MONTHLY SALARY & OTHER INCOME STATEMENT : 2008-09

NAME SHIVAJI S. VAGH INC.MTH 5 BASIC 7950 HRA(Y/N) Y MA (Y/N) Y HANDI ? N Prof.Tax ? Y PAN No.
DESIG. DY. MAMLATDAR SEX : M INC.AMT 175 SCAL_ID 5500-9000
8 CLA(Y/N) Y TA (Y/N) Y HANDI % GIS :- BB AAZPV4998F

DA/DP/
BASIC D.P.

DA RATE

HRA RATE
SR. MONTH & YEAR D.A. HRA CLA MA W.A SP. PTA TRAN. GROS I-TAX PROF GIS- GIS-F GPF GPF. HBA HBA- TOT NET Days

RENT OF
BUILD
HRA/CLA
Diff.
NO. PAY ALL S F. I AD -PRI. INT DEDU
TAX V
1 MAR 2008 7950 3975 4889 1789 180 100 0 0 0 75 0 18958 0 0 80 60 140 3500 0 0 0 3780 15178 41 15 31

2 APR 2008 7950 3975 5605 1789 180 100 0 0 0 75 0 19674 0 0 200 60 140 3500 0 0 0 3900 15774 47 15 30

3 MAY 2008 8125 4063 5728 1828 180 100 0 0 0 75 0 20099 0 0 200 60 140 3500 0 0 0 3900 16199 47 15 31

4 JUN 2008 8125 4063 5728 1828 240 100 0 0 0 75 0 20159 0 0 200 60 140 3500 0 0 0 3900 16259 47 15 30

5 JUL 2008 8125 4063 5728 1828 240 100 0 0 0 75 0 20159 0 0 200 60 140 3500 0 0 0 3900 16259 47 15 31

6 AUG 2008 8125 4063 5728 1828 240 100 0 0 0 75 0 20159 0 0 200 60 140 3500 0 0 0 3900 16259 47 15 31

7 SEP 2008 8125 4063 5728 1828 240 100 0 0 0 100 0 20184 0 0 200 60 140 3500 0 0 0 3900 16284 47 15 30

8 OCT 2008 8125 4063 5728 1828 240 100 0 0 0 100 0 20184 0 0 200 60 140 3500 0 0 0 3900 16284 47 15 31

9 NOV 2008 8125 4063 5728 1828 240 100 0 0 0 100 0 20184 0 0 200 60 140 3500 0 0 0 3900 16284 47 15 30

10 DEC 2008 8125 4063 5728 1828 240 100 0 0 0 100 0 20184 0 0 200 60 140 3500 0 0 0 3900 16284 47 15 31

11 JAN 2009 8125 4063 5728 1828 240 100 0 0 0 100 0 20184 0 0 200 60 140 3500 0 0 0 3900 16284 47 15 31

12 FEB 2009 8125 4063 5728 1828 240 100 0 0 0 100 0 20184 0 0 200 60 140 3500 0 0 0 3900 16284 47 15 28

13 01/08 TO 3/08 0 0 2148 0 0 0 0 0 0 0 0 2148 0 0 0 0 0 0 0 0 0 0 2148

D.A.DIFF.
14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

16 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TOTAL 97150 48580 69922 21858 2700 1200 0 0 0 1050 0 242460 0 0 2280 720 1680 42000 0 0 0 46680 195780

OTHER INCOME 0 OTHER SAVINGS AMT. RS. OTHER SAVINGS AMT. RS. Ded. under Chapter VI-A HOUSING LOAN
P.P.F 0 TUTION FEES 0 MEDI CLAIM 0 AFTER 1/4/99 ? Y/N N
LESS:H.R.A U.L.I.P 0 MUTUAL FUND 0 C.M. FUND 0 PRINCIPAL 0
Atual Rent Paid L.I.C + Jivan Suraksha 0 ANY BONDS 0 INTEREST 0
Atual HRA Received 0 P.L.I. 0 P.O.T.D 0 (SHIVAJI S. VAGH)
40% of Salary 0 NSC NEW 0 DY. MAMLATDAR
 INCOME TAX STATEMENT FOR THE FINANCIAL YEAR 2008-2009
Name :- SHIVAJI S. VAGH IT P.A.No. Assmt. Year SEX PH.HANDI.
Designation.:- DY. MAMLATDAR AAZPV4998F 2009-10 MALE NO
01 SALARY INCOME :- Rs. Rs.
(a) Pay + Sp. Pay. 97150 B/F. 241410
(b) D.P. 48580 (g) Transporting Allowance 1050
(c) D.A. 69922 (h) DA/DP/HRA/CLA Difference. 0
(d) H.R.A. 21858 (i) R.F.Acco. 0
(e) C.L.A. 2700 (j) P.T.A. 0
(f) M.A. 1200 (k) W.A. 0
C/F. 241410 Total 242460
02 GROSS INCOME 242460
03 LESS :
(a) Professional Tax [u/s 16(iii)] 2280
(b) Transport Allowance [u/s16(iii)] 1050
Total [a + b] 3330
04 ADD : Any Other Income (Exa./ Remuneration / NSC Int. etc) 0
05 LESS : House Rent u/s 10 0 0
(1) Actual rent paid in excess of @ 10% of salary or salary=pay+dp+da 0
(2) Actual HRA Recd. 0
(3) 40% of salary or (pay+Dp+Da) which ever is less 0
06 LESS : H.B.Loan Interest Max. Rs.150000/- u/s 24 (Cond. cost. after 0 0
1.4.99 or loan to be taken for house after 1.4.99, otherwise Rs. 30000)
07 Deduction under Chapter VI-A
(a) Medi. Claim Insu.Premium U/s.80-D 0
(b) P.T.A. 0
(c) Chief Min. Relief Fund./ Donation u/s 80(g)(5) 0
(d) Physical Handicaped u/s 80DD(1) or 80-U [Ristricted to Rs.50000/-] 0
if desability is more than 80% dedu. is Rs.75000/-
Total Excemption ( Col. 7(a) to 7(e) 0
NET INCOME:............. 239130
08 LESS : 96984 Rs.
(a) Savings upto 1 Lacs u/s 80-C
(1) G.P.F. 42000
(2) P.P.F. 0
(3) U.L.I.P. 0
(4) L.I.C. Premium + Jivan Suraksha Plan 0
(5) NSC(VIII) Series (New) 0
(6) P.L.I. 0
(7) State Group Insurance 2400
(8) Repayment of Hsg.Loan 0
(9)Tution fees [Excluding donation or development fee] 0
(10) P.O.T.D. 0
(11) Mutual Fund u/s 23-V MEP 98-99 0
(12) Any Bonds 0
Total ( a(1) to a(11) 44400 44400
09 TAXABLE INCOME 194730 i.e. 194730
10 INCOME TAX ON TAXABLE INCOME 4473
11 ADD: Educational Cess Tax on Income Tax @ 3% 134
13 I Tax & E.C. Payable for F.Y.2008-09 4607
14 Tax Deduction from Paybill (Mar'08 to Jan'09) 0
15 Tax Payable from February'09 Paybill. 0
16 Total Tax Deduction for F.Y.2008-09 0
17 I.TAX PAYABLE(+) /REFUNDABLE (-) 4607
PLACE : Surat (SHIVAJI S. VAGH)
DATE:- / /2009 SIGN. OF DRAWING OFFICER SIGN. OF EMPLOYEE
 DETAILS REGARDING SAVINGS IN THE FINANCIAL YEAR 2008-2009
SR.NO. POLICY NO. NATURE OF PREMIUM AMOUNT OF PREMIUM TOTAL
AMOUNT
1
2
3
4
5
6
7
8
9
10
TOTAL
N.S.C. DETAILS
SR.NO. N.S.C. NUMBER DATE AMOUNT
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
TOTAL
RATE OF INCOME TAX - 2008-2009
UP TO 1,50,000/- ----N I L----
RS. 1,50,000/- BUT DOES NOT EXCEED RS.3,00,000/- 10% OF THE AMOUNT EXCEEDING RS.1,50,000/-
RS. 3,00,000/- BUT DOES NOT EXCEED RS.5,00,000/- 20 % OF THE AMOUNT EXCEEDING Rs.3,00,000/-+15000/-
ABOVE RS.5,00,000/- 30 % OF THE AMOUNT EXCEEDING Rs.5,00,000/-+55000/-
RATE OF INCOME TAX - 2008-2009 In Case of Female
UP TO 1,80,000/- ----N I L----
RS. 1,80,000/- BUT DOES NOT EXCEED RS.3,00,000/- 10% OF THE AMOUNT EXCEEDING RS.1,80,000/-
RS. 3,00,000/- BUT DOES NOT EXCEED RS.5,00,000/- 20 % OF THE AMOUNT EXCEEDING Rs.3,00,000/-+12000/-
ABOVE RS.5,00,000/- 30 % OF THE AMOUNT EXCEEDING Rs.5,00,000/-+52000/-
NSC INTREST (PER RS.100/-)
YEAR 1/1/1999 1/15/2000 3/1/2001 3/1/2002 3/1/2003
TO TO TO TO TO
1/14/2000 2/28/2001 2/28/2002 2/28/2003 ONWARDS
1ST 11.83 11.30 9.72 9.20 8.16
2ND 13.23 12.58 10.67 10.05 8.83
3RD 14.80 14.00 11.71 10.97 9.55
4TH 16.54 15.58 12.85 11.98 10.33
5TH 18.51 17.85 14.10 13.09 11.17
6TH 20.69 19.31 15.47 14.29 12.06

(SHIVAJI S. VAGH)
SIGN. OF DRAWING OFFICER SIGN. OF EMPLOYEE
SCALSC1 SCAL T.A Old-DA
1 2500-3200 2550-55-2660-60-3200 100 200 JAN 2004 59
2 2610-3540 2610-60-3150-65-3540 100 200 FEB 2004 59
3 2650-4000 2650-65-3300-70-4000 100 200 MAR 2004 59
4 3050-4590 3050-75-3950-80-4590 100 200 APR 2004 59
5 4000-6000 4000-100-6000 100 200 MAY 2004 59
6 4500-7000 4500-125-7000 100 200 JUN 2004 59
7 5000-8000 5000-150-8000 100 200 JUL 2004 61
8 5500-9000 5500-175-9000 100 200 AUG 2004 61
9 6500-10500 6500-200-10500 400 800 SEP 2004 61
10 8000-13500 8000-275-13500 800 1600 OCT 2004 61
11 8000-14050 8000-275-14050 800 1600 NOV 2004 61
12 8500-14100 8500-275-14100 800 1600 DEC 2004 61
13 10000-15200 10000-325-15200 800 1600 JAN 2005 61
14 12000-16500 12000-375-16500 800 1600 FEB 2005 61
15 14300-18300 14300-400-18300 800 1600
16 18000 FIXED 18000 FIXED 800 1600
17 16000-20050 16000-450-20050 800 1600
18 18400-22400 18400-500-22400 800 1600
19 15100-18300 15100-400-18300 800 1600

AB 81AB=120/280 120.00 280.00

BB 81BB=60/140 60.00 140.00
CB 81CB=30/70 30.00 70.00
DB 81DB=15/35 15.00 35.00
New DA GIS-I GIS-F
61
61
61
61
61
61
64
64
64
64
64
64
64
64
Certificate under section 203 of the income-tax Act.1961 for tax deducted at FORM NO.16
source fromincome chargeable under the head "Salaries" (See rule 31(1)(a)
Name and Address of the Employer . Name and Designation of the Employee.
GOVT. OF GUJARAT SHIVAJI S. VAGH
Collectorate, Surat DY. MAMLATDAR
PAN/GIR NO. SRTC00718E TAN PAN/GIR NO. AAZPV4998F SEX MALE
TDS Circle where Annual Return/Statement under Period Assmt. Year Phy. Handicaped
section 206 is to be filed 01/4/2008 TO 31/3/2009 2009-10 NO
I.T. OFFICER, AYAKAR BHAVAN, SURAT
DETAILS OF SALARY PAID AND ANY OTHER INCOME AND TAX DEDUCTED
Rs. Rs. Rs. Rs.
1. GROSS SALARY* 242460
2. Less Allw. to the extent exempt u/s10
(a) P.T.A. 0
(b) House Rent 0
Total (2a + 2b) 0
3. BALANCE (1-2) 242460 242460
4. DEDUCTION :
(a) Trans. Allo. 1050
(b) Tax on Employment 2280
5. Agregate of 4 (a to b) 3330 3330
6. INCOME CHARGEABLE UNDER THE HEAD SALARIES (3-5) 239130
7 ADD Any other income reported by the employee (NSC INT.) 0
8 Less: loss from house property (Interest for Housing Loan U/S 24) 0
9. GROSS TOTAL INCOME 239130
10 DEDU. UNDER CHAPTER VI-A Gross Amt. Quali. Amt. Dedu.Amt.
(a) Medi. Claim u/s 80(D) 0 0 0
(b) C.M. Fund u/s 80(G)(5) 0 0 0
(c) Phy.Handi. u/s 80DD1,80-U 0 0 0
11 Aggregate of deductible amount under Chapter VI-A 0
REBATE AT RELIEF UNDE CHAPTER VIII
Under Section 80 (Please specify) Gross Amt. Quali.Amt. Tax Reb.Rel.
(a) G.P.F 42000
(b) P.P.F 0
(c) U.L.I.P 0
(d) L.I.C + Jivan Suraksha Plan 0
(e) N.S.C. VIII Series 0
(f) P.L.I. 0
(g) State Group Insurance 2400
(h) Repayment of Housing Loan 0
(i) Tution Fees 0
(j) P.O.T.D. 0
(k) Mutual Fund (MAP 98-99) 0
 (l) Any Bond 0
Total (a) to (k) 44400 44400
12. TOTAL TAXABLE INCOME 194730 194730
13 INCOME TAX ON TAXABLE INCOME 4473
14 ADD: Educational Cess Tax on Income Tax @ 3% 134
15 INCOME TAX AND E.C. PAYABLE FOR 2008-09 4607
16 LESS : TAX DEDUCTED AT SOURCE 0
17 TAX PAYBLE 4607

DETAILS OF DEDUCTED AND DEPOSITED INTO CENTRAL GOVERNMENT ACCOUNT

SR. AMOUNT DATE OF NAME OF BANK AND BRACH WHERE TAX DEPPOSITED
NO. PAYMENT
1
2
3
4
5
6
7
8
9
10
11
12
Total
Certified that a sum of Rs
has been deducted at source and paid to the credit of the Central Government. Further
certified that the above information is true and correct as per records.

Signature of the Person resposible for deduction of tax

Place : Surat
Date: Full name :
Designation :
* See section 15 and 17 and rule 3 Furnish separate details of value of the perquisites
and profits in lieu of or in addition to salary or wages.
 INDIAN INCOME TAX RETURN ASSESMENT YEAR
FORM
[For Indivisuals having Income from Salary / Pension / family pension) & Interest]
ITR-1 ( Please see Rule 12 of the Income-tax Rules, 1962)
2 0 0 9 - 1 0
( Also see attached instruction )
First Name Middle Name Last Name PAN
PERSONAL INFORMATION

SHIVAJI SHANKARRAO VAGH A A Z P V 4 9 9 8 F

Flat/Door/Block No Name Of Premises/Building/Village Date of Birth [ DD/MM/YYYY]
7/4301-2 3/10/1962
Road/Street/Post Office Area / Locality Employer Category(Tick) √
SUTHAR FALIA GALEMANDI √ Govt PSU Other
Town/City/District State Pin code Sex (Tick) √

SURAT G U J A R A T 3 9 5 0 0 3 √ Male Female

E-Mail Address : shivajivagh@gmail.com (STD Code)- Phone Number (0261) 2492697

Designation of Assessing Officer (Ward/Circle) Return filed under Section - 1 1

FILING STATUS

8(4) [Please see instruction number-9(i)]

Whether original or Revised return ? √ Original Revised

If revise, enter Receipt No and Date of filing

original return (DD/ MM/ YYYY )

Residential Status √ Resident Non - Resident Resident but Not Ordinarily Resident
1 Income chargeable under the Head 'Salaries'(Salary/Pension) 1 239130
2 Income Chargeable under the Head 'Other Souces'
a Family Pension 2a 0
b Interest 2b 0
c Total ( 2a + 2b ) 2c 0
FILING STATUS

3 Gross Total Income ( 1 + 2c ) 3 239130

4 Deductions under chapter VI A (Section)
a 80 C 44400 c 80 DD 0 c 80 GG 0
d 80 CCC 0 f 80 DDB 0 f 80 GGA 0
g 80 CCD 0 i 80 E 0 i 80 GGC 0
j 80 D 0 l 80 G 0 l 80 U 0
m Deduction ( Totoal a to l ) 4m 44400
Total Income ( 3 - 4m) = Rs. 194730
5 Nearest Rs.10/- 5 194730
6 Net Agricultural Income ( Enter only if greater than Rs. 5,000) 6 0
7 Aggregate Income (5+6) 7 194730
8 a Tax Payable on 'Aggreate Income' 8a 4473
b Rebate in respect of Net Agricultural income 8b 0
4473
FILING STATUS

9 a Tax Payable on Total Income ( 8a - 8b ) 9a

b Surcharge on 9a 9b 0
c Education Cess on (9a+9b) 9c 134
d Total Tax, Surcharge & Education Cess Payable (9a+9b+9c) 9d 4607
10 Relif under Section 89 10 0
11 Relief under section 90 / 91 11 0
12 Balance Tax Payable ( 9d - 10 - 11 ) 12 4607
Do not write or stamp in this area ( Space for bar code)
13 a Interest Payable U/s 234A 13a 0
b Interest Payable U/s 234B 13b 0
c Interest Payable U/s 234C 13c 0
d Total Interest Payable (13a+13b+13c) 13d 0
14 Total Tax and Interest Payable (12 + 13d) 14 4607
For Office Use Only Seal and Signature of receiving Official
Receipt No
 Date
15 Taxes Paid
a Advance Tax (From Item 23) 0
TAXES PAID
15a

b TDS (Column 7 ot item 21 + column 7 of item 22) 15b 0

c Self Assessment Tax (From item 23) 15c 0
d Total Taxes Paid (15a+15b+15c) 15d 0
16 Tax Payble (14-15d) (Enter if 14 is greater than 15d, else leave blank) 16 4607
17 Refund (15d-14) (Enter if 15d is greater than 14, also give Bank Account details below) 17 0
18 Enter your bank account number (mandatory in case of refund) 1 0 3 3 8 0 5 9 3 0 0
REFUND

19 Do You want your refund by √ Cheque, or deposited directly into your bank account ? (tick as applicable √ )
In case of direct deposit to your bank account give additional details
20
MICR CODE Type of Account ( trick as applicable) √ Saving Current
21 Details of Tax Deducred at Source from Salary [As per From 16 issued by Employer(s))
Sl Tax Deducation Accunt Number Name and Income Deduction Tax payable Total Tax Tax Payble
No
(TAN) of the Employer address of the chargeble under chapter (incl. surch. deposited
TDS ON SALARY

Employer under the VI-A and edn.cess)

head Salaries

(1) (2) (3) (4) (5) (6) (7) (8)

Mamlatdar(N.A.)
i S R T C 0 0 7 1 8 E Collectorate, Surat
239130 44400 4607 0 4607

ii

22 Details of Tax Deducred at Source on Interest [As per From 16 A issued by Deductor(s)) :- NOT APPLICABLE
Sl Tax Deducation Accunt Number Name and address of the Amount Date of Total tax Amount out of
No (6) claimed for
(TAN) of the Employer Deductor paid/credited payment/ deposited
TDS ON INTEREST

Credit this year

(1) (2) (3) (4) (5) (6) (7)

i
ii
iii
NOTE > Enter the total of column (7) of 21 column (7) of 22 in Sl No. 15b of TAXES PAID
23 Details of Advance Tax and Self Assessment Tax Payments :
Sl Name of Bank & Branch BSR Code Date of Deposit Serial Number of Amount (Rs)
No
(DD/MM/YYYY) Challan
TDS ON INTEREST

(1) (2) (3) (4) (5) (6)

i
ii
NOTE > Enter the total of column (7) of 21 column (7) of 22 in Sl No. 15b of TAXES PAID
24 Other Information (transaction reported through Annual Information Return) (Please see instruction number 9-(ii) for code)
Sl. Code Amount (Rs.) Sl. Code Amount (Rs.) Sl. Code Amount (Rs.)
a 001 N.A. d 004 N.A. g 007 N.A.
b 002 N.A. e 005 N.A. h 008 N.A.
c 003 N.A. f 006 N.A.
25 Tax-exempt interest income (for reporting purposes only)
26 E-filling Acknowledgement Number Date (DD/MM/YYYY)

VERIFICATION
I SHIVAJI SHANKARRAO VAGH son of SHANKARRAO NANURAO VAGH solemnly
declare that to the best of my knowledge and belief, the information given in the return thereto is correct and complete and that the
amount of total income and other particulars shown therein are truly stated and are in accordance with the provisions of the Income
tax Act, 1961, in respect of income chargeable to Income-Tax for the previous year relevant to the Assessment Year 2009-10

PLACE : SURAT DATE : SIGN HERE -.................................................

27 If the return has been prepared by a Tax Return Preparer (TRP) give further details as below :
Identification No. of TRP Name of TRP Counter Signature of TRP
If TRP is entitled for any reimbursement from the Government, amount thereof (to be filled by TRP) 28
 Government of India

INCOME-TAX DEPARTMENT
ACKNOWLEDGEMENT

Received with thanks from ARVIND MOHANBHAI PATEL a return of income in Form No. ITR-1
for assesment year 2008-09, havig the following particulars.
Name PAN
PERSONAL INFORMATION

SHIVAJI SHANKARRAO VAGH A A Z P V 4 9 9 8 F

Flat/Door/Block No Name Of Premises/Building/Village
7/4301-2
Road/Street/Post Office Area / Locality
SUTHAR FALIA GALEMANDI
Town/City/District State
SURAT GUJARAT
Designation of Assessing Officicer (Ward/Circle) 8(4)
1 Gross total income 1 239130
2 Deductions under Chapter VI-A 2 44400
3 Total Income 3 194730
3a Current Year loss (if any) 3a 0
COMPUTATION OF INCOME

4 Net tax payable 4 0

AND TAX THEREON

5 Interest payable 5 0
6 Total tax and interest payable 6 4473
7 Taxes Paid
a Advance Tax 7a 0
b TDS 7b 0
c TCS 7c 0
d Self Assesment Tax 7d 0
e Total Taxes Paid (7a+7b+7c+7d) 7e 0
8 Tax Payable (6-7E) 8 4473
9 Refund (7e-6) 9 -4473
10 Value of Fringe Benefits 10 0
BENEFITS AND TAX TEREON
COMPUTATION OF FRINGE

11 Total Fringe benefit tax liability 11 0

12 Total interest payable 12 0
13 Total tax and interest payable 13 0
14 Taxes Paid
a Advance Tax 14a 0
d Self Assesment Tax 14b 0
c Total Taxes Paid (14a+14b) 14c 0
15 Tax Payable (13-14c) 15 0
16 Refund (14c-13) 16 0
Receipt No. Seal and Signature of receiving official
Date :
 INCOME TAX STATEMENT FOR THE FINANCIAL YEAR 2008-2009
Name :- IT P.A.No. Assmt. Year SEX PH.HANDI.
Designation.:- 2009-10
01 SALARY INCOME :- Rs. Rs.
(a) Pay + Sp. Pay. B/F.
(b) D.P. (g) Transporting Allowance
(c) D.A. (h) DA/DP/HRA/CLA Difference.
(d) H.R.A. (i) R.F.Acco.
(e) C.L.A. (j) P.T.A.
(f) M.A. (k) W.A.
C/F. Total
02 GROSS INCOME
03 LESS :
(a) Professional Tax [u/s 16(iii)]
(b) Transport Allowance [u/s16(iii)]
Total [a + b]
04 ADD : Any Other Income (Exa./ Remuneration / NSC Int. etc)
05 LESS : House Rent u/s 10
(1) Actual rent paid in excess of @ 10% of salary or salary=pay+dp+da
(2) Actual HRA Recd.
(3) 40% of salary or (pay+Dp+Da) which ever is less
06 LESS : H.B.Loan Interest Max. Rs.150000/- u/s 24 (Cond. cost. after
1.4.99 or loan to be taken for house after 1.4.99, otherwise Rs. 30000)
07 Deduction under Chapter VI-A
(a) Medi. Claim Insu.Premium U/s.80-D
(b) P.T.A.
(c) Chief Min. Relief Fund./ Donation u/s 80(g)(5)
(d) Physical Handicaped u/s 80DD(1) or 80-U [Ristricted to Rs.50000/-]
if desability is more than 80% dedu. is Rs.75000/-
Total Excemption ( Col. 7(a) to 7(e)
NET INCOME:.............
08 LESS : 0 Rs.
(a) Savings upto 1 Lacs u/s 80-C
(1) G.P.F.
(2) P.P.F.
(3) U.L.I.P.
(4) L.I.C. Premium + Jivan Suraksha Plan
(5) NSC(VIII) Series (New)
(6) P.L.I.
(7) State Group Insurance
(8) Repayment of Hsg.Loan
(9)Tution fees [Excluding donation or development fee]
(10) P.O.T.D.
(11) Mutual Fund u/s 23-V MEP 98-99
(12) Any Bonds
Total ( a(1) to a(11)
09 TAXABLE INCOME i.e.
10 INCOME TAX ON TAXABLE INCOME
11 ADD: Educational Cess Tax on Income Tax @ 3%
13 I Tax & E.C. Payable for F.Y.2008-09
14 Tax Deduction from Paybill (Mar'08 to Jan'09)
15 Tax Payable from February'09 Paybill.
16 Total Tax Deduction for F.Y.2008-09
17 I.TAX PAYABLE(+) /REFUNDABLE (-)
PLACE : Surat
DATE:- / /2009 SIGN. OF DRAWING OFFICER SIGN. OF EMPLOYEE

DETAILS REGARDING SAVINGS IN THE FINANCIAL YEAR 2008-2009

SR.NO. POLICY NO. NATURE OF PREMIUM AMOUNT OF PREMIUM TOTAL
AMOUNT
1
2
3
4
5
6
7
8
9
10
TOTAL
N.S.C. DETAILS
SR.NO. N.S.C. NUMBER DATE AMOUNT
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
TOTAL
RATE OF INCOME TAX - 2008-2009
UP TO 1,50,000/- ----N I L----
RS. 1,50,000/- BUT DOES NOT EXCEED RS.3,00,000/- 10% OF THE AMOUNT EXCEEDING RS.1,50,000/-
RS. 3,00,000/- BUT DOES NOT EXCEED RS.5,00,000/- 20 % OF THE AMOUNT EXCEEDING Rs.3,00,000/-+15000/-
ABOVE RS.5,00,000/- 30 % OF THE AMOUNT EXCEEDING Rs.5,00,000/-+55000/-
RATE OF INCOME TAX - 2008-2009 In Case of Female
UP TO 1,80,000/- ----N I L----
RS. 1,80,000/- BUT DOES NOT EXCEED RS.3,00,000/- 10% OF THE AMOUNT EXCEEDING RS.1,80,000/-
RS. 3,00,000/- BUT DOES NOT EXCEED RS.5,00,000/- 20 % OF THE AMOUNT EXCEEDING Rs.3,50,000/-+12000/-
ABOVE RS.5,00,000/- 30 % OF THE AMOUNT EXCEEDING Rs.5,00,000/-+52000/-
NSC INTREST (PER RS.100/-)
YEAR 1/1/1999 1/15/2000 3/1/2001 3/1/2002 3/1/2003
TO TO TO TO TO
1/14/2000 2/28/2001 2/28/2002 2/28/2003 ONWARDS
1ST 11.83 11.30 9.72 9.20 8.16
2ND 13.23 12.58 10.67 10.05 8.83
3RD 14.80 14.00 11.71 10.97 9.55
4TH 16.54 15.58 12.85 11.98 10.33
5TH 18.51 17.85 14.10 13.09 11.17
6TH 20.69 19.31 15.47 14.29 12.06
SIGN. OF DRAWING OFFICER SIGN. OF EMPLOYEE
 MONTHLY SALARY & OTHER INCOME STATEMENT : 2008-09
NAME INC.MTH BASIC HRA(Y/N) MA (Y/N) HANDI ? Prof.Tax ? PAN No.
DESIG. SEX : INC.AMT SCAL_ID CLA(Y/N) TA (Y/N) HANDI % GIS SCHEME :-

DA/DP/

RENT OF
MONTH & YEAR D.A. HRA CLA MA W.A SP. PTA TRAN. I-TAX PROF GIS- GIS-F GPF NET

DA RATE

HRA RATE
SR. BASIC D.P. GROS GPF. HBA HBA- TOT

BUILD
Diff.
HRA/CLA
NO. PAY ALL S F. I AD -PRI. INT DEDU
TAX V
1 MARCH 2008

2 APRIL 2008

3 MAY 2008

4 JUNE 2008

5 JULY 2008

6 AUGUST 2008

7 SEPTEMBER 2008

8 OCTOBER 2008

9 NOVEMBER 2008

10 DECEMBER 2008

11 JANUARY 2009

12 FEBRUARY 2009

13 01/08 TO 3/08
D.A.DIFF.
14

15

16

TOTAL

OTHER INCOME OTHER SAVINGS AMT. RS. OTHER SAVINGS AMT. RS. Deduction under Chapter VI-A HOUSING LOAN
P.P.F TUTION FEES MEDI CLAIM AFTER 1/4/99 ? Y/N
LESS:H.R.A U.L.I.P MUTUAL FUND C.M. FUND PRINCIPAL
Atual Rent Paid L.I.C + Jivan Suraksha ANY BONDS INTEREST
Atual HRA Received P.L.I. P.O.T.D
40% of Salary NSC NEW
Certificate under section 203 of the income-tax Act.1961 for tax deducted at FORM NO.16
source fromincome chargeable under the head "Salaries" (See rule 31(1)(a)
Name and Address of the Employer . Name and Designation of the Employee.

PAN/GIR NO. TAN PAN/GIR NO. SEX

TDS Circle where Annual Return/Statement under Period Assmt. Year Phy. Handicaped
section 206 is to be filed 01/4/2008 TO 31/3/2009 2009-10
I.T. OFFICER, AYAKAR BHAVAN, SURAT
DETAILS OF SALARY PAID AND ANY OTHER INCOME AND TAX DEDUCTED
Rs. Rs. Rs. Rs.
1. GROSS SALARY*
2. Less Allw. to the extent exempt u/s10
(a) P.T.A.
(b) House Rent
Total (2a + 2b)
3. BALANCE (1-2)
4. DEDUCTION :
(a) Trans. Allo.
(b) Tax on Employment
5. Agregate of 4 (a to b)
6. INCOME CHARGEABLE UNDER THE HEAD SALARIES (3-5)
7 ADD Any other income reported by the employee (NSC INT.)
8 Less: loss from house property (Interest for Housing Loan U/S 24)
9. GROSS TOTAL INCOME
10 DEDU. UNDER CHAPTER VI-A Gross Amt. Quali. Amt. Dedu.Amt.
(a) Medi. Claim u/s 80(D)
(b) C.M. Fund u/s 80(G)(5)
(c) Phy.Handi. u/s 80DD1,80-U
11 Aggregate of deductible amount under Chapter VI-A
REBATE AT RELIEF UNDE CHAPTER VIII
Under Section 80 (Please specify) Gross Amt. Quali.Amt. Tax Reb.Rel.
(a) G.P.F
(b) P.P.F
(c) U.L.I.P
(d) L.I.C + Jivan Suraksha Plan
(e) N.S.C. VIII Series
(f) P.L.I.
(g) State Group Insurance
(h) Repayment of Housing Loan
(i) Tution Fees
(j) P.O.T.D.
(k) Mutual Fund (MAP 98-99)
(l) Any Bond
Total (a) to (k)
12. TOTAL TAXABLE INCOME
13 INCOME TAX ON TAXABLE INCOME
14 ADD: Educational Cess Tax on Income Tax @ 3%
15 INCOME TAX AND E.C. PAYABLE FOR 2008-09
16 LESS : TAX DEDUCTED AT SOURCE
17 TAX PAYBLE
 DETAILS OF DEDUCTED AND DEPOSITED INTO CENTRAL GOVERNMENT ACCOUNT
SR. AMOUNT DATE OF NAME OF BANK AND BRACH WHERE TAX DEPPOSITED
NO. PAYMENT
1
2
3
4
5
6
7
8
9
10
11
12
Total
Certified that a sum of Rs.
has been deducted at source and paid to the credit of the Central Government. Further
certified that the above information is true and correct as per records.

Signature of the Person resposible for deduction of tax

Place : Surat
Date: Full name :
Designation :
* See section 15 and 17 and rule 3 Furnish separate details of value of the perquisites
and profits in lieu of or in addition to salary or wages.
 INDIAN INCOME TAX RETURN ASSESMENT YEAR
FORM [For Indivisuals having Income from Salary / Pension / family pension) & Interest]
ITR-1 ( Please see Rule 12 of the Income-tax Rules, 1962)
( Also see attached instruction )
First Name Middle Name Last Name PAN
PERSONAL INFORMATION

Flat/Door/Block No Name Of Premises/Building/Village Date of Birth [ DD/MM/YYYY]

Road/Street/Post Office Area / Locality Employer Category(Tick) √

Govt PSU Other
Town/City/District State Pin code Sex (Tick) √

Male Female

E-Mail Address : shivajivagh@gmail.com (STD Code)- Phone Number (0261) 2492697

Designation of Assessing Officer (Ward/Circle) Return filed under Section -

FILING STATUS

[Please see instruction number-9(i)]

Whether original or Revised return ? Original Revised

If revise, enter Receipt No and Date of filing

original return (DD/ MM/ YYYY )

Residential Status Resident Non - Resident Resident but Not Ordinarily Resident
1 Income chargeable under the Head 'Salaries'(Salary/Pension) 1
2 Income Chargeable under the Head 'Other Souces'
a Family Pension 2a
b Interest 2b
c Total ( 2a + 2b ) 2c
FILING STATUS

3 Gross Total Income ( 1 + 2c ) 3

4 Deductions under chapter VI A (Section)
a 80 C c 80 DD c 80 GG
d 80 CCC f 80 DDB f 80 GGA
g 80 CCD i 80 E i 80 GGC
j 80 D l 80 G l 80 U
m Deduction ( Totoal a to l ) 4m

Total Income ( 3 - 4m) = Rs. 149759

5 Nearest Rs.10/- 5

Net Agricultural Income ( Enter only if greater than Rs. 5,000)

6 6

7 Aggregate Income (5+6) 7

8 a Tax Payable on 'Aggreate Income' 8a

b Rebate in respect of Net Agricultural income 8b

FILING STATUS

9 a Tax Payable on Total Income ( 8a - 8b ) 9a

b Surcharge on 9a 9b

c Education Cess on (9a+9b) 9c

d Total Tax, Surcharge & Education Cess Payable (9a+9b+9c) 9d

10 Relif under Section 89 10

11 Relief under section 90 / 91 11

12 Balance Tax Payable ( 9d - 10 - 11 ) 12

Do not write or stamp in this area ( Space for bar code)

13 a Interest Payable U/s 234A 13a
b Interest Payable U/s 234B 13b
c Interest Payable U/s 234C 13c
d Total Interest Payable (13a+13b+13c) 13d
14 Total Tax and Interest Payable (12 + 13d) 14
For Office Use Only Seal and Signature of receiving Official
Receipt No
Date
 15 Taxes Paid
TAXES PAID a Advance Tax (From Item 23) 15a

b TDS (Column 7 ot item 21 + column 7 of item 22) 15b

c Self Assessment Tax (From item 23) 15c

d Total Taxes Paid (15a+15b+15c) 15d

16 Tax Payble (14-15d) (Enter if 14 is greater than 15d, else leave blank) 16

17 Refund (15d-14) (Enter if 15d is greater than 14, also give Bank Account details below) 17
18 Enter your bank account number (mandatory in case of refund)
REFUND

19 Do You want your refund by Cheque, or deposited directly into your bank account ? (tick as applicable √ )
In case of direct deposit to your bank account give additional details
20
MICR CODE Type of Account ( trick as applicable) √ Saving Current
21 Details of Tax Deducred at Source from Salary [As per From 16 issued by Employer(s))
Sl Tax Deducation Accunt Number Name and Income Deduction Tax payable Total Tax Tax Payble
No
(TAN) of the Employer address of the chargeble under chapter (incl. surch. deposited
TDS ON SALARY

Employer under the VI-A and edn.cess)

head Salaries

(1) (2) (3) (4) (5) (6) (7) (8)

ii

22 Details of Tax Deducred at Source on Interest [As per From 16 A issued by Deductor(s)) :- NOT APPLICABLE
Sl Tax Deducation Accunt Number Name and address of the Amount Date of Total tax Amount out of
No (6) claimed for
(TAN) of the Employer Deductor paid/credited payment/ deposited
TDS ON INTEREST

Credit this year

(1) (2) (3) (4) (5) (6) (7)

i
ii
iii
NOTE > Enter the total of column (7) of 21 column (7) of 22 in Sl No. 15b of TAXES PAID
23 Details of Advance Tax and Self Assessment Tax Payments :
Sl Name of Bank & Branch BSR Code Date of Deposit Serial Number of Amount (Rs)
No
(DD/MM/YYYY) Challan
TDS ON INTEREST

(1) (2) (3) (4) (5) (6)

i
ii
NOTE > Enter the total of column (7) of 21 column (7) of 22 in Sl No. 15b of TAXES PAID
24 Other Information (transaction reported through Annual Information Return) (Please see instruction number 9-(ii) for code)
Sl. Code Amount (Rs.) Sl. Code Amount (Rs.) Sl. Code Amount (Rs.)
a 001 N.A. d 004 N.A. g 007 N.A.
b 002 N.A. e 005 N.A. h 008 N.A.
c 003 N.A. f 006 N.A.
25 Tax-exempt interest income (for reporting purposes only)
26 E-filling Acknowledgement Number Date (DD/MM/YYYY)

VERIFICATION
I son of solemnly
declare that to the best of my knowledge and belief, the information given in the return thereto is correct and complete and that the
amount of total income and other particulars shown therein are truly stated and are in accordance with the provisions of the Income
tax Act, 1961, in respect of income chargeable to Income-Tax for the previous year relevant to the Assessment Year 2009-10

PLACE : SURAT DATE : SIGN HERE -.................................................

27 If the return has been prepared by a Tax Return Preparer (TRP) give further details as below :
Identification No. of TRP Name of TRP Counter Signature of TRP
If TRP is entitled for any reimbursement from the Government, amount thereof (to be filled by TRP) 28
 INCOME TAX : 2008-09

A DATA-ENTRY
1 MONTHLY SALARY DETAIL
2 FOR SARAL FORM
B REPORTS
1 MONTHLY STATEMENT
2 IT-STATEMENT FOR TRASURY
3 FORM - 16
4 SARAL
5 AKNOWLEDGEMENT
C BLANK FORMS
1 MONTHLY STATEMENT
2 IT-STATEMENT FOR TRASURY
3 FORM - 16
4 SARAL
5 AKNOWLEDGEMENT
 Government of India

INCOME-TAX DEPARTMENT
ACKNOWLEDGEMENT

Received with thanks from ARVIND MOHANBHAI PATEL a return of income in Form No. ITR-1
for assesment year 2008-09, havig the following particulars.
Name PAN
PERSONAL INFORMATION

Flat/Door/Block No Name Of Premises/Building/Village

Road/Street/Post Office Area / Locality

Town/City/District State

Designation of Assessing Officicer (Ward/Circle)

1 Gross total income 1
2 Deductions under Chapter VI-A 2
3 Total Income 3
3a Current Year loss (if any) 3a
COMPUTATION OF INCOME

4 Net tax payable 4

AND TAX THEREON

5 Interest payable 5
6 Total tax and interest payable 6
7 Taxes Paid
a Advance Tax 7a
b TDS 7b
c TCS 7c
d Self Assesment Tax 7d
e Total Taxes Paid (7a+7b+7c+7d) 7e
8 Tax Payable (6-7E) 8
9 Refund (7e-6) 9
10 Value of Fringe Benefits 10
BENEFITS AND TAX TEREON
COMPUTATION OF FRINGE

11 Total Fringe benefit tax liability 11

12 Total interest payable 12
13 Total tax and interest payable 13
14 Taxes Paid
a Advance Tax 14a
d Self Assesment Tax 14b
c Total Taxes Paid (14a+14b) 14c
15 Tax Payable (13-14c) 15
16 Refund (14c-13) 16
Receipt No. Seal and Signature of receiving official
Date :