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FORM OF RETURN OF INCOME UNDER THE INCOME TAX ORDINANCE, 1984 (XXXVI OF 1984) FOR INDIVIDUAL AND OTHER TAXPAYERS (OTHER THAN COMPANY) Be a Respectable Taxpayer Submit return in due time Avoid penalty Put the tick ( ) mark wherever applicable Self Universal Self Normal
IT-11GA
Photograph of the Assessee [to be attested on the photograph]
1. Name of the Assessee: 2. National ID No (if any): 3. UTIN (if any): 4. TIN: 5. (a) Circle: 6. Assessment Year: 2012-2013 8. Status: N/A 9. Name of the employer/business (where applicable): 10. Wife/Husbands Name (if assessee, please mention TIN): 11. Fathers Name: 12. Mothers Name: 13. Date of Birth (in case of individual): 14. Address (a) Present: (b) Taxes Zone: 7. Residential Status: N/A
(b) Permanent:
15. Telephone: Office/Business 16. VAT Registration Number (if any):
Residential:
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Statement of income of the Assessee Statement of income during the income year ended on 30th June, 2012. Serial no. Heads of Income Amount in Taka
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Salaries : u/s 21 (as per schedule 1) Interest on Securities : u/s 22 Income from house property : u/s 24 (as per schedule 2) Agricultural income : u/s 26 Income from business or profession : u/s 28 Share of profit in a firm : Income of the spouse or minor child as applicable : u/s 43(4) Capital Gains : u/s 31 Income from other source : u/s 33 Total (serial no. 1 to 9) Foreign Income: Total income (serial no. 10 and 11) Tax leviable on total income Tax rebate: u/s 44(2)(b)(as per schedule 3) Tax payable (difference between serial no. 13 and 14) Tax Payments: Tax on taxed income: Tk. (a) Tax deducted/collected at source Tk. (Please attach supporting documents/statement) Cap./82C: Tk.
218,470.00
218,470.00
218,470.00 3,000.00 4,369.40 3,000.00
16
(b) Advance tax u/s 64/68 (Please attach challan ) Tk. (c) Tax paid on the basis of this return (u/s 74) (Please attach challan/pay order/bank draft/cheque) Tk. (d) Adjustment of Tax Refund (if any) Total of (a), (b), (c) and (d) 3,000.00 3,000.00 1,427,909.00
17 18 19
Difference between serial no. 15 and 16 (if any) Tax exempted and Tax free income Income tax paid in the last assessment year
*If needed, please use separate sheet Verification I father/husband UTIN/TIN: solemnly declare that to the best of my knowledge and belief the information given in this return and statements and documents annexed herewith is correct and complete. Place: Date: Signature (Name in block letters) Designation and Seal (for other than individual)
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SCHEDULES SHOWING DETAILS OF INCOME Name of the Assessee: TIN: Schedule-1 (Salaries) Pay & Allowance Basic pay Special pay Dearness allowance Conveyance allowance House rent allowance Medical allowance Servant allowance Leave allowance Honorarium / Reward/ Fee Overtime allowance Bonus / Ex-gratia Other allowances Employers contribution to Recognized Provident Fund Interest accrued on Recognized Provident Fund Deemed income for transport facility
Deemed income for free furnished/unfurnished accommodation
Amount of Income (Tk.) 218,470.00
Amount of exempted income (Tk.)
Net taxable income (Tk.) 218,470.00
120,159.00
120,159.00
96,880.00 27,750.00
96,880.00 27,750.00
Other, if any (give detail) Net taxable income from salary 463,259.00 244,789.00 218,470.00
Schedule-2 (House Property income) Location and description of property Particulars 1. Annual rental income 2. Claimed Expenses : Repair, Collection, etc. Municipal or Local Tax Land Revenue Interest on Loan/Mortgage/Capital Charge Insurance Premium Vacancy Allowance Other, if any Total = 3. Net income ( difference between item 1 and 2) Tk. Tk.
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Schedule-3 (Investment tax credit) 1. Life insurance premium 2. Contribution to deferred annuity 3. Contribution to Provident Fund to which Provident Fund Act, 1925 applies 4. Self contribution and employers contribution to Recognized Provident Fund 5. Contribution to Super Annuation Fund 6. Investment in approved debenture or debenture stock, Stock or Shares 7. Contribution to deposit pension scheme 8. Contribution to Benevolent Fund and Group Insurance premium 9. Contribution to Zakat Fund 10. Others, if any (give details) Total 142,182.00 *Please attach certificates/documents of investment. List of documents furnished 142,182.00
G
Salary Statement.
*Incomplete return is not acceptable
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IT-10B Statement of Assets and Liabilities (as on 30th June, 2012) Name of the Assessee: 1. (a) Business Capital (Closing balance) (b) Directors Shareholdings in Limited Companies (at cost) Name of Companies Number of shares TIN:
2. Non-Agricultural Property (at cost with legal expenses ) : Land/House property (Description and location of property)
750,000.00
3. Agricultural Property (at cost with legal expenses ) : Land (Total land and location of land property)
4. Investments: (a) Shares/Debentures (b) Saving Certificate/Unit Certificate/Bond (c) Prize bond/Savings Scheme (d) Loans given Name: TIN: (e) Other Investment Total = 600,000.00 5. Motor Vehicles(at cost) : Type of motor vehicle and Registration number 6. Jewellery (quantity and cost) : 7. Furniture (at cost) : 8. Electronic Equipment (at cost) : 9. Cash Asset Outside Business: (a) Cash in hand (b) Cash at bank (c) Other deposits 42,197.00 600,000.00
Total = 42,197.00
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10. Any other assets (With details) ( Addition of The Year = 142,182.00 )
142,182.00
Total Assets = 1,534,379.00 11. Less Liabilities: (a) Mortgages secured on property or land (b) Unsecured loans (c) Bank loan (d) Others
Total Liabilities = 12. Net wealth as on last date of this income year (Difference between total assets and total liabilities) 13. Net wealth as on last date of previous income year 14. Accretion in wealth (Difference between serial no. 12 and 13) 15. (a) Family Expenditure: (Total expenditure as per Form IT 10 BB) (b) Number of dependant children of the family: Adult Child 1,646,379.00 1,534,379.00 112,000.00 1,534,379.00
16. Total Accretion of wealth (Total of serial 14 and 15) 17. Sources of Fund : (i) Shown Return Income (ii) Tax exempted/Tax free Income (iii) Other receipts
218,470.00 1,427,909.00
Total source of Fund = 1,646,379.00 18. Difference (Between serial 16 and 17) I solemnly declare that to the best of my knowledge and belief the information given in the IT-10B is correct and complete.
Name & signature of the Assessee Date....................... * Assets and liabilities of self, spouse (if she/he is not an assessee), minor children and dependant(s) to be shown in the above statements. * If needed, please use separate sheet.
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Form No. IT-10BB FORM Statement under section 75(2)(d)(i) and section 80 of the Income Tax Ordinance, 1984 (XXXVI of 1984) regarding particulars of life style Name of the Assessee: Serial No. 1 2 3 4 5 6 7 8 9 10 11 Particulars of Expenditure Personal and fooding expenses Tax paid including deduction at source of the last financial year Accommodation expenses Transport expenses Electricity Bill for residence Wasa Bill for residence Gas Bill for residence Telephone Bill for residence Education expenses for children Personal expenses for Foreign travel Festival and other special expenses, if any Total Expenditure 112,000.00 12,000.00 TIN: Amount of Tk. 100,000.00 Comments
I solemnly declare that to the best of my knowledge and belief the information given in the IT-10BB is correct and complete.
Name & signature of the Assessee Date....................... *If needed, please use separate sheet.
...............................................................................................................................................
Acknowledgement Receipt of Income Tax Return
Name of the Assessee: UTIN/TIN: Circle: Taxes Zone:
TIN:
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Instructions to fill up the Return Form Instructions: 1. This return of income shall be signed and verified by the individual assessee or person as prescribed u/s 75 of the Income Tax Ordinance, 1984. 2. Enclose where applicable: (a) Salary statement for salary income; Bank statement for interest; Certificate for interest on savings instruments; Rent agreement, receipts of municipal tax and land revenue, statement of house property loan interest, insurance premium for house property income; Statement of professional income as per IT Rule-8; Copy of assessment/ income statement and balance sheet for partnership income; Documents of capital gain; Dividend warrant for dividend income; Statement of other income; Documents in support of investments in savings certificates, LIP, DPS, Zakat, stock/share etc. (b) Statement of income and expenditure; Manufacturing A/C, Trading and Profit & Loss A/C and Balance sheet; (c) Depreciation chart claiming depreciation as per THIRD SCHEDULE of the Income Tax Ordinance, 1984; (d) Computation of income according to Income tax Law; 3. Enclose separate statement for: (a) Any income of the spouse of the assessee (if she/he is not an assessee), minor children and dependant; (b) Tax exempted/tax free income. 4. Fulfillment of the conditions laid down in rule-38 is mandatory for submission of a return under "Self Assessment". 5. Documents furnished to support the declaration should be signed by the assessee or his/her authorized representative. 6. The assesse shall submit his/her photograph with return after every five year. 7. Furnish the following information: (a) Name, address and TIN of the partners if the assessee is a firm; (b) Name of firm, address and TIN if the assessee is a partner; (c) Name of the company, address and TIN if the assessee is a director. 8. Assets and liabilities of self, spouse (if she/he is not an assessee), minor children and dependant(s) to be shown in the IT-10B. 9. Signature is mandatory for all the assessee or his/her authorized representative. For individual, signature is also mandatory in I.T-10B and I.T-10BB. 10. If needed, please use separate sheet. ............................................................................................................................................... Total income shown in Return: Tk. 218,470.00 Net Wealth of Assessee: Tk. 1,534,379.00 Date of receipt of return: Nature of Return: Self Universal Self Normal Signature of Receiving officer with seal Thank you for using this software. © 2012 www.taxmatebd.com Tax paid:Tk. 3,000.00 Serial No. in return register
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Name of the Assessee: Circle:
TIN: Taxes Zone: Calculation Sheet Assessment Year: 2012-2013
Exempted Income Details of Exemption Exempted From Salary Amount of Taka 244,789.00
Exempted From Foreign Income 1,183,120.00 Total Exemption= 1,427,909.00
Name & signature of the Assessee Date....................... Thank you for using this software. © 2012 www.taxmatebd.com
© taxmatebd
Page 9 of 9
IT-11GA
Photograph of the Assessee [to be attested on the photograph]
1. Name of the Assessee: 2. National ID No (if any): 3. UTIN (if any): 4. TIN: 5. (a) Circle: 6. Assessment Year: 2012-2013 8. Status: N/A 9. Name of the employer/business (where applicable): 10. Wife/Husbands Name (if assessee, please mention TIN): 11. Fathers Name: 12. Mothers Name: 13. Date of Birth (in case of individual): 14. Address (a) Present: (b) Taxes Zone: 7. Residential Status: N/A
(b) Permanent:
15. Telephone: Office/Business 16. VAT Registration Number (if any):
Residential:
© taxmatebd
Page 1 of 9
Statement of income of the Assessee Statement of income during the income year ended on 30th June, 2012. Serial no. Heads of Income Amount in Taka
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Salaries : u/s 21 (as per schedule 1) Interest on Securities : u/s 22 Income from house property : u/s 24 (as per schedule 2) Agricultural income : u/s 26 Income from business or profession : u/s 28 Share of profit in a firm : Income of the spouse or minor child as applicable : u/s 43(4) Capital Gains : u/s 31 Income from other source : u/s 33 Total (serial no. 1 to 9) Foreign Income: Total income (serial no. 10 and 11) Tax leviable on total income Tax rebate: u/s 44(2)(b)(as per schedule 3) Tax payable (difference between serial no. 13 and 14) Tax Payments: Tax on taxed income: Tk. (a) Tax deducted/collected at source Tk. (Please attach supporting documents/statement) Cap./82C: Tk.
218,470.00
218,470.00
218,470.00 3,000.00 4,369.40 3,000.00
16
(b) Advance tax u/s 64/68 (Please attach challan ) Tk. (c) Tax paid on the basis of this return (u/s 74) (Please attach challan/pay order/bank draft/cheque) Tk. (d) Adjustment of Tax Refund (if any) Total of (a), (b), (c) and (d) 3,000.00 3,000.00 1,427,909.00
17 18 19
Difference between serial no. 15 and 16 (if any) Tax exempted and Tax free income Income tax paid in the last assessment year
*If needed, please use separate sheet Verification I father/husband UTIN/TIN: solemnly declare that to the best of my knowledge and belief the information given in this return and statements and documents annexed herewith is correct and complete. Place: Date: Signature (Name in block letters) Designation and Seal (for other than individual)
© taxmatebd
Page 2 of 9
SCHEDULES SHOWING DETAILS OF INCOME Name of the Assessee: TIN: Schedule-1 (Salaries) Pay & Allowance Basic pay Special pay Dearness allowance Conveyance allowance House rent allowance Medical allowance Servant allowance Leave allowance Honorarium / Reward/ Fee Overtime allowance Bonus / Ex-gratia Other allowances Employers contribution to Recognized Provident Fund Interest accrued on Recognized Provident Fund Deemed income for transport facility
Deemed income for free furnished/unfurnished accommodation
Amount of Income (Tk.) 218,470.00
Amount of exempted income (Tk.)
Net taxable income (Tk.) 218,470.00
120,159.00
120,159.00
96,880.00 27,750.00
96,880.00 27,750.00
Other, if any (give detail) Net taxable income from salary 463,259.00 244,789.00 218,470.00
Schedule-2 (House Property income) Location and description of property Particulars 1. Annual rental income 2. Claimed Expenses : Repair, Collection, etc. Municipal or Local Tax Land Revenue Interest on Loan/Mortgage/Capital Charge Insurance Premium Vacancy Allowance Other, if any Total = 3. Net income ( difference between item 1 and 2) Tk. Tk.
© taxmatebd
Page 3 of 9
Schedule-3 (Investment tax credit) 1. Life insurance premium 2. Contribution to deferred annuity 3. Contribution to Provident Fund to which Provident Fund Act, 1925 applies 4. Self contribution and employers contribution to Recognized Provident Fund 5. Contribution to Super Annuation Fund 6. Investment in approved debenture or debenture stock, Stock or Shares 7. Contribution to deposit pension scheme 8. Contribution to Benevolent Fund and Group Insurance premium 9. Contribution to Zakat Fund 10. Others, if any (give details) Total 142,182.00 *Please attach certificates/documents of investment. List of documents furnished 142,182.00
G
Salary Statement.
*Incomplete return is not acceptable
© taxmatebd
Page 4 of 9
IT-10B Statement of Assets and Liabilities (as on 30th June, 2012) Name of the Assessee: 1. (a) Business Capital (Closing balance) (b) Directors Shareholdings in Limited Companies (at cost) Name of Companies Number of shares TIN:
2. Non-Agricultural Property (at cost with legal expenses ) : Land/House property (Description and location of property)
750,000.00
3. Agricultural Property (at cost with legal expenses ) : Land (Total land and location of land property)
4. Investments: (a) Shares/Debentures (b) Saving Certificate/Unit Certificate/Bond (c) Prize bond/Savings Scheme (d) Loans given Name: TIN: (e) Other Investment Total = 600,000.00 5. Motor Vehicles(at cost) : Type of motor vehicle and Registration number 6. Jewellery (quantity and cost) : 7. Furniture (at cost) : 8. Electronic Equipment (at cost) : 9. Cash Asset Outside Business: (a) Cash in hand (b) Cash at bank (c) Other deposits 42,197.00 600,000.00
Total = 42,197.00
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Page 5 of 9
10. Any other assets (With details) ( Addition of The Year = 142,182.00 )
142,182.00
Total Assets = 1,534,379.00 11. Less Liabilities: (a) Mortgages secured on property or land (b) Unsecured loans (c) Bank loan (d) Others
Total Liabilities = 12. Net wealth as on last date of this income year (Difference between total assets and total liabilities) 13. Net wealth as on last date of previous income year 14. Accretion in wealth (Difference between serial no. 12 and 13) 15. (a) Family Expenditure: (Total expenditure as per Form IT 10 BB) (b) Number of dependant children of the family: Adult Child 1,646,379.00 1,534,379.00 112,000.00 1,534,379.00
16. Total Accretion of wealth (Total of serial 14 and 15) 17. Sources of Fund : (i) Shown Return Income (ii) Tax exempted/Tax free Income (iii) Other receipts
218,470.00 1,427,909.00
Total source of Fund = 1,646,379.00 18. Difference (Between serial 16 and 17) I solemnly declare that to the best of my knowledge and belief the information given in the IT-10B is correct and complete.
Name & signature of the Assessee Date....................... * Assets and liabilities of self, spouse (if she/he is not an assessee), minor children and dependant(s) to be shown in the above statements. * If needed, please use separate sheet.
© taxmatebd
Page 6 of 9
Form No. IT-10BB FORM Statement under section 75(2)(d)(i) and section 80 of the Income Tax Ordinance, 1984 (XXXVI of 1984) regarding particulars of life style Name of the Assessee: Serial No. 1 2 3 4 5 6 7 8 9 10 11 Particulars of Expenditure Personal and fooding expenses Tax paid including deduction at source of the last financial year Accommodation expenses Transport expenses Electricity Bill for residence Wasa Bill for residence Gas Bill for residence Telephone Bill for residence Education expenses for children Personal expenses for Foreign travel Festival and other special expenses, if any Total Expenditure 112,000.00 12,000.00 TIN: Amount of Tk. 100,000.00 Comments
I solemnly declare that to the best of my knowledge and belief the information given in the IT-10BB is correct and complete.
Name & signature of the Assessee Date....................... *If needed, please use separate sheet.
...............................................................................................................................................
Acknowledgement Receipt of Income Tax Return
Name of the Assessee: UTIN/TIN: Circle: Taxes Zone:
TIN:
© taxmatebd
Page 7 of 9
Instructions to fill up the Return Form Instructions: 1. This return of income shall be signed and verified by the individual assessee or person as prescribed u/s 75 of the Income Tax Ordinance, 1984. 2. Enclose where applicable: (a) Salary statement for salary income; Bank statement for interest; Certificate for interest on savings instruments; Rent agreement, receipts of municipal tax and land revenue, statement of house property loan interest, insurance premium for house property income; Statement of professional income as per IT Rule-8; Copy of assessment/ income statement and balance sheet for partnership income; Documents of capital gain; Dividend warrant for dividend income; Statement of other income; Documents in support of investments in savings certificates, LIP, DPS, Zakat, stock/share etc. (b) Statement of income and expenditure; Manufacturing A/C, Trading and Profit & Loss A/C and Balance sheet; (c) Depreciation chart claiming depreciation as per THIRD SCHEDULE of the Income Tax Ordinance, 1984; (d) Computation of income according to Income tax Law; 3. Enclose separate statement for: (a) Any income of the spouse of the assessee (if she/he is not an assessee), minor children and dependant; (b) Tax exempted/tax free income. 4. Fulfillment of the conditions laid down in rule-38 is mandatory for submission of a return under "Self Assessment". 5. Documents furnished to support the declaration should be signed by the assessee or his/her authorized representative. 6. The assesse shall submit his/her photograph with return after every five year. 7. Furnish the following information: (a) Name, address and TIN of the partners if the assessee is a firm; (b) Name of firm, address and TIN if the assessee is a partner; (c) Name of the company, address and TIN if the assessee is a director. 8. Assets and liabilities of self, spouse (if she/he is not an assessee), minor children and dependant(s) to be shown in the IT-10B. 9. Signature is mandatory for all the assessee or his/her authorized representative. For individual, signature is also mandatory in I.T-10B and I.T-10BB. 10. If needed, please use separate sheet. ............................................................................................................................................... Total income shown in Return: Tk. 218,470.00 Net Wealth of Assessee: Tk. 1,534,379.00 Date of receipt of return: Nature of Return: Self Universal Self Normal Signature of Receiving officer with seal Thank you for using this software. © 2012 www.taxmatebd.com Tax paid:Tk. 3,000.00 Serial No. in return register
© taxmatebd
Page 8 of 9
Name of the Assessee: Circle:
TIN: Taxes Zone: Calculation Sheet Assessment Year: 2012-2013
Exempted Income Details of Exemption Exempted From Salary Amount of Taka 244,789.00
Exempted From Foreign Income 1,183,120.00 Total Exemption= 1,427,909.00
Name & signature of the Assessee Date....................... Thank you for using this software. © 2012 www.taxmatebd.com
© taxmatebd
Page 9 of 9
