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Phone No
Bank A/C No :
1.
2.
3.
4.
5.
6.
7.
8.
0
Department
0
0
Cell No
MICR code No : 0
Accured interest on housing loan for self occupied house property(HBA U/S 24(i)) (up to max 1,50,000)
TOTA
Counter Signed
Signature of Em
Head of Office
IMPORTANT NOTE
1.
The salary bill for febrauary - 2015 shall be presented along with the pre-checked income tax statement of
for Feb. 2015 with income statement without precheck by this office will be returned with a request to pres
80-G Donation
I.
Donations made through employer such as Gujarat Relief fund alone can be considered by employer.
be considered while filing the return of income
7.
80 TTA. Where the gross total income of an individual or a HUF includes an income of interest on deposits
bank, a co-op society carrying a banking business or a post office, such interest income up to Rs. 10,000 is
8.
When total income of the Resident Individual does not exceed Rs. 5 Lakhs, Rebate U/S 8A = 100% of Tax p
Note:
Taxable income less than Rs. 5,00,000/- can be filed return of income with the Department.
TAX PAID
SI NO
TDS
Rs.
BILL DATE
CHALLAN
Nature of Policy
Amount In
Issue No
N.S.C Number
TOTA
DETAILS OF INTEREST ACCURED ON N.S.C (VIII ISSUE)
NSC & Name of Post
Office
TOTA
Particulars of details towards Infrastructure Bonds
Nature of Deposit
Account No.
Date of Deposit
Place of D
THE
FINANCIAL YEAR 2014-2015 (ASST. YEAR 2015-2016)
ST BUTTON OR ENTER MANUALLY
PAN
TAN
:
:
0
CHOOSE FROM LIST BUTTON
0 Pin
Branch :
#N/A
0
Rs.
Rs.
598266
A)
0
56775
0
0
227100
0
598266
598266
2636
0
0
0
0
595630
595630
595630
Pension
0
360
0
FILL
FILL THE
THE MAXIMUM
MAXIMUM ELIGIB
ELIGIB
ACCORDINGLY
ACCORDINGLY
Bank
,50,000/-)
360
1800
595270
icapped dependent)
{Note-7}
lity cases)
TOTAL
upees)
nearest rupee)
1800
593470
593470
25000
18694
0
43694
43694
0
43694
cess @ 1% on col.No. 13
1311
45005
m No. 10E)
45005
0
11000
330
19a)]
33675
0
PORTANT NOTE
ildren
,000/- for Senior Citizen) whichever is less. Copy of the bills &
. 5 Lakhs, Rebate U/S 8A = 100% of Tax payable or Rs. 2000 whichever is less
10
TAX PAID
BILL DATE (or)
CHALLAN DATE
BSR CODE
TOTAL
sed during the financial year 2013-2014
N.S.C Number
0
Amount Insured
Rs.
TOTAL
T ACCURED ON N.S.C (VIII ISSUE)
Rate of Interest (%)
Ps.
0
Amount
Rs.
TOTAL
ls towards Infrastructure Bonds
Ps.
0
Amount
Rs.
Place of Deposit
11
Ps.
TOTAL
12
STATEMENT SHOWING SALARY DRAWN DURING THE PERIOD FROM MARCH 2014 TO FEBRAUARY 2015
BANK ACCOUNT NO :
NAME
PAN NO
:
RESIDENTIAL ADDRESS WITH PI
BRANCH
FATHERS NAME
:
PHONE NO :
:
DATE OF BIRTH
CELL NO
:
MICR NO
:
TAN NO
:
Format: dd/mm/yyyy 0R mm/dd/yyyy DEPENDING
ON YOUR COMPUTER'S DATE SETTING
PAY DRAWN
TOTAL
RECOVERIES
Salary for the month
GRADE
OTHERS (IT
SP
OTHERS
Pay
D.A
HRA
CCA
MA
OA
GPF/CPF
FBF
SPF
CF
HF
ADV IT
PT
PAY
Mar-14
April
May
June
July
August
September
October
November
December
Jan-15
Feb-15
DA Arrears 1
DA Arrears 2
Bonus/Pongal gift
17530
17530
17530
17530
17530
17530
17530
17530
17530
17530
17530
17530
5400
5400
5400
5400
5400
5400
5400
5400
5400
5400
5400
5400
CESS)
20637
22930
22930
22930
22930
22930
22930
24535
24535
24535
24535
24535
6879
4815
1400
1400
1400
1400
1400
1400
1400
1400
1400
1400
1400
1400
360
360
360
360
360
360
360
360
360
360
360
360
300
300
300
300
300
300
300
300
300
300
300
300
100
100
100
100
100
100
100
100
100
100
100
100
300
300
300
300
300
300
300
300
300
300
300
300
1000
PAY ARREAR
Surrender leave salary
INCREMENT ARREAR
Duty Allowance
Over Coat Allowance
CMHIS
Total
GROSS SALARY
HRA(exclu. surrender)
PT Paid
GPF
210360
598266
16800
2636
0
FBF
SPF
HF
64800
360
0
1800
292586
16800
4320
ADV IT
MEDICLAIM
3600
1200
11000
3600
1000
46027
48320
48320
48320
48320
48320
48320
49925
49925
49925
49925
49925
6879
4815
1000
0
0
0
0
0
0
0
598266
0
0
0
0
0
0
0
0
0
0
0
0
30
30
30
30
30
30
30
30
30
30
30
30
0
0
0
0
0
0
0
0
0
0
0
0
10
10
10
10
10
10
10
10
10
10
10
10
150
150
150
150
150
150
150
150
150
150
150
150
1000
1000
1000
1000
1000
1000
1000
1000
1000
1000
1000
1318
1318
30
30
30
30
30
30
30
30
30
30
30
360
120
1800
11000
2636
330
TOTAL
TOT
1220
1220
1220
1220
1220
2538
1220
1220
1220
1220
2538
190
0
0
0
0
0
0
0
0
0
0
16246
IT Cess Deducted
330
SIGNATURE OF THE EMPLOYEE
Counter signed
HEAD OF OFFICE
NOTES: The HRA drawn for surrender leave salary should not be taken in to account for the purpose of claiming rebate (i.e.) exemption under HRA. kindly fill up Date of Birth, Pan No, Bank A/c, Residential Address
44807
47100
47100
47100
47100
45782
47100
48705
48705
48705
47387
49735
6879
4815
1000
0
0
0
0
0
0
0
582020