FILL IN THE DATA BELOW

1 2 3 4

Name of the Employee TREASURY ID No: PAN NO. Designation Name of the Office EARNINGS Basic Pay as on Jan-2013(for DA calculation)

B. SANKAR SINGH 0706764 AFGPB9002G SCHOOL ASSISTANT(SS) ZPHS, KARUMANCHI

5 6

Basic Pay as on MAR-13 MONTH OF NEW BASIC AFTER AAS/INCREMENT/STEPUP

25600 25600

JAN
26300

7PAY AFTER AAS/INCREMENT/STEP-UP 8 9 10 11 12 13 14 15 16 MONTH OF INCREMENT/AAS/STEP-UP PAY AFTER INCREMENT/AAS/STEP-UP AI PP/FP HMA CA(PH ALLOWANCE) CCA HRA % RENT ACTUALLY PAID PER MONTH
DEDUCTIONS

FEB
26300
70 0 0

NO 0
12 7000 ZPPF AMOUNT (MAR 12)

ZPPF/GPF/CPS

ZPPF

3000

3 4

GIS APGLI

120 450

ZPPF ENHANCEMENT MONTH(SELECT'0' IF NOT ENHANCED) APGLI ENHANCEMENT MONTH (SELECT '0' IF NOT ENHANCED) GIS ENHANCEMENT MONTH (SELECT '0' IF NOT ENHANCED)

CSS

6 7 8 9

LOANS(GPF/ZPPF/APG LI) EWFLOAN LIC(SALARY) LIC(BYHAND)

0 0 0 48063
LIC ENHANCEMENT MONTH (SELECT '0' IF NOT ENHANCED)

DA ARREARS GROSS AMOUNT DA 1(47.936% to 54.784%) DA 1(54.784% to 63.344%) DA 2(63.344%) CASH MONTH PAY GPF/ZPPF ADJUSTMENT

8765 8764 NOV

7012 6573

SELECT THE MONTH FROM WHICH THE NEW DA IS DR CASH ALONG WITH REGULAR SALARY PRC ARREARS/STEP UP ARREARS DA HRA

AI

1342
PAY AI

351
DA

850
HRA

6/12/18/24 YEARS SCALE/INCREMENTAL ARREARS

0
SURRENDER LEAVE

DAYS

S.L. ENCASHMENT MONTH

JUL
0

FEES REIMBURSEMENT
OTHER DEDUCTIONS 1 2 3 Housing Loan Principle Tuition Fee INFRASTRUCTURAL BONDS(max. Rs. 20000/-)

0 0 0

4 5 6 7 8 9 10 11 12 13 14 15 16

P.L.I/N.S.C. Interest on Housing loan(U/S 24(L)(VI) interest on Education loan Bonds Any other Mediclaim Insurance (80-D) Exception on PHC dependent (80DD) Rs. 50000/Exp. On Medical Treatment Donations (80 G) C.M.Relief Fund Deduction on to PHC Employees(80 U) Health insurance(Max. 15000/-, Rs. 20000/- for Sr. citizens) RAJIV GANDHI EQUITY SHARE SCHEME(80CCG) MAX 50000

0 0 0 0 0 0 0 0 0 0 0 0 0

EMPLOYEE INFORMATION FOR ITR-1 AND FORM 16

NAME OF THE EMPLOYEE B. SANKAR SINGH FATHER'S NAME DATE OF BIRTH(mm/dd/yyyy) HOUSE NO.

Name of Premises/Building/Village Road/Post Office/Street

TOWN/CITY/DISTRICT STATE

PIN CODE

DDO INFORMATION DDO DESIGNATION GAZETTED HEAD MASTER

DDO FATHER'S NAME

M. HANUMA NAIK

TAX DEDUCTION AT SOURCE(TDS) AND ADVANCE TAX PAID BY THE EMPLOYEER OR EMPLOYEE

S. No

Month and Year

Amount of Tax Paid

Bill ID No. Issued by treasury

1 2 3 4 5 6 7 8 9 10 11 12

Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 TOTAL

0 0 0 0 0 1500 1500 1500 1500 1500 5000 9830 22330

9830

Rs.

22330

nineteen thousand two hundred and forty only

THE DATA BELOW TO PREFIX A ZERO HIT SINGLE INVERTED COMMA(') AND ENTER THE NUMBER GAZETTED N.G.O. N.G.O

1 IF YOU HAVEN'T GOT ANY BENEFIT UNDER AAS OR STEP UP SELECTED THE FIRST TWO BASIC PAYS AS SAME , THEN SELECT YOUR MONTH OF INCREMENT AND SELECT YOUR BASIC PAY.

ENHANCEMENT MONTH

TOTAL

ANY CORRECTIONS OR SUGGESTIONS PLEASE CALL 8897515307(V.MURALI KRISHNA)

ANY CORRECTIONS OR SUGGESTIONS PLEASE CALL 8897515307(V.MURALI KRISHNA)

CASH 1753 2191

MONTH FROM WHICH THE NEW DA IS DRAWN IN SH ALONG WITH REGULAR SALARY REARS/STEP UP ARREARS IR TOTAL 2704 TOTAL 0 P. TAX ZPPF CASH 2704 CASH 0

161
IR

0
ZPPF

0
P. TAX

ALE/INCREMENTAL ARREARS

ATION FOR ITR-1 AND FORM 16

FIRST NAME MIDDLE NAME LAST NAME

BONDILI

SANKAR BHAVAN SINGH

SINGH

8 8-292 VINNAKOTAVARI STREET ONGOLE

1958

PRAKASAM Andhra pradesh 523001

O INFORMATION

DDO NAME DDO TAN

L. SAMBASADA SIVA RAO HYDZ-00398-G

MPLOYEER OR EMPLOYEE

TAX PAID

BALANCE

DATE

22330

y only

Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14

25600 25600 25600 25600 25600 25600 25600 25600 25600 25600 25600 25600 26300 26300

14025 14025 14025 14025 14025

12272 12272 12272 12272 12272

1753 1753 1753 1753 1753

8765 8765

877 7012

7888 1753

16216 16216 16216 16216

14025 14025 14025 14025

2191 2191 2191 2191 8764 8764 876 6573 7888 2191

OCT NOV

STATEMENT OF EARNINGS AND DEDUCTIONS/SAVINGS IN RESPECT OF B. SANKAR SINGH,SCHOOL ASSISTANT(SS) FOR THE YEAR MARCH 2013-FEBRUARY 2014 S.NO 1 2 3 4 5 6 7 8 9 10 11 12 MONTH&YEAR Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14
DA ARREARS 1 DA ARREARS 2 PRC ARREARS 6/12/18/24 scale arrears CSS FEES REIMBURSEMENT

PAY 25600 25600 25600 25600 25600 25600 25600 25600 25600 25600 26300 26300

AI 70 70 70 70 70 70 70 70 70 70 70 70

PP/FP 0 0 0 0 0 0 0 0 0 0 0 0

CA 0 0 0 0 0 0 0 0 0 0 0 0

EARNINGS ALLO WANC IR ES

DEDUCTIONS HMA 0 0 0 0 0 0 0 0 0 0 DA 12272 12272 12272 14025 14025 14025 14025 14025 16216 16216 16659 16659 8765 8764 HRA 3072 3072 3072 3072 3072 3072 3072 3072 3072 3072 3156 3156 TOTAL 41014 41014 41014 42767 42767 42767 42767 42767 44958 44958 53286 53286 8765 8764 850 0 2704 0 0 0 0 0 0 0 1440 5400 2400 40 413 0 22330 0 0 0 ZPPF 3000 3000 3000 3000 3000 3000 3000 3000 3000 3000 3000 3000 7012 6573 0 0 0 0 0 GIS 120 120 120 120 120 120 120 120 120 120 120 120 APGLI 450 450 450 450 450 450 450 450 450 450 450 450 P.TAX 200 200 200 200 200 200 200 200 200 200 200 200 20 EWF/S CMRF LOANS WF 20 0 0 0 0 413 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 IT 0 0 0 0 0 1500 1500 1500 1500 1500 5000 9830 LIC 0 0 0 0 0 0 0 0 0 0 0 0

TOTAL DEDUCTI ONS 3790 3770 3770 3770 4183 5270 5270 5270 5270 8790 8770 13600 7012 6573 0 0 0 0 0 85108

7101 7101

0 0

MORE EARNINGS

1342 0

0 0 0

161

351 0 0

0 0 309942 0 840 0 0 0 0 0 161 14202

Surrender Leave

TOTAL

190571 37882 553598 49585

SIGNATURE OF THE D.D.O.

Signature of the Employee

RY 2014 NET 37224 37244 37244 38997 38584 37497 37497 37497 39688 36168 44516 39686 1753 2191 2704 0 0 0 0 468490

ature of the Employee

TAN :HYDZ-00398-G 1 Name of the Employee 2 Designation 3 Name of the Office 4 Gross salary Income 5 HRA Exmpted

INCOME TAX CALCULATION FOR THE YEAR 2013-14 PAN AFGPB9002G

: B. SANKAR SINGH ID No:0706764 : SCHOOL ASSISTANT(SS) : ZPHS, KARUMANCHI : Rs 553598 : : Rs 37882 : Rs 33949 : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : Rs 124060 Rs 33949 Rs 519649 Rs 2400 Rs 0 Rs 2400 Rs 517249

i) Actual HRA Received ii) Rent paid in Excess of 10% of Salary (Pay+DA)
[Actual Rent Paid 7000X12=84000-50051[(Pay+DA)*10%]=33949]

6 7

8 9

iii) 40% of Salary (Deduct least of the above three) Net salary Income(4-5) Deductions a) Profession Tax(U/S 16(iii) b) Interest on Housing loan(U/S 24(L)(VI) Total Total Income(6-7) Deductions under chapter VI -A A)Savings(U/S 80C) (Max.Rs.1,00,000) i)G.P.F/Z.P.P.F/C.P.S/C.S.S ii)G.I.S iii)L.I.C iv)P.L.I/N.S.C. v) A.P.G.L.I vi) Tution Fee vii) Housing loan principle amount viii) Bonds ix) Any other Total (U/S 80C) B) INFRASTRUCTURE BONDS(MAX. 20000/-) C) Mediclaim Insurance (80-D) D) Expenditure on PHC dependent (80DD) E) Interest on Education Loan(80-E) F) Exp. On Medical Treatment(80-DDB) G) RAJIV GANDHI EQUITY SHARE SCHEME(80 CCG) F) Donations (80 G) i) C.M.Relief Fund ii) Sainic welfare fund iii) Employees welfare fund iv) Other donations if any G) Deduction on to PHC Employees(80 U) Total(Chapter VI-A)

Rs Rs Rs Rs Rs Rs Rs Rs Rs Rs Rs Rs Rs Rs Rs Rs Rs Rs Rs Rs Rs Rs Rs

49585 1440 48063 0 5400 0 0 0 0 104488 0 0 0 0 0 0 0 413 20 20 0 0 453

Rs 104941

10 Taxable Income(8-9) 11 Tax on total Income

MALE/FEMALE SERVANT 2,00,000-Nil

TOTAL DEDUCTIONS( ADMISSIBLE) Rs 100453 : Rs 416796 : : Rs 0 : Rs 21680 : Rs 0 : Rs 0 : Rs 21680 Rs 0 : : : : Rs Rs Rs Rs Rs 21680 0 434 217 22331 -

TDS PAID

2,00,001 to 5,00,000-10% of the amount exceeding 5 lakhs Rs. 5,00,001/-to 10,00,000/-Rs.30000+20% of the amount exceeding 5,00,000/-

10,00,001/-and above-Rs.1,30,000+30% of the amount

12 13 14 15 16 17

exceedings Rs. 10,00,000 Tax on total Income

TAX RELIEF Rs.2000/- UNDER SECTION 87A FOR EMPLOYEES WHOSE GROSS INCOME DOES NOT EXCEED Rs. 500000/Tax Payable

Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 total

Surcharge Education Cess(2%) Secondary&Higher Education Cess 1% Net Tax Payable

ROUNDED TO : Rs 22330

Signature Designation

002G

TDS PAID Rs1,500.00 Rs1,500.00 Rs1,500.00 Rs1,500.00 Rs1,500.00 Rs5,000.00 Rs9,830.00 Rs22,330.00

SARAL-II FORM

INDIAN INCOME TAX RETURN [For Individuals having Income from Salary/Pension/Income from One House Property(excluding loss brought forward from previous years)/Income from other sources(Excluding Winning from Lottery and Income from Race Horses)] (Please see rule 12 of the Income-Tax Rules, 1962)(Also see attached instructions)

Assessment Year

(ITR-1)

First Name BONDILI PERSONAL INFORMATION Flat/Door/Block No 8-292 Road/Street/Post Office ONGOLE Town/City/District PRAKASAM E-mail Address

Middle Name SANKAR

Last Name SINGH

PAN AFGPB9002G Date of Birth 1/8/1958 Employer Category,(Tick)

Name of Premises/Building/Village VINNAKOTAVARI STREET Area/Locality

State Andhra pradesh Pin Code 523001 STD Code-Phone Number(

Govt

PSU
Sex(Tick)

ERS
Female

OTH

Male

FILING STATUS

Designation of the Assessing Officer(Ward/circle) Whether Original or Revised return?(Tick)

Returns filed under Section [Please see instruction no.9(i)

Original

Revised DD/MM/YYYY

If revised,enter Receipt No. and date of filing original return Residential Status(Tick) 1 2 3

Resident

Non-Resident

Resident but not ordinarily Resident

1 2 3 4 519649 519649

Income Chargeable under the Head 'Salaries' (Salary/Pension) Income Chargeable under the Head 'House Property'(enter -ve sign in case of loss, if any) Income Chargeable under the Head ' Other Sources '(enter -ve sign in case of loss, if any) Gross Total Income(1+2+3) Deductionsunderchapter VI A(Section) a b c d 80 C 80 CCC 80 CCD 80 D 0 100000 2400 e f g h 80DD 80DDB 80E 80G 453 0 i j k l

INCOME & DEDUCTIONS

4 5

80GG 80GGA 80GGC 80U 6 7 8 9 10 11 12 13 14 15 0 102853 416796 21680 651 22330 0 0 22330 0 22330

6 7 8 9 TAX COMPUTATION 10 11 12 13 14 15

Deductions ( Total of 5a to 5i) Total income(4-6) Tax Payable on Total Income Secondary and Higher Education cess on 8 Total Tax and Education cess Payable(8+9) ROUNDED TO NEAREST 10 Relief under Section 89 Relief under Section 90/91 Balance Tax Payable (10-11-12) Total Interest Payable U/s 234A/B/C Total Tax and Interest Payable (13+14) Do not write or stamp in this area For Office use only

Seal and Signature of the receiving official Receipt No. Date

16 Taxes Paid a Advance Tax(from item 25) TAXES PAID b TDS(Column 7 of item 23+Column 7 of item 24) c Self Assessment Tax(From item 25) 17 Total Taxes Paid(16a+16b+16c) 18 Tax Payable(15-17)(Enter if 15 is greater than 17 else leave blank) 19 Refund((17d-16)(enter if 17d is greater than 16, also give Bank account details below 16 a 16 b 16c 17 18 19 0 22330 0 22330 0

20. Enter your bank account number (mandatory in case of refund) 21. Do you want your refund by

cheque or deposited directly into your bank account *(tick as applicalble)

Type of Account(tick as applicable

22. Give additional details of your bank account 22.MICR CODE 23 Details of Tax Deducted at Source from salary(As per Form 16 issued by Employer(s) Tax Deduction Income chargeable Account Name and address of Deduction under Under the head S.No Number(TAN) of the the Employer Chapter VI-A salaries Employer (1) (2) (3) (4) (5) 1 B TDS ON INTEREST 24 Details of Tax Deducted at Source other than salary Tax Deduction Income chargeable Account Name and address of Under the head S.No Number(TAN) of the the Employer salaries Employer (2) (3) (4) (1) 1 B Note Enter the total of column (7) of 23 and column (7) of 24 in S. No.(17b of Taxes Paid) Tax Payable(In cl. edn. Cess) (6) HYDZ-00398-G
GAZETTED HEAD MASTER

savings
Tax Payable(In cl. edn. Cess) (6) 22330 Total Tax deducted (7) 22330 Tax payable/re fundable (8) 0

TDS ON SALARY

517249

100453

Deduction under Chapter VI-A (5)

Total Tax deducted (7)

Tax payable/re fundable (8)

25 Details of Advance Tax and Self Assessment Tax Payments S. No i ii iii NOTE Enter the totals of Advance tax and self Assessment tax in sl . No. 17 a of TAXES PAID Name of Bank & Branch BSR CODE Date of Deposit Serial No. (dd/mm/yyyy) of Challan Amount

Sl No a b c

26 Other Information(transactions reported through Annual Information Return)(Please see instruction number 9(ii) for code) Code Amount Rs. Code Amount Rs. Code Amount Rs. 001 002 003 001 002 003 001 002 003 27

27 Exempt income only for reporting purposes(from Dividend, Capital gains etc)

VERIFICATION I B. SANKAR SINGH son/daughter of BHAVAN SINGH 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 other particulars shown therein are truly stated and are in accordance with the provisions of Income Tax Act, 1961, in respect of income chargeable to Income-tax for the previous year relevant to the Assessment year 2013-14. Place Date Sign here

28 If the retun 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

29 If TRP is entitled for any reimbursment from the Government, amount thereof(to be filled by TRP).

29

FORM NO.16 [See rule 31(1)(a)] Certificate under section 203 of the Income-tax Act, 1961 for Tax deducted at source from income chargeable under the head " Salaries" NAME AND ADDRESS OF THE EMPLOYER GAZETTED HEAD MASTER PAN of Deductor TAN No. of the Deductor HYDZ-00398-G ACKNOWLEDGEMENT Nos of all quartely statement of TDS under sub-section(3) of of section 200 as provided by TIN facilitation Centre or NSDL website QUARTER ACKNOWLEDGEM ENT No. Mar-13 Feb-14 2014-15 NAME AND DESIGNATION OF THE EMPLOYEE B. SANKAR SINGH ,SCHOOL ASSISTANT(SS) PAN No. of the Employee AFGPB9002G PERIOD FROM TO

ASSESMENT YEAR

Details of Salary paid and any other income and tax deducted 1 Gross Salary Salary as per provisions contained in (a) sec.17(1) (b) Value of perquisites u/s 17(2) (as per Form No.12BB, wherever applicable)

553598

Profits in lieu of salary under section 17(3)(as per Form No.12BB, wherever applicable) (d) Total Less: Allowance to the extent exempt u/s 10 (c) H.R.A 33949 519649

3 4

5 6 7

Balance(1-2) Deductions u/s 16: (a) Entertainment allowance (b) Tax on employment Aggregate of 4(a) to (b) Income chargeable under the head 'salaries' (35) Add: Any other income reported by the employee

2400 2400 517249

8 9

Gross total income (6+7) Deductions under Chapter VIA A) Section 80C, 80CCC, and 80CCD (a) Section 80C (i) Provident Fund (ii) G.I.S (iii) L.I.C. (iv) P.L.I.C./N.S.C (v) A.P.G.L.I (vi) TUITION FEES
(vii) H/LOAN PRINCIPLE

517249 Gross Amount 49585 1440 48063 0 5400 0 0 Qualifying Amount

(b) Section 80 CCC (c) Section 80 CCD

(B) OTHER SECTIONS( for e.g., 80E, 80 G etc) Under Chapter VIA Section Gross Amount

Qualifying Amount

Deduction amount

(a)

i) C.M.Relief Fund

413

(b)

ii) Sainic welfare fund

20

(c)

iii) Employees welfare fund

20

(d)

iv) Other donations if any

(e) Aggregate of deductible amount under Chapter VIA

10

100453

11

Total Income (8-10)

416796

12

Tax on total income

21680

13

Surcharge(on tax computed at S.No. 12)

434

14

Education Cess(on tax at S. No. 12 and surcharge at S.No. 13)

217

15

Tax Payable(12+13+14)

22331

16

Relief Under Section 87 A

17

Tax Payable(15-16)

#N/A

18

Less:

(a) Tax dedution at source u/s 192(1)

(b) Tax paid by the employer on behalf of the employee u/s 192(IA) on perquisites u/s 17(2)

22330

19

Tax Payble/refundable (17-18)

#N/A

DETAILS OF TAX DEDUCTED AND DEPOSITED INTO CENTRAL GOVERNMENT ACCOUNT Date on Transfer B.S.R.Code which which Cheque /DD voucher/challa of Bank tax No.(if any) n identification Branch deposited(d No. d/mm/yyyy) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

S. NO

TDS Rs.

Surcharge Rs.

Education Cess Rs.

Total tax deposited Rs.

1 2 3 4 5 6 7 8 9 10 11 12

0 0 0 0 0 1500 1500 1500 1500 1500 5000 9830

0 0 0 0 0 1500 1500 1500 1500 1500 5000 9830

I L. SAMBASADA SIVA RAO,son/daughter of M. HANUMA NAIK working in the capacity of GAZETTED HEAD MASTER (designation) do hereby certify that a sum of Rs.22330 [Rupees nineteen thousand two hundred and forty only (in words)] has been deducted at source and paid to the credit of the Central Government. I further certify that the information given above is true and correct based on the books of accounts, documents and other available records. Place Date Designation Signature of person responsible for deduction of tax Full Name

RECEIPT OF HOUSE RENT Under Section 1(13-A) of Income Tax Act) Received a sum of Rs.84000@ Rs.7000 per month from March 2013 to February 2014 in respect of House No:8-292 situated at VINNAKOTAVARI STREET ONGOLE,PRAKASAM

(Affix Revenue Stamp of Rs.1/-)

Date:

Name: Address:______________________ _____________________________ _____________________________ PAN______________________