve sign in case ofloss, if any)

Gross Total Income(1+2+3) 519649

Deductionsunderchapter VI A(Section)

Residential Status(Tick) Resident Non-Resident Resident but not ordinarily Resident F I L I N G

S T A T U S

Income Chargeable under the Head 'Salaries ' (Salary/Pension) 519649

Whether Original or Revised return?(Tick) Original Revised

If revised,enter Receipt No. and date of filing original return DD/MM/YY

P E R S O N A L I N F O R M A T I O N

Designation of the Assessing Officer(Ward/circle)Returns filed under Section

[Please see instructionno.9(i)

E-mail Address

Sex(Tick)

Male F

STD Code-Phone Number( )

Town/City/District

Name of Premises/Building/Village

Road/Street/Post Office

ONGOLE

Area/Locality

PRAKASAM

State

Andhra pradesh

Pin Code

523001

First Name

BONDILI

8-292

Govt

Middle Name

SANKAR

Last Name

SINGH

Employer Category,(Tick

Date of Birth

1/8/1958VINNAKOTAVARI STREET

F O R M

(ITR-1)

INDIAN INCOME TAX RETURN

[For Individuals having Income from Salary/Pension/Income from One HouseProperty(excluding loss brought forward from previous years)/Income from other

sources(Excluding Winning from Lottery and Income from Race Horses)]

(Please see rule 12 of the Income-Tax Rules, 1962)(Also see attached instructions)

Assessment Year

Flat/Door/Block No

AFGPB9002G

2 0 1 4 -

PAN

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16

a 16 a

b 16 b

c 16c

17 17

18 18

19 19

22.MICRCODE

23

S.No

(1)

1

B

24

S.No

(1)

1

B

25

S. No

i

ii

iii

26Sl No Code Code Code

a 001 001 001

b 002 002 002

c 003 003 003

27 27

I B. SANKAR SINGH son/daughter of BHAVAN SINGH solemnly declare that to the best of my knowledgeand belief, the information given in the return thereto is correct and complete and that the amount of total income other particulars showntherein are truly stated and are in accordance with the provisions of Income Tax Act, 1961, in respect of income chargeable to Income-taxfor the previous year relevant to the Assessment year 2013-14.

Place Date Sign here

Details of Advance Tax and Self Assessment Tax Payments

Exempt income only for reporting purposes(from Dividend, Capital gains etc)

VERIFICATION

Other Information(transactions reported through Annual Information Return)(Please see instruction number 9(ii) for code) Amount Rs. Amount Rs. Amount Rs.

NOTE Enter the totals of Advance tax and self Assessment tax in sl . No. 17 a of TAXES PAID

Note

Name of Bank & BranchSerial Nof ChallaBSR CODE

Date of Deposit(dd/mm/yyyy)

Enter the total of column (7) of 23 and column (7) of 24 in S. No.(17b of Taxes Paid)

(5) (6)(3) (4)

517249 100453 22330HYDZ-00398-G GAZETTED HEADMASTER

T D S O N I N T E R E S T

Details of Tax Deducted at Source other than salaryTax Deduction

AccountNumber(TAN) of the

Employer

Name and address ofthe Employer

Income chargeableUnder the head

salaries

Deduction underChapter VI-A

TaxPayable(In

cl. edn.

Cess)(7)(2)

T A X E S P A I D

Type of Account(tick as appl

savings

Details of Tax Deducted at Source from salary(As per Form 16 issued by Employer(s)

T D S O N S A L A R Y

21. Do you want your refund by cheque or deposited directly into your bank account *(tick as applicalble)

Deduction underChapter VI-A

(5)

Tax Deduction Account

Number(TAN) of theEmployer

(2)

Total Taxdeducted

22. Give additional details of your bank account

(4)

TaxPayable(In

cl. edn.Cess)

Total Taxdeducted

(6)

22330

Taxes Paid

20. Enter your bank account number (mandatory in caseof refund)

Name and address ofthe Employer

Refund((17d-16) (enter if 17d is greater than 16, also give Bank account detailsbelow

Advance Tax (from item 25)

Income chargeableUnder the head

salaries

Total Taxes Paid(16a+16b+16c) 22330

Tax Payable(15-17) (Enter if 15 is greater than 17 else leave blank) 0

(3) (7)

TDS (Column 7 of item 23+Column 7 of item 24)

Self Assessment Tax (From item 25)

0

22330

0

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TO

ACKNOWLEDGEMENT No.

1

(a) 553598

(b)

(c)

(d)2

3 5196494

24005 2400

6 517249

7

8 517249 9

A) Gross Amount Qualifying Amount

495851440

480630

540000

(iii) L.I.C. (ii) G.I.S

(vii) H/LOAN PRINCIPLE

Gross total income (6+7)Deductions under Chapter VIA

(a) Section 80C (i) Provident Fund

(v) A.P.G.L.I (vi) TUITION FEES

Add: Any other income reported by theemployee

(a)

Balance(1-2)

Deductions u/s 16:

(b) Aggregate of 4(a) to (b)Income chargeable under the head 'salaries' (3-5)

Salary as per provisions contained insec.17(1)

Value of perquisites u/s 17(2) (as per FormNo.12BB, wherever applicable)

Section 80C, 80CCC, and 80CCD

Entertainment allowanceTax on employment

Profits in lieu of salary under section17(3)(as per Form No.12BB, whereverapplicable)Total

Less: Allowance to the extent exempt u/s 10H.R.A 33949

FORM NO.16[See rule 31(1)(a)]

Certificate under section 203 of the Income-tax Act, 1961 for Tax deducted at source from income chargeable underthe head " Salaries"

NAME AND ADDRESS OF THE EMPLOYER NAME AND DESIGNATION OF THE EMPLOYEE

GAZETTED HEAD MASTER B. SANKAR SINGH ,SCHOOL ASSISTANT(SS)

QUARTER

PAN No. of the Employee

AFGPB9002G

PERIOD

PAN of Deductor TAN No. of the Deductor

ASSESMENTYEAR

FROM

Details of Salary paid and any other income and tax deducted

2014-15

HYDZ-00398-G

ACKNOWLEDGEMENT Nos of all quartelystatement of TDS under sub-section(3) of of section200 as provided by TIN facilitation Centre or NSDL

website

Mar-13 Feb-14

Gross Salary

(iv) P.L.I.C./N.S.C

(b) Section 80 CCC (c) Section 80 CCD

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0

(a) 413

(b) 20

(c) 20

(d) 0

(e)

100453

416796

21680

434

217

22331

0

#N/A

22330

#N/A

Gross Amount Qualifying Amount Deduction amount

17 Tax Payable(15-16)

Education Cess(on tax at S. No. 12 andsurcharge at S.No. 13)

14

16 Relief Under Section 87 A

15 Tax Payable(12+13+14)

10 Aggregate of deductible amount underChapter VIA

18 Less:

Section

12

19 Tax Payble/refundable (17-18)

Surcharge(on tax computed at S.No. 12)13

i) C.M.Relief Fund

(B) OTHER SECTIONS( for e.g., 80E, 80 G etc) UnderChapter VIA

ii) Sainic welfare fund

iii) Employees welfare fund

iv) Other donations if any

(b) Tax paid by the employer on behalf of theemployee u/s 192(IA) on perquisites u/s 17(2)

(a) Tax dedution at source u/s 192(1)

11 Total Income (8-10)

Tax on total income

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S. NO TDS Rs.Surcharge

Rs.EducationCess Rs.

Cheque /DDNo.(if any)

B.S.R.Codeof BankBranch

Date onwhich which

taxdeposited(dd/mm/yyyy)

Transfervoucher/challan identification

No.

1 0 0 02 0 0 03 0 0 04 0 0 05 0 0 06 1500 0 07 1500 0 08 1500 0 09 1500 0 0

10 1500 0 011 5000 0 012 9830 0 0

DETAILS OF TAX DEDUCTED AND DEPOSITED INTO CENTRAL GOVERNMENT ACCOUNT

Total tax deposited Rs.

0

1500

0

0

9830

5000

1500

1500

1500

0

0

1500

Designation Full Name

I L. SAMBASADA SIVA RAO,son/daughter of M. HANUMA NAIK working in the capacity of GAZETTED HEAD MASTER (designation)do hereby certify that a sum of Rs.22330 [Rupees nineteen thousand two hundred and forty only (in words)] has been deducted atsource and paid to the credit of the Central Government. I further certify that the information given above is true and correct based onthe books of accounts, documents and other available records.

Place

Date Signature of person responsible for deduction of tax

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Received a sum of Rs.84000@ Rs.7000 per month from March 2013 to

February 2014 in respect of House No:8-292 situated at VINNAKOTAVARI STREET

ONGOLE,PRAKASAM

(Affix Revenue Stamp of Rs.1/-)

Date:

Name:

Address:______________________ _____________________________ _____________________________

PAN______________________

RECEIPT OF HOUSE RENT

Under Section 1(13-A) of Income Tax Act)