FORM NO.

10E [See rule 21AA]

Form for furnishing particulars of income under section 192(2A) for
the year ending 31st March, 2022,for claiming relief under section
89(1) by a Government servant or an employee in a company, co-
operative society, local authority, university, institution, association
or body.
Acknowledgement Number -879783460291222

1. Name and Address of the employee NAVEEN KUMAR SHARMA

b126motikunj extension, thana

highway, MATHURA, motikunj
extension army cantt, , Uttar
Pradesh, INDIA - 281006

2. Permanent Account Number COVPS3086K

3. Residential status 'RES' - Resident

Particulars of income referred to in rule 21A of the Income tax Rules, 1962, during the previous year relevant to .
assessment year, 2022

1. (a) Salary received in arrears in accordance with the provisions of ₹ 1,01,632

sub-rule (2) of rule 21A

(b) Salary received in advance in accordance with the provisions of ₹0

sub-rule (2) of rule 21A

(c) Payment in the nature of gratuity in respect of past services, -

extending over a period of not less than 5 years in accordance
with the provisions of sub-rule (3) of rule 21A

(d) Payment in the nature of compensation from the employer or -

former employer at or in connection with termination of
employment after continuous service of not less than 3 years or
where the unexpired portion of term of employment is also not
less than 3 years in accordance with the provisions of sub-rule
(4) of rule 21A

(e) Payment in commutation of pension in accordance with the -

provisions of subrule (5) of rule 21A

2. Detailed particulars of payments referred to above may be given

in Annexure I, II, IIA, III or IV, as the case may be

Verification
I, NAVEEN KUMAR SHARMA, do hereby declare that what is stated above is true to the best of my knowledge
and belief.
 Verified today the 29th day of December, 2022.

Place

IP Address 106.215.220.209

Date 29-Dec-2022

Annexure I - ARREARS SALARY/FAMILY PENSION

[See item 2 of Form No. 10E]

1. Total income (excluding salary received in arrears) ₹ 4,36,867

2. Salary received in arrears ₹ 1,01,632

3. Total income (as increased by salary received in arrears)[Add item 1 ₹ 5,38,499

and item 2]

4. Tax on total income as per system calculation (as per item 3) ₹ 21,008

4. Tax on total income as per taxpayer (as per item 3) ₹ 21,008

5. Tax on total income as per system calculation (as per item 1) ₹0

5. Tax on total income as per taxpayer (as per item 1) ₹0

6. Tax on salary received in arrears [Difference of item 4 and item 5] ₹ 21,008

7. Tax computed in accordance with Table "A" [Brought from column 7 ₹0

of Table "A"

8. Relief under section 89(1) [Indicate the difference between the ₹ 21,008
amounts mentioned against items 6 and 7]

TABLE "A"
[See item 7 of Annexure I]

Sl. No. Previous Total Salary/ Total Tax on total Tax on total Difference in
Year(s) income of Family income (as income [as income [as tax [Amount
the relevant Pension increased by per per under
previous received in salary column(2)] column(4)] column(6)
year arrears received in minus
relating to arrears) of amount
the relevant the relevant under
previous previous column (5)]
year as year
mentioned mentioned
in column(1) in column(1)
[Add
columns (2)
and (3)]
 Sl. No. Previous Total Salary/ Total Tax on total Tax on total Difference in
Year(s) income of Family income (as income [as income [as tax [Amount
the relevant Pension increased by per per under
previous received in salary column(2)] column(4)] column(6)
year arrears received in minus
relating to arrears) of amount
the relevant the relevant under
previous previous column (5)]
year as year
mentioned mentioned
in column(1) in column(1)
[Add
columns (2)
and (3)]
1 2020-21 526834 101632 628466 0 39721 0

Note : In this Table, details of salary received in arrears relating to different previous years may be furnished.

Acknowledgement Number - 879783460291222