INCOME TAX STATEMENT 2015-16 Office Ref No 99
Computation of Salary Income for the Financial Year 2015-16
( Assessment Year -2016-17)
Name : PAN :
Designation :
1 a Gross Salary
(includes Salary, DA, HRA, CCA, Interim Relief, OT Allowance, Deputation Allowance, Med Allowance, DA Arrear,
Pay Revision Arrear etc) :
b Value of Perquisites
c Profits in lieu of salary under section 17(3)
d Leave Surrender :
e Festival Allowance / Bonus / Ex-gratia and incentive : OCT
g Total Salary Income (a+b+c+d+e) :
2 Deduct HRA in the case of persons who actually incur expenditure by way of Rent
i) Actual HRA Received :
ii) Actual Rent paid in excess 1/10th of the salary : ( Total Rent Paid for FY 2015 -16 is
iii) 40% Salary ( For this salary means Basic + DA) : Rs.__________)
(i) to (iii) whichever is least is exempted :
3 Balance ( 1- 2) :
4 Allowance to the extent exempt u/s 10 : :
5 Deduct
a) Entertainment Allowance
b) Profession Tax Paid : :
6 Net Salary Income 3-(4+5) :
Any other income ie; Income from House Property, Business, Capital
7 Gains or other Sources (Interest on Housing loan is treated as loss :
from House property)
8 Gross Total Income (6+7) :
9 A - Deduction under section 80C
a) Life Insurance Premia of self, spouse and children :
b) Family Benefit Scheme :
c) GIS & SLI :
d) HBA Principal and Otherdeductions :
e) Group Personal Accident Insurance Scheme (GPAIS) :
f) Contribution towards General Provident Fund :
g) :
h) :
i) :
j) :
B Contribution to Pension Fund (80CCC) :
C Contribution to Pension Fund Scheme of Central Govt (80 CCD) :
Total Deduction u/s 80 C, 80CCC & 80 CCD is
10 D. investment in Infrastructre Bonds approved by Government :
(80CCF) - Maximum Rs. 20,000
11 E. Deduction under other sections of Chapter VI A
a) Mediclaim ( Maximum of Rs.15,000 for self, spouse, dependent
children and Rs.15000 for Parents. if Parents are senior citizens Rs. :
20,000)
b) Expenditure on Medical treatment of mentally or physically
handicapped dependents (including the amount deposited in
:
their name. ( Max. Rs.50,000/- in case of severe disability max.
Rs.1,00,000)
c) Expenditure incurred on medical treatment of the employee
for specified diseases or ailment like cancer, AIDS, etc. ( Max.
:
Rs.40,000/- in case of treatment is made to a person who is a
senior citizen Rs.60,000)
d) Any amount of interest paid for Educational Loan taken from
Bank or approved institution for higher education of the :
employee's dependent children [u/s 80E]
e) Donation to various charitable and other funds including
PM's National Relief Fund, Gujarat Earthquake Relief Fund. :
Etc
f) Contribution made to Political Party :
g) Dedution for Handicapped Employees u/s 80U :
Total of (a) to (g)
12 Total Deduction (9+10+11)
13 Total Income rounded to the nearest multiple of ten u/s 288A ( No Taxable Income )
14 Tax on Total Income :
15 Less : Tax Credit (u/s 87 A) :
16 Tax on Total Income After availing Tax credit : Nil
17 Education Cess @ 3% of item 16 : Nil
18 Total Tax Payable (16+17) : Nil
19 Less : Relief for Arrears of Salary u/s 89(1) :
20 Balance Tax Payable (18-19) Rounded to nearest multiples of ten u/s 288B : Nil
21 Amount of Tax already deducted from salary :
22 Balance Income Tax to be paid : Nil
Signature :
Place:
Name :
Designation :
Date :
Office :
DECLARATION
I, …………………………………………………………………………, do hereby declare that I am actually incurring expenditure towards payment of rent of
my residential accommodation to House No: ......................... Place : ........................................... and that the amount of rent actually paid by
me during ............................................. is Rs. ..........................................................
Place : .......................................... Signature :
Date : ........................................... Name, Designation & Office :
PARTICULARS OF SALARY DRAWN in rupees
Earnings Deductions
Month GPAIS
FBS &
Pay DA HRA LOP (-) PA CA MA Total EPF LIC & Total
HBA
Other
Apr-15
May-15
Jun-15
Jul-15
Aug-15
Sep-15
Oct-15
Nov-15
Dec-15
Jan-16
Feb-16
Mar-16
Deducted Month SEP OCT NOV DEC JAN FEB MAR Total Deduction
Amount to be deducted in Rupees
COLUMN TOTAL of Pay, DA, HRA, LOP, PA, CA, MA, EPF, LIC
Total
Place :
Date : Signature of Head of the Institution
Income Slab Tax Rate
Taxable income < Rs. 2,50,000 Nil
Rs. 2,50,000 < Taxable income < Rs. 5,00,000 10% of the amount above and over 2,50,000.
Rs. 5,00,000 < Taxable income < Rs. 10,00,000 Rs. 25,000 + 20% of the amount by which the taxable income exceeds Rs. 5,00,000
Taxable income > Rs. 10,00,000 Rs. 1,25,000 + 30% of the amount by which the taxable income exceeds Rs. 10,00,00
