Sample Income Tax Form

FORM OF RETURN OF INCOME UNDER THE INCOME TAX
ORDINANCE, 1984 (XXXVI OF 1984)
IT-11GA
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
Photograph of the
Assessee
(to be attested on
the photograph)
Revised
Normal
1. Name of the Assessee:

2. National ID No (if any):
3. UTIN (if any):
---
---
4. TIN:
---
---
5. (a) Circle:
(b) Taxes Zone:
6. Assessment Year:
2016-2017
8. Status: Individual
Firm
7. Residential Status: Resident

X
Association of Persons
/ Non-resident
X Hindu Undivided Family
9. Name of the employer/business (where applicable):
10. Wife/Husband's Name (if assessee, please mention TIN):

11. Father's Name:
12. Mother's Name:
13. Date of Birth (in case of individual) :
Day
Month
14. Address (a) Present:
(b) Permanent:
15. Telephone: Office/Business:
Residential:
16. VAT Registration Number (if any):
Page 1
Year
Statement of Income of the Assessee

30th June 2016
Statement of income during the income year ended on

Serial
Heads of Income
Amount in taka
Salaries : u/s 21 (as per schedule-I)
Interest on Securities : u/s 22
3
4
5
6
7
8
Income from house property : u/s 24 (as per schedule-II)

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
10
11
Total (Serial 1-9)

Foreign Income: (Tax free income)
12
Total income (Serial 10 and 11)
13
Tax leviable on total income (As per Computation Sheet)
14
Tax rebate: u/s 44 (2) (b) (as per schedule-III)
15
(a) Tax payable (difference between serial 13 and 14)

(b) Add: Sur-Charge (10% of Total Tax)
(c) Total Tax Payable
Tax Payments:
(a) Tax deducted/Collected at Source
(Please submit supporting documents/statement)
Tk.
(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)
Tk.
16
Total of (a) (b), (c) and (d)
17
Difference between serial 15 and 16 (if any) Not claimed
18
Tax exempted and tax free income
19
Income tax paid in the last assessment year
* If needed, please use separate sheet.
Verification
0
0
I
father/husband
UTIN/TIN: 0 0 0 --- 0 0 0 --- 0 0 0 0 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 : 24/Sep/16
Signature
0
(Name in block letters)
Designation
and Seal (for other than individual)
Page 2
SCHEDULES SHOWING DETAILS OF INCOME

Name of the Assessee:
TIN
0 0 ---
--- 0
Schedule-1 (Salaries)
Amount of
Income
(Tk.)
Pay & Allowance
Amount of
exempted income
(Tk.)
Net Taxable
income
(Tk.)
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
Other, if any (give details) Share Income from

Secondary Market
Net taxable income from Salary
Schedule-2 (House Property income)

Location and description of
Property
Particulars
Tk.
Tk.
1. Annual rental income

2. Claimed Expenses :
Repair, Collection, etc.
Municipal or Local Tax
Land Revenue
Interest on loan/mortgage/Capital change
Insurance Premium
Vacancy Allowance
Other, if any
Total =
3. Net income (difference between item 1 and 2)
Page 3
Schedule-3 (Investment tax credit)

(Section 44(2)(b) read with part B of Sixth Schedule)
1. Life insurance premium
Tk.
2. Contribution to deferred annuity
Tk.
3. Contribution to Provident Fund to which Provident Fund Act, 1925 applies
Tk.
4. Self contribution and employers contribution to Recognized Provident Fund
Tk.
5. Contribution to Super Annuation Fund
Tk.
6. Investment in approved debenture or debenture stock, Stock or Shares
Tk.
7. Contribution to deposit pension scheme
Tk.
8. Contribution to Benevolent Fund and Group Insurance premium
Tk.
9. Contribution to Zakat Fund
Tk.
10. Others, if any (give details )
Tk.
Tk.
Total =
*Please attach certificates/documents of investment.
List of documents furnished
1. Income Tax Computation
6.
2. Income Statement
7.
3. Bank Statement
8.
4. Challan of Tax Deducted at source
9.
5.
10.
*Incomplete return is not acceptable
Page 4
IT-10B
Statement of Assets and Liabilities as on
30th June 2016
TIN 0
0 --- 0
1. (a) Business Capital (Closing balance)
---
Tk.
Tk.
Tk.
(b) Directors Shareholdings in Limited Companies (at cost)

Name of Companies
Number of shares
2. Non-Agricultural Property (at cost with legal expenses ) :

-
1
2
3
4
5
6
7
3. Agricultural Property (at cost including legal charges) As before

Land (Total land and location of land property)
4. Investments:
(a) Shares/Debentures
Tk.
(b) Pension Scheme
Tk.
(c) Prize bond/Savings Scheme
Tk.
(d) Loans given
Tk.
(e) Other Investment (FDR)
Tk.
Total =
Tk.
Tk.
5. Motor Vehicles (at cost)
As before
Tk.
6. Jewellery (quantity and cost)
As before
Tk.
7. Furniture (at cost)
As before
Tk.
Tk.
Tk.
Purchase This Year

8. Electronic Equipment (at cost)
As before
9. Cash asset Outside Business:

(a) Cash in hand
(Cash and Cash equivalent)
(b) Cash at bank
(c) Other deposits
(As per cash account)
Tk.
Tk.
Tk.
Total =
Page 5
B/F =
Tk.
Tk.
10. Any other assets :

(give details)
Tk.
Tk.
12. Net wealth as on last date of this income year

(Difference between total assets and total liabilities)
Tk.
13. Net wealth as on last date of previous income year
Tk.
14. Accretion in wealth (Difference between serial 12 and 13)
Tk.
15. (a) Family Expenditure: (Total expenditure as per Form IT 10 BB)
Tk.
Tk.
Tk.
Tk.
Total assets =
11. Less Liabilities:
Tk.
(b) Unsecured loans

Tk.
(c) Bank loan
Bank Loan from Standard Chartered Tk.
(d) Others (Loans from Relatives)
Tk.
(a) Mortgages secured on property or land
Total liabilities =
(b) Number of dependant children of the family:

0
Adult
0
Child
16. Total Accretion of wealth (total of serial 14 and 15)

17. Sources of Fund :
(i) Shown Return Income
Tk.
(ii) Tax exempted/Tax free Income
Tk.
(iii) Other receipts:
Tk.
Total source of Fund =

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
24/Sep/16
* 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.
Page 6
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
Serial
No.
TIN 0
Particulars of Expenditure
0 --- 0
Amount of Tk.
---
Comments
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
10
Personal expenses for Foreign travel
11
Festival and other special expenses, if any
Total Expenditure
I solemnly declare that to the best of my knowledge and belief the information given in the
IT-10BB is correct and complete.
Name and signature of the Assessee

24/Sep/16
Date
Acknowledgement Receipt of Income Tax Return

UTIN/TIN:
0 0 0 --- 0 0
Assessment Year:
---
Page 7
Circle:
2016-2017
Taxes Zone:
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.
Tax paid :
Net Wealth of Assessee :
Tk.
Refund :
Date of receipt of return :

Nature of Return :
Self
Tk.
Tk.
Serial No. in return register :

Universal Self
Normal
Signature of Receiving
officer with seal
Page 8

Sample Income Tax Form

Uploaded by

Copyright:

Available Formats

Sample Income Tax Form

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Sample Income Tax Form

Uploaded by

Copyright:

Available Formats

FORM OF RETURN OF INCOME UNDER THE INCOME TAX

ORDINANCE, 1984 (XXXVI OF 1984)

FOR INDIVIDUAL AND OTHER TAXPAYERS

1. Name of the Assessee:

(b) Taxes Zone:

7. Residential Status: Resident

X Hindu Undivided Family

9. Name of the employer/business (where applicable):

10. Wife/Husband's Name (if assessee, please mention TIN):

14. Address (a) Present:

15. Telephone: Office/Business:

16. VAT Registration Number (if any):

Statement of Income of the Assessee

Statement of income during the income year ended on

Salaries : u/s 21 (as per schedule-I)

Interest on Securities : u/s 22

Income from house property : u/s 24 (as per schedule-II)

Income from other source : u/s 33

Total (Serial 1-9)

Total income (Serial 10 and 11)

Tax leviable on total income (As per Computation Sheet)

Tax rebate: u/s 44 (2) (b) (as per schedule-III)

(a) Tax payable (difference between serial 13 and 14)

(b) Advance tax u/s 64/68 (Please attach challan)

(c) Tax paid on the basis of this return (u/s 74)

(d) Adjustment of Tax Refund (if any)

Total of (a) (b), (c) and (d)

Difference between serial 15 and 16 (if any) Not claimed

Tax exempted and tax free income

Income tax paid in the last assessment year

* If needed, please use separate sheet.

SCHEDULES SHOWING DETAILS OF INCOME

Pay & Allowance

House rent allowance

Employers Contribution to Recognized

Interest accrued on Recognized Provident

Deemed income for transport facility

Deemed income for free

Other, if any (give details) Share Income from

Net taxable income from Salary

Schedule-2 (House Property income)

1. Annual rental income

Municipal or Local Tax

Interest on loan/mortgage/Capital change

Schedule-3 (Investment tax credit)

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 )

List of documents furnished

1. Income Tax Computation

4. Challan of Tax Deducted at source

*Incomplete return is not acceptable

30th June 2016