R.G.KAR MEDICAL COLLEGE & HOSPITAL
1, KHUDURAM BOSE SARANI, KOLKATA-700004.
Income Tax Statement For the year 2013 - 14 (A.Y 2014 –15)
PART - A
Name & Designation of the Employee (in Block letters) Dr. / Sri / Smt.
Name of the Office & Address
Residential Address
Phone Number with Ext. No. Mobile Number.
Residing in rented house/ Govt. qtr (Mention the monthly rent: proof to be submitted)
Date of final Retirement: (if retirement falls due in the F.Y 2013 – 2014):
PAN No.
PART – B
COMPUTATION OF TOTAL INCOME & TAX PAYABLE FOR THE ASSESMENT YEAR 2014-15 & PREVIOUS YEAR 2013-14 (MARCH TO FEBRUARY), WHERE TOTAL INCOME EXCEEDS Rs. 2,00,000/-.
Rs. / Rs. / Rs.1 / (a) / Gross salary (incl. allowances, Bonus, Overtime, Pension from former employer.
(b) / Add: Arrear Received during the year
TOTAL {1(a)+1(b)}
2 / Less :-
a) / P. Tax U/S 16 (iii)
b) / H.R.A. exemption u/s 10(13A)
i) / Actual H.R.A. received
ii) / Rent paid in excess of 10% salary
(salary means P.B + G. Pay + NPA + DA )
iii) / 50% of salary residing at Kolkata (salary means P.B + G. Pay + NPA + DA) or 40% of salary residing outside Kolkata
Least of (b) above (I , ii, iii ){Attach Proof}
3 / Total Income from Salaries (1 – 2a - 2b)
4 / {Attach Proof} / Income from Other Sources:
a) / Interest of NSC/ RD interest,
b) / Fixed Deposit interest
c) / Medical Examination Charge/ Honorarium
d) / Dividend & other income.
e) / Any other income from other sources
f) / All Savings Bank Interest (Attach Bank interest details)
TOTAL OF 1ST PAGE
TOTAL OF 1ST PAGE
g) / Royalty Income
5 / Gross Total Income (3 + 4a + 4b + 4c +4c +4d + 4e + 4f + 4g)
6 / Less: Income from House properties: - Interest of H.B.L up to Rs. 1.5 lakhs for 1st time construction & Rs. 30,000 for re-construction, renewal [u/s 24(I) (vi)]. (Accrual basis as per I.T Rule)
7 / Gross Total Income after HBL interest (5 - 6)
8 / Less: deduction under section 80 (Other than 80C,80CCC,80CCD)
a) / {Attach Proof} / Investment under RGESS U/S 80CCG (50%, Max. Rs. 25,000/-)
b) / Mediclaim u/s 80D (not exceeding Rs. 15,000/- & 20,000 for Senior Citizen) including Rs. 5,000/- for preventive health check-up
C0 / Maintenance including Medical treatment of dependant with disability u/s 80 DD for more than 40% disability (Max. Rs. 50,000/-) & above 80% (Max. Rs. 1,00,000/-)
d) / Expenses on Medical treatment for Cancer, AIDS, chronic renal failure.(U/s 80DDB, Max. Rs. 40,000/- & Rs. 60,000/- for Sr. Citizen)
e) / 100% Interest of Higher Studies loan u/s 80E
f) / Deduction in respect of donation u/s 80G (50% & 100% for specific case ) cash donation subject to maximum Rs. 10,000/-.
g) / Deduction for Royalty income of Authors, u/s 80QQB (100%)
h) / Deduction of Savings bank interest u/s 80TTA (Max. Rs. 10,000/-)
Considerable amount, mentioned in 4(f)
i) / Person with permanent physical disability u/s 80U (not exceeding Rs. 1,00,000/-
Total Deduction u/s 80 (a + b + c + d + e + f + g + h + i)
9 / Net income (7 – 8)
10 / {Attach Proof} / Deduction of u/s 80C, 80CCC, 80CCD
(Max. Amount eligible for exemption Rs. 1,00,000/-)
I) / G.P.F with A/C No.
II) / G.I.S.
III) / P.L.I
IV) / L.I.C. (Max. 20% of Sum Assured value)
V) / P.P.F. (Max. Rs. 1,00,000/-)
VI) / NSC VIII th Issue to be invested within 31/03/2014
VII) / ULIP of UTI/LIC
VIII) / Approved Mutual Fund
IX) / Tution fees paid, Max. 2 children for fulltime Education in India
(No Donation & Dev. Fees)
X) / Principal of H.B.L during the year 2013-2014
XI) / Deposit of premium under Pension scheme u/s 80CCC
XII) / Amount deemed to be Re-investment on the Interest of NSC
a) / Rs.______during 2011 – 2012 @ Rs. 87.80 per thousand
b) / Rs. ______During 2010 - 2011 @ 95.60 per thousand
c) / Rs. ______during 2009- 2010 @ Rs. 104.00 per thousand
TOTAL OF 2ND PAGE
TOTAL OF 2ND PAGE
d) / Rs. ______During 2008 - 2009 @ 113.10 per thousand
e) / Rs. ______During 2007 - 2008 @ Rs.123.00 per thousand
** / Rs. ______During 2006 - 2007 @ Rs. 120.80 per thousand {not to be deducted here only added at’ income from other sources’} [at 4(a) column]
11 / Total deduction u/s 80C & u/s 80CCC (Max. Rs.1,00,000/-)
{I + II + III + IV + V + VI + VII + VIII + IX + X + XI + XII}
12 / Taxable Income ( 9 – 11 )
13 / a) / Tax on total income upto Rs. 2,00,000 (men & women) / NIL
b) / Rs. 2,00 001 to Rs. 5,00,000 / 10%
c) / Rs. 5,00,001 to Rs. 10,00,000/- / 20%
d) / Rs. 10,00,001/- and above / 30%
14 / Total Tax ( 13a + 13b + 13c + 13d )
15 / Rebate u/s 87A (Max. Rs. 2,000/- up to taxable income Rs. 5 lakh)
16 / TOTAL TAX AFTER REBATE (14-15)
17 / Add Education Cess 3% {2% + 1%}
18 / Total Tax payable ( 16 + 17 )
19 / Less: Relief u/s 89 (if any)
20 / Total tax payable in the year 2013-2014 (18-19)
21 / Tax already Paid from Salary Bills up to December ‘13
22 / I Tax deducted from Salary Bill of January 2014
And February’2014 (20 -21 ) / JAN ‘13
FEB ‘13
A. I hereby declare that:
L.I.C. Policy/Policies/ Jeevan Dhara/ Jeevan Akshay Plans/ NSC(s) in respect of which rebate in income tax is being claimed, have not been/will not be surrendered/expired/ with drawal before the 31st March 2014. The house property for which deduction is claimed for repayment of loan U/s 80C is not and/or will not be transferred to others within the expiry of Five years from the end of the financial year in which possession of such property was obtained and construction of the house property have been completed by the end of the financial year (subject to production of Certificates). I have submitting all attachments (12 months House rent receipts/ 12 months Rent Control payment receipts, Savings bank interest, Royalty, LIC, PPF, NSC, Tution Fees, HBL Principal & Interest, documents of 80D, 80DD, 80DDB, 80E, 80G, 80TTA, 80C) with this I.T statement. I have claimed tax rebate u/s 89(I) on splitting up the arrear salary that I have received during the previous year. Certified that my Children reads in school. Their Tution fee is Rs. Per month (enclose proof); and my spouse is not claiming deduction in respect of their Tution fees.
B. I understand that :
The filling Income Tax Return is a legal obligation of every person whose total income during the previous year exceeds the maximum amount which is not chargeable to income tax under the provisions of I.T. Act, 1961. All declarations made above and pre page are true.
*Strike out whichever is not applicable.
Signature & Designation of Assessee
Verified by Countersigned by
Dealing Assistant Accounts Officer, R. G. Kar Medical
College & Hospital, Kolkata.
To
Sub: Submission of Income Tax Statement for the Accounting Year 2013-2014 relating to the Assessment Year 2014-2015
Please submit two copies of Income Tax Statement for the Accounting Year 2013-2014 (salary from March to February) corresponding to the Assessment Year 2014-2015 to the Accounts section within 10/01/2014 positively as per Proforma enclosed.
Income Tax Statement duly filled submitted to the Accounts section/Accounts Officer within prescribed time mentioned above, falling which pay for the month February 2014 will not be drawn & disbursed to the defaulter employee. (As per I. Tax Rule).
Thanking you
Accounts Officer & D.D.O
R. G. Kar Medical College & Hospital, Kolkata.
Enclosed:
1. PROFORMA OF INCOME TAX STATEMENT
2. PAY STATEMENT FORMAT 2013-2014
Please read the following note, for your ready reference:-
Ø No tax payment by bank Challan is entertained by the DDO.
Ø In case of 80D – payment of Mediclaim should be made by Cheque not by cash.
Ø At the time of submission of I.T statement, Tax payer should submit all documents along with I.T statement positively. Otherwise no deduction claim will be entertained by the DDO at the time of TDS deduction.
Ø Taxable income upto Rs. 5.00 Lakh will entitled rebate , Maximum of Rs. 2000.00 u/s 87A
Ø In case of 80C – premium on LIC must be less than 20% of the sum assured amount (excluding bonus amount).
Ø In case of claim of deduction on interest of HBL house building advance taken by the Govt. employee under Govt. loan scheme, deduction u/s 24(1)(iv) would be on Accrual basis of interest which would start running from the date of the drawal of the advance.
Ø TDS should be deducted equally starting from Pay bill for the month of March.
R. G. KAR MEDICAL COLLEGE & HOSPITAL
Pay Statement of Dr. / Sri/ Smt.
For the month of March 2013 to February, 2014 (GPF A/c No. )
Months / Basic Pay / Grade Pay / NPA / DA / HRA / Spl. Pay/ Allow / MA / Gross Total / GPF Cont. / GPF Reco / HR Reco / HBL Prin / HBL Intt / P.Tax / I.
Tax / GISS / Over Drawl / Net Pay
1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10 / 11 / 12 / 13 / 14 / 15 / 16 / 17 / 18 / 19
Mar‘13
Apr’13
May’13
Jun’13
Jul’13
Aug’13
Sep‘13
Oct’13
Nov’13
Dec’13
Jan’14
Feb’14
Arrear(1)
Arrear(2)
Bonus
Total