3

5

7

Statement of assets and liabilities for Salaried preson(as on 30/06/2016 )

Md. Sakir Hossain 5 5 1 1 4 2 1 0 5 9 0 8

11,556,000

Inharited 1,050,000

500,000

360,000860,000

2,600,000

40,000250,000

170,000

41,600689,400

731,000560,000

17,817,000

2,156,000

2,156,000

15,661,00014,088,650

1,572,350560,000

2,132,350

1,718,350414,000

2,132,350

50 TollaDhaka Metro Kha-2450 (15000cc)

Note-8

Note-9

Note-11

Note-10

4 katha land with 3 storied building of Badda

5 Acore land of Sirajganj

P.F Fund

(Including Tax)

16 17

ONLY FOR THE SALARIEDINDIVIDUAL

11UMA

12345678

9

Note-1

Note-3

Note-4

Note-5

Note-6

Note-7

Note-2

5 5 1 1 4 2 1 0 5 9 0 8

2 6 1 9 3 5 1 9 6 1 0 95

1,69,620

1,300,000256,350

12,000

1,718,3502,28,670

59,0501,69,620

1,50,000

Nil

Md. Sakir Hossain

551142105908

30 06

0 1 0 3 1 9 6 8

306 (salary) 14

Sunbulah Welfarre Association

House-13, Sector-13, Uttara, Dhaka

15

√

wZb cvZvi dig-IT-UMA

Md. Sakir Hossain 2016 2017

5 5 1 1 4 2 1 0 5 9 0 8

1,718,350 1,69,620

17,817,000 15,661,000

306 (salry) : 14:

Name of the Assessee: Md. Sakir Hossain

Amount of Amount of Net income exempted taxable

Income Income(Tk.) (Tk.) (Tk.)

Basic pay 960,000 - 960,000Special pay - - - Dearness allowance - - - Conveyance allowance 30,000 30,000 - House rent allowance 384,000 300,000 84,000 Medical allowance 84,000 84,000 - Servant allowance - - - Leave allowance/encashment - Honorarium/ Reward/ Fee - - - Overtime allowance - - - Bonus/Ex-gratia 160,000 - 160,000 Other allowances - - - Employer's Contribution to P.F (Recognised) Interest accrued on Recognised P. F. - - - Deemed income for transport facility - - - Deemed income for free accommodation - - - Others if any (give detail) - - - Net taxable income from salary 1,714,000 414,000 1,300,000

Working SheetSCHEDULES SHOWING DETAILS OF INCOME

Schedule - I (Salaries)

Schedule-I (Salaries)

Pay and Allowance

TIN: 551142105908

Note-1

Note-2Schedule-2 (House Property income)

Location and Particulars TK. Tk.description of property

1. Annual rental income 612,000 2. Claimed Expenses :Repair, Collection, etc. 153,000 Municipal or Local Tax 45,600 Land Revenue 450 Interest on Loan/Mortgage/Capital Charge 105,600 Insurance Premium - Vacancy Allowance 51,000 Other, if any - Total = 355,650 355,650 3. Net income ( difference between item 1 and 2) 256,350

96,000 96,000

Note-7

Tax Deducted Paid in Advance/with Return:Tax Deducted at Source as Per Salary 108,000/-Tax Deducted at Source BRTA 15,000/-Tax Deducted at Source as Per Bank statement 17,500/-Advance Tax Paid As Per Challan Divident warent pay order 15,000/-Tax Paid with Return 14,120/- Total TK. 169,620/-

Note-8

Land/House property (Description and location of property)GB RvqMvq Avcbvi evox Ges †Kv_vq Aew¯’Z Zv _vK‡e GKvwaK evox _vK‡j RvqMv msKzjb

bv n‡j c„_K KvMR wjL‡Z n‡e |

Note-9

Land (Total land and location of land property)GB RvqMvq Avcbvi Rwg Ges †Kv_vq Aew¯’Z Zv _vK‡e GKvwaK evox _vK‡j RvqMv msKzjb

bv n‡j c„_K KvMR wjL‡Z n‡e|

Note-10

‡bvU 1 G D‡jøwLZ 3q Kjvg Amount of exempted income Gi Total UvKv GLv‡b

Avm‡e|

Note-11

Any other assets:

Md. Asraful Islam (Son)5 khata Land of Gazipur 3,85,000/-Mrs. Rasma (Doughter) 2 khata land of Gazipur 1,75,000/- 5,60,000/-

[wb‡Ri Dci wbf©ikxj †Q‡j, †g‡q, ¯¿xi †Kvb m¤úwË _vK‡j Ges Zv‡`i bv‡g †Kvb AvqKi

dvBj bv _vK‡j D³ Kjv‡g †`Lv‡Z n‡e|]

Note-3

Total Income from Agricultural 30,000/- ( -)Exempenses 60% 18,000/- Net Income tk. 12,000/-

wnmv‡ei LvZv cÎ bv ivLv n‡j 60% LiP Aby‡gv`b †hvM¨ |

Note-4

Income from Other Source: Dividend income from ICAB Unite Certificate 135,000/-Less: Exampted 25,000/- 110,000/-Bank Interest 40,000/- Total Income from Other Source 150,000/-

Note-5

CALCULATION OF TAX LIABILITY ON TOTAL INCOME1st Taka 250,000 NIL NILOn next Taka 400,000 10% 40,000 On next Taka 500,000 15% 75,000 On next Taka 568,350 20% 113,670

Tax rebate: 15% on allowable investment 59,050 Total gross tax 169,620 Tax paid at source + Advance payment 155,500 Balance payable

1,718,350 228,670

14,120

Note-6

Schedule-3 (Investment tax credit)(Section 44(2)(b) read with part ‘B’ of Sixth Schedule)

1. Life insurance premium Tk. 15,000 2. Contribution to deferred annuity Tk. - 3. Tk. - 4. Tk. 5. Contribution to Super Annuation Fund Tk. - 6. Tk.

192,000

7. Contribution to deposit pension scheme Tk. 8. Tk. - 9. Contribution to Zakat Fund Tk. -

10. Others, if any (Laptop computer ) Tk. - Total= 467,000

200,000

60,000

Contribution to Provident Fund to which Provident Fund Act, 1925 applies Self contribution and employer’s contribution to Recognized Provident Fund

Investment in approved debenture or debenture stock, Stock or Shares

Contribution to Benevolent Fund and Group Insurance premium

First 250,000 15% = 37,500Rest 179,588 12% = 21,550 429,588 59,050

Note-6

2619351961095

2016-2017

†Mv‡ìb evsjv‡`k

5 5 1 1 4 2 1 0 5 9 0 4

AvU cvZvi dig-IT-GA6

13,00,000.00

15,000.00

-

-

6

2,56,350.00

12,000.00

1,69,620.00

1,25,000.00

1,40,500.00

14,120.00

1,50,000.00

17,18,350.00

17,18,350.00

2,28,670.00

59,050.00

1,69,620.00

2,00,000.00

4

Zdwmj-3 (wewb‡qvM RwbZ Ki †iqvZ)

AvqKi Aa¨v‡`‡ki Zdwmj-6 Gi we As‡ki mv‡_ cwVZe¨ aviv 44(2)(we)-

1| Rxeb exgvi cÖ` &Ë wKw¯Í UvKv 15,000.00

2| fwel¨‡Z cÖvc¨ evwl©K fvZv cÖvwßi D‡Ï‡k¨ cÖ`Ë Puv`v UvKv

3| fwel¨ Znwej AvBb, 1925 Abyhvqx cÖ‡hvR¨ fwel¨ Znwe‡j

cÖ`Ë Puv`v UvKv

4| ¯̂xK…Z fwel¨ Znwe‡j ¯̂xq I wb‡qvMKZ©v KZ©„K cª`Ë Puv`v UvKv 1,92,000.00

5| Aby‡gvw`Z eqmRwbZ Znwe‡j cÖ`&Ë Puv`v UvKv

6| Aby‡gvw`Z FYcÎ ev wW‡eÂvi ÷K, ÷K ev †kqvi G wewb‡qvM UvKv

7| wW‡cvwRU †cbkb ¯‹x‡g cÖ`Ë Puv`v UvKv 60,000.00

8| Kj¨vY Znwe‡j cÖ`Ë Puv`v Ges †Mvôx exgv ¯‹x‡gi Aaxb cÖ`Ë

wKw¯Í UvKv

9| hvKvZ Znwe‡j cÖ`Ë Puv`v UvKv

10| Ab¨vb¨, hw` _v‡K (weeiY w`b) UvKv

†gvU UvKv 4,67,000.00

* AbyMÖn K‡i wewb‡qvMmg~‡ni cÖZ¨qbcÎ/cÖgvYcÎ mshy³ Kiæb|

AvqKi wiUv‡Y©i mv‡_ `vwLjK…Z `wjjcÎvw`i ZvwjKv

1| †eZ‡bi weeiY

6| wW‡cvwRU †cbmb ¯‹x‡gi e¨vsK weeibxi

d‡UvKwc

2| e¨vsK weeibxi d‡UvKwc 7| mÂqcÎ µ‡qi mvwU©wd‡K‡Ui d‡UvKwc

3| wmwU Ki‡cv‡ik‡b Ki cÖ`v‡bi iwk‡`i d‡UvKwc 8|

4| f~wg ivR¯̂ Gi iwk‡`i d‡UvKwc| 9|

5| Rxeb exgvi wKw¯Íi iwk‡`i d‡UvKwc 10|

Am¤ú~Y© wiUvY© MÖnY‡hvM¨ n‡e bv|

3

Av‡qi we¯ÍvwiZ weeiYx m¤^wjZ Zdwmj

weeiYx m¤̂wjZ Zdwmj

Ki`vZvi bvgt- †gvt mvwKi †nv‡mb

Zdwmj-1 (†eZbvw`)

‡eZb I fvZvw`

Av‡qi

cwigvY (UvKv)

Ae¨vnwZcÖvß Av‡qi

cwigvY (UvKv)

bxU Ki‡hvM¨

Avq (UvKv)

g~j †eZb (80,000 x 12) 9,60,000.00 9,60,000.00

we‡kl †eZb

gnvN© fvZv

hvZvqvZ fvZv (2,500 x 12) 30,000.00 30,000.00 -

evwo fvov fvZv (32,000 x 12) 3,84,000.00 3,00,000.00

wPwKrmv fvZv (7,000 x 12) 84,000.00 84,000.00 -

cwiPviK fvZv

QzwU fvZv

m¤§vbx/cyi¯‹vi/wd

Ifvi UvBg fvZv

‡evbvm/G·-‡MÖwmqv (80,000 x 2) 1,60,000.00 1,60,000.00

Ab¨vb¨ fvZv

¯^xK…Z fwel¨ Znwe‡j wb‡qvMKZ©v KZ©„K cÖ`Ë Puv`v 96,000.00 96,000.00

¯^xK…Z fwel¨ Znwe‡j AwR©Z my`

hvbevnb myweavi Rb¨ we‡ewPZ Avq

webvg~‡j¨ mw¾Z ev A-mw¾Z evm ’̄v‡bi Rb¨ we‡ewPZ Avq

Ab¨vb¨, hw` _v‡K (weeiY w`b)

‡eZb n‡Z bxU Ki‡hvM¨ Avq 17,14,000.00 4,14,000.00 13,00,000.00

Zdwmj-2 (M„n m¤úwËi Avq)

M„n m¤úwËi Ae ’̄vb I eY©bv weeiY UvKv UvKv

`w¶b Lvb, DËiv, XvKv 1| fvov eve` evwl©K Avq 6,12,000.00 4_© Zjv evox 2| `vexK…Z e¨qmg~n t

1g Zjv (9,000 x 12)= 1,08,000 ‡givgZ, Av`vq, BZ¨vw` 1/4 1,53,000.00

‡cŠi Ki A_ev ¯’vbxq Ki 45,600.00

2q Zjv (11,000x

x

f~wg ivR¯̂ 450.00

F‡Yi Dci my`/eÜKx/g~jabx PvR© 1,05,600.00 exgv wKw¯—

M„n m¤úwË Lvwj _vKvi Kvi‡Y `vweK…Z †iqvZ

Ab¨vb¨, hw` _v‡K

†gvU = 3,55,650.00

3| bxU Avq (µwgK bs 1 n‡Z 2 Gi we‡qvMdj) 2,56,350.00

3q Zjv (10,000x

x

84,000.00

51,000.00

3,55,650.00

-

-

-

c~e©eZ©x c„ôvi †Ri UvKv 17,257,000.00

10| Ab¨vb¨ cwim¤c`

UvKv 5,60,000.00

5 KvVv Rwg MvRxcy‡i †Q‡ji bv‡g 3,85,000.00

2 KvVv Rwg MvRxcy‡i †g‡qi bv‡g 1,75,000.00

†gvU cwim¤c` = UvKv 1,78,17,000.00

11| ev`t `vqmg~n

(K) m¤c` A_ev Rwg eÜK UvKv -

(L) RvgvbZ wenxb FY`vq UvKv -

(M) e¨vsK FY UvKv 21,56,000.00

(N) Ab¨vb¨ UvKv -

†gvU `vq = UvKv 21,56,000.00

12|

GB Avq erm‡ii †kl Zvwi‡Li bxU m¤c` (†gvU cwim¤ú` n‡Z †gvU

`v‡qi we‡qvMdj) UvKv

13| weMZ Avq erm‡ii †kl Zvwi‡Li bxU m¤c` UvKv 1,40,88,650.00

14|

m¤ú‡`i cwie„w× (µwgK 12 n‡Z 13 Gi we‡qvMdj)

UvKv 5,60,000.00

UvKv 15,72,350.00

15|

(K) cvwievwiK e¨q t [ dig bs AvBwU-10wewe Abyhvqx †gvU LiP ]

(L) cwiev‡ii wbf©ikxj m`m¨ msL¨vt

c~Y© eq¯‹ wkï

16|

m¤ú‡`i †gvU cwie„w× (µwgK 14 Ges 15 Gi †hvMdj ) UvKv

21,32,350.00

17| AwR©Z Znwej mg~nt -

(1) cÖ`wk©Z wiUvb© Avq UvKv 17,18,350.00

(2) Ki Ae¨vnwZ cÖvß I Kigy³ Avq UvKv 4,14,000.00

(3) Ab¨vb¨ cÖvwß UvKv

†gvU AwR©Z Znwej = UvKv 21,32,350.00

18| cv_©K¨ (µwgK 16 n‡Z 17 Gi we‡qvMdj )= UvKv

Avwg wek¦¯’’Zvi mv‡_ †lvlYv KiwQ †h, Avgvi Ávb I wek¦vm g‡Z AvBwU-10we †Z cÖ`Ë Z_¨ mwVK I m¤c~Y©|

Ki`vZvi bvg I ¯̂v¶i

ZvwiLt

* Ki`vZvi wb‡Ri, Zuvi ¯Îx/¯^vgxi (wiUvb© `vwLjKvix bv n‡j),bvevjK I wbf©ikxj mšÍ vb‡`i cwim¤c` I `vq

* cÖ‡qvR‡b c„_K KvMR e¨envi Kiæb|

6

Dcwi-D³ weeiYx‡Z cÖ`k©b Ki‡Z n‡e|

1,56,61,000.00

01

02

AvBwU-10we

cwim¤c`, `vq I e¨q weeiYx (30-06-2016 Zvwi‡L)

Ki`vZvibvgt †gvt mvwKi †nv‡mb wUAvBGbt

1|

(K) e¨emvi cuywR (g~ja‡bi †Ri)

UvKv ---------------

(L) cwiPvjK wnmv‡e wjwg‡UW †Kv¤úvbx‡Z †kqvi wewb‡qvM (µq g~j¨)

UvKv -------------

†Kv¤úvbxi bvg

‡kqv‡ii msL¨v

2| A-K…wl m¤úwË (AvBb m¤§Z e¨qmn µq g~j¨)

t (Rwg/M„n m¤cwË (m¤cwËi weeiY I Ae ’̄vb)

UvKv 1,15,56,000.00

(4 KvVv Rwgi Dci 3q Zjv wewìs

evÇv, ¸jkvb, XvKv)

3|

K…wl m¤úwË (AvBb m¤§Z e¨qmn µq g~j¨) t c~‡e©i b¨vq

UvKv 10,50,000.00

( Rwg (†gvU Rwgi cwigvb I Rwgi Ae ’̄vb)

(5 weNv Rwg wmivRMÄ †PŠnvjx Dc‡Rjvq)

4| wewb‡qvMt

(K) †kqvi/wW‡eÂvi UvKv

(L) mÂqcÎ/BDwbU mvwU©wd‡KU/eÛ

UvKv 5,00,000.00

(M) cÖvBR eÛ/mÂq ¯‹xg

UvKv

(N) FY cÖ`vb UvKv

(O) Ab¨vb¨ wewb‡qvM- fwel¨r Znwej

UvKv 3,60,000.00

†gvU = UvKv 8,60,000.00

5| †gvUi hvb (µqg~j¨) UvKv 26,00,000 .00

†gvUi hv‡bi cÖK…wZ I †iwR‡ó«kb b¤^i

(1500 wmwm U‡qvUv Kvi, bs XvKv g¨vUª-

N 5550)

6|

AjsKvivw` (cwigvb I µqg~j¨) 30 †Zvjv

we‡q‡Z `vbK…Z UvKv

7| AvmevecÎ (µqg~j¨) we‡q‡Z `vbK…Z c~‡e©i b¨vq UvKv 2,50,000.00

40,000.00

8| B‡jKUªwbK mvgMÖx (µqg~j¨) j¨vcUc UvKv 1,70,000.00

9|

e¨emv ewnf©~Z A_© m¤c`

UvKv

(K) bM` UvKv 41,600.00

(L) e¨vs‡K Mw”QZ

UvKv 6,89,400.00

(M) Ab¨vb¨

UvKv

†gvU = UvKv 7,31,000.00

7

dig

AvqKi Aa¨v‡`k, 1984 Gi aviv 75(2)(wW)(AvB) Ges aviv 80 Abymv‡i

e¨w³ Ki`vZvi Rxeb hvÎvi gvb m¤cwK©Z Z‡_¨i weeibx|

Ki`vZvi bvgt †gvt mvwKi †nv‡mb wUAvBGb

µwgK

b¤ ^i

Li‡Pi weeiY UvKvi cwigvY gšÍe¨

1 e¨w³MZ I fib‡cvlb LiP Uvt 180,000.00

2

Dr†m Ki KZ©bmn weMZ A_© erm‡i cwi‡kvwaZ AvqKi

Uvt 1,55,500.00

3

Avevmb msµvb LiP

Uvt

4

e¨w³MZ hvbevnb e¨envi msµvšÍ hveZxq LiP

Uvt 120,000.00

5

AvevwmK we` y¨r wej

Uvt 9,850.00

6

AvevwmK cvwbi wej

Uvt 4,600.00

7

AvevwmK M¨vm wej

Uvt 5,400.00

8

AvevwmK †Uwj‡dvb wej

Uvt

9

mšÍvb‡`i †jLvcov LiP

Uvt 47,000.00

10

wbR e¨‡q we‡`k ågb msµvšÍ LiP

Uvt

11

Drme e¨qmn Ab¨vb¨ we‡kl e¨q, hw` _v‡K

Uvt 30,000.00

‡gvU LiP

Uvt 5,60,000.00

cÖ`Ë Z_¨ mwVK I m¤ú~Y©|

Ki`vZvi bvg I ¯̂v¶i

ZvwiLt

* cÖ‡qvR‡b c„_K KvMR e¨envi Kiæb|

AvqKi wiUvb© cÖvwß ¯̂xKvi cÎ

Ki`vZvi bvgt †gvt mvwKi †nv‡mb Ki ermit 2016-2017

BDwUAvBGb

/wUAvBGbt

dig bs AvBwU-10 wewe

Avwg wek¦¯ÍZvi mv‡_ †lvlYv KiwQ †h, Avgvi Ávb I wek¦vm g‡Z GB AvBwU-10wewe †Z

wb‡R WªvBwfs Kwi

7,650.00

1,69,620.00

PART IIParticulars of Income and Tax

Particulars of Total Income Amount $

TIN

Salaries (annex Schedule 24A)24

25 Interest on securities

S.21

S.22

S.24

S.26

S.28

S.31

S.33

S.43

Income from house property (annex Schedule 24B)26

27 Agricultural income

28 Income from business or profession

(annex Schedule 24C)

29 Capital gains

30 Income from other sources

31 Share of income from firm or AOP

Income of minor or spouse under section 43(4)32

Foreign income33

34 Total income (aggregate of 24 to 33)

Tax Computation and Payment Amount $

Gross tax before tax rebate

Tax rebate (annex Schedule 24D)36

35

37 Net tax after tax rebate

38 Minimum tax

Net wealth surcharge39

40 Interest or any other amount under the Ordinance (if any)

41 Total amount payable

Tax deducted or collected at source (attach proof)42

43 Advance tax paid (attach proof)

44 Adjustment of tax refund [mention assessment year(s) of refund]

45 Amount paid with return (attach proof)

46 Total amount paid and adjusted (42+43+44+45)

47 Deficit or excess (refundable) (41-46)

Tax exempted income48

5 5 1 1 2 2 1 0 5 9 0 1

1,300,000

256,350

12,000

150,000

1,718,350

228,670

59,051

169,620

169,620

140,500

15,000

14,120

The following schedules shall be the integral part of this return and

must be annexed to return in the following cases:

Schedule 24A if you have income from Salaries

Schedule 24B if you have income from house property

Schedule 24C if you have income from business or profession

Schedule 24D if you have investment and claim tax rebate

IT-11GA2016

RETURN OF INCOMEFor an Individual Assesse

photo

-

PART IBasic information

03 Name of the Assessee: Md. Sakir Hossain 04 Gender M √ F

05 Twelve-digit TIN: 551142105908 06 Old TIN

07 Circle: 306 (Salary) 08 Zone-14

09 Resident Status (tick one) Resident √ Non-resident

10 Tick on the box(es) below if you are:

10AA gazetted war-woun-ded freedom fighter 10B A person with disability

10C Aged 65 years or more 10DA parent of a person withdisability

11 Date of birth (DDMMYYYY) 12 Income Year

2015 to 2016

13 If employed, employer’s name: Golden Bangladesh

Spouse Name: Mrs. Rebeka khatun 14 15 Spouse TIN (if any): 55142104102

16 Father’s Name: Md. Moshiur Rahman Mother’s Name: Nurjahan Begum17

18 Present Address: House-6, Road-1, Sector-4, Uttara , Dhaka-1230

19 Permanent Address: Vill. SantosaPost. Stall, Thana. Chowhali , Dist. Sirajganj

20 Contact Telephone: 8951233 21

23

E-mail

Business Identification Numbers22 National Identification Number:2619351961095

01 Assessment Year 02 Return submitted under

2 0 1 6 1 7 section82BB? (tick one)

Yes √ No

0 1 0 3 1 9 6 8

bZzb dig-IT-GHA-2016

ACKNOWLEDGEMENT RECEIPT OFRETURN OF INCOME

Individual

Assessment Year Return under section 82BB? (tick one)

2 0 1 6 1 7-Yes No

Name of the Assessee: Md. Shakir Hossain

Twelve-digit TIN: 551142105908 Old TIN

Circle: 306 (Salary) Taxes Zone: 14

Total income shown (serial 34): 1,718,350

$

Amount payable (serial 41): 172,500 $

Amount paid and adjusted (serial 46):172,500

$

Amount of net wealth shown in IT10B15,661,000 $

Amount of net wealth surcharge paid$

Date of Submission (DD– MM –YYYY) Tax Office Entry Number

Signature and seal of the official receiving the return

Date of Signature Contact Number of Tax Office

2 0

√

49

50

51

52

53

54

PART IIIInstruction, Enclosures and Verification

TIN

Instructions1. Statement of assets, liabilities and expenses (IT-10B) and statement of life style expense (IT-10BB) must be furnished with the return unlessyou are exemptedfrom furnishing such statement(s) under section 80.2. Proof of payments of tax, including advance tax and withholding taxand the proof of investment for tax rebate must be provided along with return.3. Attach account statements and other documents where applicable

If you are a parent of a person with disability, has your spouseavailed the extended tax exemption threshold? (tick one)

Schedules annexed(tick all that are applicable)

24A 24B 24C 24D √

Statements annexed(tick all that are applicable)

IT-10B2016 IT-10BB2016

Other statements, documents, etc. attached (list all)

Are you required to submiit a statement of assets, liabilities and expenses (IT-10B2016) under section 80(1)? (tick one)

Verification and signature

VerificationI solemnly declare that to the best of my knowledge and belief the information given in this return and statements and documents annexed or attached herewith are correct and complete.

Name Signature

Date of Signature (DDMMYY) Place of Signature

2 0

2 0

For official use onlyReturn Submission Information

Date of Submission (DD– MM –YYYY) Tax Office Entry Number

5 5 1 1 2 2 1 0 5 9 0 1

Yes No

Yes No

√ √

√

√

SCHEDULE 24BParticulars of income from house property

Annex this Schedule to the return of income if you have income from house property

01 02Assessment Year: 2016-17 TIN:551142105908

For each house property

03 Description of the house property

03A Address of the property 03B Total area

03C Share of the asessee (%)

Income from house property Amount

Annual Value04

$

05 Deductions (aggregate of 05A to 05G)

05A Repair, Collection, etc.

05B Municipal or Local Tax

05C Land Revenue

05D Interest on Loan/Mortgage/Capital Charge

05E Insurance Premium

05F Vacancy Allowance

05G Other, if any

06 Income from house property (04-05)

07 If case of partial ownership., the share of income

Provide information if income from more than one house property

08 Aggregate of income of all house properties (1+2+3+- - - )(provide additional papers if necessary) $

$

$

$

1 (Income from house property 1)

2 (Income from house property 2)

3 (Income from house property 3)

Name: Md. Sakir Hossain Signature & Date

612,000

153,000

45,600

450

105,600

51,000

256,350

SCHEDULE 24AParticulars of income from Salaries

Annex this Schedule to the return of income if you have income from Salaries

01 Assessment Year: 2016-17 02 TIN: 551142105908

ParticularsAmount Tax exempted Taxable

(A) (B) (C = A-B)03 Basic pay

Special pay

05 Arrear pay (if not included in taxableincome earlier)

04

06

07

Dearness allowance

House rent allowanceMedical allowance08

091011

12

13

14

15

1617

18

19

Deemed income for free furnished/unfurnished accommodation

20

2122

Name: Md. Sakir Hossain Signature & Date

All figures of amount are in taka ($)

Conveyance allowanceFestival Allowance

Allowance for support staff

Leave allowance

Honorarium/ Reward/Fee

Overtime allowance

Bonus / Ex-gratia

Other allowancesEmployer’s contribution to arecognized provident fundInterest accrued on a recognizedprovident fund

Deemed income for transport facility

TotalOther, if any (give detail)

960,000 960,000

384,000 300,000 84,000 84,000 84,000 30,000 30,000

160,000 160,000

96,000 96,000

1,714,000 414,000 1,300,000

SCHEDULE 25tobe annexed to the Statement of Assets, Liabilities and Expenses (IT-10B)

01 02Assessment Year: 2016-17 TIN: 551142105908

03 Shareholdings in limited companies as director No. of shares Value$

1

2

3

4

1

2

3

4

1

2

3

4

04 Non-agricultural property at costvalue or any advance made for

such property (description,location and size)

Value at thestart of

income year$

increased/decreasedduring the

income year$

Value at thelast date of

income year$

Value at thestart of

income year$

increased/decreasedduring the

income year$

Value at thelast date of

income year$

05 Agricultural property at cost value(description, location and size)

(Provide additional paper if necessary)

Name: Md. Sakir Hossain Signature & Date.”;

11,556,0004 Khata Land and 2 Storied Building at Dakkin Khan, Uttara, Dhaka 11556000

5 Acore Land at Sirajganj 1,050,000 1,050,000

SCHEDULE 24DPARTICULARS OF TAX CREDIT/REBATE

TO BE ANNEXED TO RETURN BY AN ASSESSEE CLAIMING INVESTMENT TAX CREDIT(ATTACH THE PROOF OF CLAIMED INVESTMENT, CONTRIBUTION, ETC.)

01 Assessment Year: 2016-17 02 TIN: 551142105908

Particulars of rebatable investment, contribution, etc. Amount

03 Life insurance premium

04 Contribution to deposit pension scheme (not exceeding allowable limit)

05 Investment in approved savings certificate

06Investment in approved debenture or debenture stock, Stock orShares

07 Contribution to provident fund to which Provident Fund Act,1925 applies

08 Self contribution and employer’s contribution to RecognizedProvident Fund

09 Contribution to Super Annuation Fund

10 Contribution to Benevolent Fund and Group Insurance Premiu

11 Contribution to Zakat Fund

12 Others, if any ( give details )

13 Total allowable investment, contribution etc.

14 Eligible amount for rebate (the lesser of 14A, 14B or 14C)

14A Total allowable investment, contribution, etc. (as in 13)25 % of the total income (excluding any income for which a tax exemption or a reduced rate is applicableunder subsection (4) of section 44 or any income fromany source or sources mentioned in clause (a) of sub-section (2) of section 82C.)

14B

14C 1.5 crore

15Amount of tax rebate calculated on eligible amount (Serial 14)under section 44(2)(b)

Name: Md. Sakir Hossain Signature & Date

15,000

60,000

200,000

192,000

467,000

467,000

429,588

59,050

429,588

IT-10B2016

STATEMENT OF ASSETS, LIABILITIES AND EXPENSESunder section 80(1) of the Income Tax Ordinance, 1984 (XXXVI of 1984)

1. Mention the amount of assets and liabilities that you have at the last date of the income year. All items shall be at cost value include legal, registration and all other related costs;2. If your spouse or minor children and dependent(s) are not assessee, you have to include their assets and liabilities in your statement;3. Schedule 25 is the integral part of this Statement if you have business capital or agriculture or non-agricultural property. Provide additional papers if necessary.

01 Assessment Year 02 Statement as on (DDMMYYYY)

03 Name of the Assessee: Md. Sakir Hossain 04 TIN: 551142105908

Particulars Amount

05 Business capital (05A+05B)

05B Director’s shareholdings in limited companies (as in Schedule 25)

05A Business capital other than 05B

06 06A Non-agricultural property (as in Schedule 25)

06B Advance made for non-agricultural property (as in Schedule 25)

2 0 1 6 - 1 7

07 Agricultural property (as in Schedule 25)

08 Financial assets value (08A+08B+08C+08D+08E)

08A Share, debentures etc.

08B Savings certificate, bonds and other government securities

08C Fixed deposit, Term deposits and DPS

08D Loans given to others (mention name and TIN)

08E Other financial assets (give details)

11,556,000

1,050,000

500,000 500,000

500,000

3 0 0 6 2 0 1 6

Verification and signature

Verification I solemnly declare that to the best of my knowledge and belief the information given in this statement and the schedule annexed herewith are correct and complete.

Name Signature and date

09 Motor car (s) (use additional papers if more than two cars)

Sl Brand name Engine (CC) Registration No.

1

2

10 Gold, diamond, gems and other items (mention quantity) 40 Tolla

11 Furniture, equipment and electronic items

12 Other assets of significant value

13 Cash and fund outside business (13A+13B+13C+13D)

3A Notes and currencies

13B Banks, cards and other electronic cash

13C Provident fund and other fund

13D Other deposits, balance and advance (other than 08)

14 Gross wealth (aggregate of 05 to 13)

15 Liabilities outside business (15A+15B+15C)

15A Borrowings from banks and other financial institutions

15B Unsecured loan (mention name and TIN)

15C Other loans or overdrafts

16 Net wealth (14-15)

17 Net wealth at the last date of the previous income year

18 Change in net wealth (16-17)

19 Other fund outflow during the income year (19A+19B+19C)

19A Annual living expenditure and tax payments (as IT-10BB)

19B Loss, deductions, expenses, etc. not mentioned in IT-10BB

19C Gift, donation and contribution (mention name of recipient)

20 Total fund outflow in the income year (18+19)

21 Sources of fund (21A+21B+21C)

21A Income shown in the return

21B Tax exempted income and allowance

21C Other receipts and sources

22 Shortage of fund, if any (21-20)

2,600,000

40,000

420,000

560,000

1,091,000 1,091,000

41,600

689,400

360,000

17,817,000

2,156,000

2,156,000

2,156,000

15,661,000

14,088,650

1,572,350

560,000

560,000

560,000

2,132,350

2,132,350 2,132,350

1,718,350

414,000

IT-10BB2016

STATEMENT OF EXPENSES RELATING TO LIFESTYLEunder section 80(2) of the Income Tax Ordinance, 1984 (XXXVI of 1984)

01 Assessment Year 02 Statement as on (DDMMYYYY)

03 Name of the Assessee: Md. Sakir Hossain 04 TIN: 551142105908

Particulars Amount Commen

05 Expenses for food, clothing and other essentials06 Housing expense07 Auto and transportation expenses (07A+07B)

07A Driver’s salary, fuel and maintenance

07B Other transportation08 Household and utility expenses (08A+08B+08C+08D)

08A Electricity08B Gas, water, sewer and garbage08C Phone, internet, TV channels subscription08D Home-support staff and other expenses

09 Children`s education expencess

10 Special expenses (10A+10B+10C+10D)

10A Festival, party, events and gifts

10B Domestic and overseas tour, holiday, etc.

10C Donation, philanthropy, etc.

10D Other special expenses

11 Any other expenses12 Total expense relating to lifestyle (05+06+07+08+09+10+11)13 Payment of tax, charges, etc. (13A+13B)

13A Payment of tax at source

13B Payment of tax, surcharge or other amount

14 Total amount of expense and tax (12+13)

Verification and signature

Verification I solemnly declare that to the best of my knowledge and belief the information given in this statement and the schedule annexed herewith are correct and complete.

Name Signature and date

2 0 1 6 - 1 7 3 0 0 6 2 0 1 6

180,000

120,000

120,000

27,500

9,850 10,000

7,650

30,000

30,000

47,000

404,500

155,500

140,500 15,000

560,000