INCOME TAX CALCULATION STATEMENT FOR THE …

1 EMPLOYEE CODE NO::::1: House Rent Allowance: Total Salary: of the following:a) Actual rent paid: Rs.: ) 50% of salary including DA: ) HRA received: : : Rs.: Rs.: Rs.: : : Rs.: : ) Tax on employment (PT )b) Interest on borrowed capital invested in self occupied residential house ) Maximum at ,000/- for the loan taken before (or)PAN NUMBER (MANDATORY)Gross INCOME from salary (Balance 3-4)DEDUCTIONS UNDER SECTION-16: INCOME TAX CALCULATION STATEMENT FOR THEFINANCIAL YEAR 2017-2018 Total salary (Pay+GrP+PP+Spl. Pay+DA+CCA+Surrender leave salary and arrears, if any drawn)b) Rent paid in excess of 10% of salary (Including DA)LESS: ALLOWANCE UNDER (13A)NAME AND DESIGNATIONb) Perquisite in respect of reimbursement of medical expenses in excess of in view of (2)(V)(Limited )Gross Total INCOME (7+8)ii) Maximum at ,00,000/- for the loan taken after Chargeable under the head "Salaries" (5-6)ADD: Any other INCOME reported by the employeea) INCOME from House property and INCOME from other sourcesDIVISION10I: ) CPS Employees Contribution (Not exceeding ,000/-): Rs.

2 : Rs.: Rs.: Rs.: Rs.: ) Jeevan Akshay / Jeevandhara: ) & Mutual Fund Investment: ) Infrastructure Bond: ) CTD for 10 years/15 years: Rs.: Rs.: SUBJECT TO A LIMIT OF ,50,000/- (a to n)II: : : : Rs.: Rs.(Proof and evidence to be enclosed for the above deductions): INCOME Chargeable to Tax(Rounded to nearest 10 Rupees): for repayment of interest on loan taken for higher education for self or spouse or children ( )Deduction of expediture for medical treatment of persons or dependents with disability (80DD) upto and ,25,000/- for severe in respect of donation to Prime Minister/Chief Minister's relief fund (80G)TOTAL OF I TO VII IN COLUMN 10 TOTAL INCOME (9-10)Investment made under an equity savings scheme (80 CCG) (50% of amount invested in equity shares - Maximum limit ,000/.

3 A scheme named Rajiv Gandhi Equity Savings Scheme notified for this purpose - Conditions: Gross INCOME does not exceed lakhs, If deduction claimed in any year he/she shall not be entitled to any deduction for any subsequent year), this investment is locked in for 3 years from the date of upto ,000/- / ,25,000/- for physically handicapped morethan 50% / 80% respectively( )(Copy of certificate to be enclosed)Deduction in respect of medical treatment ( ) for self or dependents for severe ailments certified by specialistsn) Contribution to any annuity plan of LIC or any other Insurer forreceiving pension from the Fund for a sum not exceeding ,50,000/- under Section 80 CCC (for existing policy holders)m) Investment as a term deposit for a fixed period of not less than fiveyears with a Schedule BankDeduction of premium upto ,000/- paid any mode other than cash Medical Insurance (for Senior Citizen ,000/-) UNDER CHAPTER VI-Aa) (Only subscription)c) FSF + SPF + HBA SPFh) VIII ) Refund of ) Tution Fees paid to Educational Institution situated in India for fulltime education of any two children (University, College, School or other educational institution)f) Public Provident Fundg) / - Premium12 TAX ON TOTAL INCOME : Where the total INCOME doesnot exceed ,50,000/-:NIL2.

4 Where the total incomeexceeds ,50,000/- but does not exceed ,00,000/-:5 per cent of the amount by which the total INCOME exceeds ,50,000/-: Where the total incomeexceeds ,00,000/- but does not exceed ,00,000/- ,500/- plus 20 per cent of the amount by which the total INCOME exceeds ,00,000/-: Where the total incomeexceeds ,00,000/- ,12,500/- plus 30 per cent of the amount by which the total INCOME exceeds ,00,000/-: : TAX: Where the total INCOME doesnot exceed ,00,000/-:NIL2. Where the total incomeexceeds ,00,000/- but does not exceed ,00,000/-:5 per cent of the amount by which the total INCOME exceeds ,00,000/-: Where the total incomeexceeds ,00,000/- but does not exceed ,00,000/- ,000/- plus 20 per cent of the amount by which the total INCOME exceeds ,00,000/-: Where the total incomeexceeds ,00,000/- ,10,000/- plus 30 percent of the amount by which the total INCOME exceeds ,00,000/-: : TAX: Where the total INCOME doesnot exceed ,00,000/-:NIL2.

5 Where the total incomeexceeds ,00,000/- but does not exceed ,00,000/-:20 per cent of the amount by which the total INCOME exceeds ,00,000/-3. Where the total incomeexceeds ,00,000/- ,00,000/- plus 30 per cent of the amount by which the total INCOME exceeds ,00,000/-TOTAL OF OF THE TAX PAYABLE FOR INDIVIDUALS HAVING TOTAL INCOME UPTO ,50,000/- (SECTION 87A)REBATE OF OF THE TAX PAYABLE FOR INDIVIDUALS HAVING TOTAL INCOME UPTO ,50,000/- (SECTION 87A)NORMAL RATES OF TAX:RATES OF TAX FOR INDIVIDUAL RESIDENT IN INDIA WHO IS OF THE AGE OF 80 YEARS OR MORE AT ANY TIME DURING THE financial YEARRATES OF TAX FOR INDIVIDUAL RESIDENT IN INDIA WHO IS OF THE AGE OF SIXTY YEARS OR MORE BUT LESS THAN EIGHTY YEARS AT ANY TIME DURING THE financial YEAR13: : : : : SIGNATURE: NAME: DESIGNATION:Tax paid upto January 2018 ADD: Education Cess at 2% on INCOME tax payableADD.

6 Secondary & Higher Education Cess at 1% on INCOME Tax---Balance tax to be deducted in February 2018(Certificate which are not required should be scored off)Certified that all the INCOME derived and chargeable under the head salaries during 2017-2018 has been included in the statementCertified that I am occupying rental house and paying monthly rent of Rs.(Rent receipt enclosed)Certified that I am paying a sum of Rs. Towards LIC & PLI premium and the policies are kept aliveCertified that a sum of Rs. is being paid by me towards CTD and the cumulative time is for 10/15 years CERTIFICATEC ertified that I reside in my INCOME Tax STATEMENT should be submitted to the Administrative Officer on or before 6th February 2018 IMPORTANT NOTETOTAL10% of basic salary ( Pay + Gr.)

7 Pay + DA) alone has to be computed for the purpose of arriving at the CALCULATION for exemption under HRAE mployees who are claiming HRA exemption of more than ,000/- have to produce rent receipt. The actual rent paid is subject to verificationPARTICULARS OF DEPOSITS TOWARDS AKSHAY/ JEEVAN THARA DURING THE financial YEAR 2017-2018 TOTALPost OfficeIssue No. and of DepositAccount of DepositPlace of DepositAmount Rs. insured Rs. of premium per annum Rs. OF of OF PREMIUMP olicy of the Company2 AmountNAME:MONTHPAY + GP + SPL. PAYDAHRACCACash Allow/ - ARR-IDA - ARR-IIBONUS / ADHOC BONUSOTHERSTOTALSIGNATURE:: DRAWN PARTICULARS FOR THE YEAR 2017-2018 DESIGNATION.