This document summarizes the income tax statement for Parijat Bhaumik for the 2012-13 financial year. It details his total income of Rs. 250,457 which includes basic pay, dearness allowance, bonus, and other income sources. It lists deductions of Rs. 14,560 under Section 80C. After deductions, his net taxable income was Rs. 235,750 and total income tax payable was Rs. 3,575.

1. Income Tax Statement for the year 2012-13 (Assessment year 2013-14)
Name parijat bhaumik PAN Dept Mines
Designation UDC Cat Male
I. Total income as per Work Sheet Enclosed
Rs. Rs.
Basic Pay (Pay in Pay band + Grade Pay) 137480
Spl Pay, NPA, Personal Pay and other Pay 0
/Pension/Family Pension
Dearness Allowance 95053
House Rent Allowance 0
Taxable Portion of Travelling Allowance 0
DA Arrears 2358
Bonus 3419
Honorarium, Over Time Allowance 0
Interest Income 0
Agriculture Income 0
Tuition Fees 0
Arrears of Pay and Allowance received during this year 12147
Any other Income/Arrears 0
Total Income (Incl. Govt Contribution for NPS:
250457
0
Rs. /- )
II. Deduct H.R.A Exemption if any (U/S 10(13A) of I.T.ACT'61)
a) Actual HRA Received 0
b) Rent paid in excess of 10% of Pay 0
c) 40% of pay (50% of Pay in case of A1/X city) 54992
HRA Exemption Allowed (Least of a, b and c) 0
III Total Salary (I-II) 250457

2. IV a) Less Professional Tax 150
b) Add/Less Income/Loss on House Property 0
V Gross Taxable Income (III - (IV a + IV b) 250307
VI. Deductions under Chapter VIA
(i) Sec.80 - E (Education Loan Repayment) 0
(ii) Sec.80 - D (Medical Premium) 0
(iii) Sec 80 - DD (Medical Treatment for PH dependants 0
(iv) Sec 80 - DDB (Medical Treatment) 0
(v) Sec 80 - G (Approved Donations) 0
(vi) Section 80 - GGA (Special Donation to scientific 0
research)
(vii) Section 80 - GGC (Contribution to Political Parties) 0
(viii) Section 80 - U (Deduction for physically disabled) 0
(ix) Section 80 - GG (Deduction of rent paid if no HRA is 0
paid)
(x) Other Deductions under Chapter VI-A 0
Total deductions under Chapter VI-A 0
VII. Savings for Rebate (U/S 80-C/CCC/CCD of I.T.Act'61)
A) GPF/EPF Subscription 8000
B) CGEGIS 60
C) HBA repayment (Principal amount) 0
D) LIC Premium 6500
E) PLI 0
F) Unit Linked Insurance Plans 0
G) ELSS (Mutual Funds) Investment 0
H) PPF 0

3. I) NSC 0
J) Tuition Fees (up to two children) 0
K) Section 80CCF Infrstructure Bond 0
L) Pension Fund (80 CCC and 80 CCD) 0
M) New Pension Scheme Employee Contribution 0
N) New Pension Scheme Govt Contribution 0
O) Other Savings 0
Total Savings 14560
VIII. Saving Eligible for Rebate 14560
IX. Net Taxable Income V-(VI + VIII) 235750
X. Income Tax Payable on (IX) 3575
XI. Less rebate for Agriculture Income 0
XII. Net Income Tax payable (X - XI) 3575
XIII. Add a) Education Cess @3% 107
Less b) Relief under Section 89(1) 0
Less c) Income Tax already deducted 0
Less d) Income Tax deducted on Interest 0
Balance Tax to be paid (XII + XIII a - XIII b -XIII c - XIII d)
XIV. 3682
negative value implies refund
Strike whichever is not applicable
The Balance Income Tax payable by me mentioned above may be deducted from my salary
for the months from 2012/2013 to 2012/2013
Income tax deducted from my salary is in excess of actual income tax payable by me and
the refund of Income tax due to me is mentioned above
Signature
INCOME TAX WORK SHEET 2012-13 (ASSESSMENT YEAR 2013-14)
MONTHLY INCOME

4. Other Other
Basic Taxabl Spl Pay Persl Pensio Month
GP DA HRA Allowanc Allowanc
Pay e TA /NPA Pay n Total
e1 e2
8830 2400 6513 0 0 0 0 0 17743
Mar 0 0
8830 2400 7300 0 0 0 0 0 18530
Apr 0 0
8830 2400 7300 0 0 0 0 0 18530
May 0 0
8830 2400 7300 0 0 0 0 0 18530
Jun 0 0
9170 2400 8330 0 0 0 0 0 19900
Jul 0 0
9170 2400 8330 0 0 0 0 0 19900
Aug 0 0
9170 2400 8330 0 0 0 0 0 19900
Sep 0 0
9170 2400 8330 0 0 0 0 0 19900
Oct 0 0
9170 2400 8330 0 0 0 0 0 19900
Nov 0 0
9170 2400 8330 0 0 0 0 0 19900
Dec 0 0
9170 2400 8330 0 0 0 0 0 19900
Jan 0 0
9170 2400 8330 0 0 0 0 0 19900
Feb 0 0
Tota 108680 28800 95053 0 0 0 0 0
0 0
232533
l
232533
0
Total Monthly Income (incl. of Govt Contribution for NPS: Rs. /-)
Deductions under Sect 80C, 80CCC
ULIP (annual) 0
NSC (annual) 0
PPF (annual) 0

5. GPF (annual) 8000 Income (Annual)
CGEGIS (annual) 60
Bonus 3419
Tuition Fees 0
DA Arrears (3 months) 2358
PLI (annual) 0
Honorarium/OT 0
Housing Loan Principal (Annual) 0
Tuition Fees 0
LIC Premium (total for the year) 6500
Pension Fund (Annual Total) 0 Agriculture Income 0
Section 80CCF Infra Bond 0
Interest income (Annual) 0
ELSS (Annual) (Mutual funds) 0
Arrears received 12147
Other Savings (up to Rs 1 lakh) 0
Any other annual income 0
Total 80C savings 14560
Total Annual Income 17924
Gross total income 250457
(monthly + annual)
Deductions under Chapter VIA
80E-Education Loan Repayment Annual 0
80D Medical Insurance (Annual) 0
80DDB Medical Treatment 0
80DD Treatment to PH dependents 0
80G Donations 0
Other deductions under Chapter VIA 0
80GGC-Contribution to Political Parties 0
80U-Disabled Persons 0
80GG-Rent paid 0
80GGA-Special Donation 0
Total Deductions under Chapter VIA 0

6. HRA exemption eligibility
Rent Paid in excess of 10% pay 0
Total HRA received (Annual) 0
40% of (Pay + GP) ( 50% for A1 cities) 54992
Your HRA exemption eligibility 0
Balance Income Tax Payable (negative value
implies refund)
3682
Rs.
Income Tax Calculation
Gross Total Income 250457
Less HRA exempted 0
Less Professional tax 150
Add/Less Income/Loss on House Property 0
Gross Taxable Income 250307
Less 80C, 8CCC deductions 14560
Less Chap VI A deductions 0
Net Taxable Income 235750
Total Tax payable 3575
Less Rebate for Agri Income 0
Net Income Tax Payable 3575
Add Education Cess 3% 107
Less Relief under Sec.89(1) 0
Less Tax already deducted 0
Less Tax deducted on Interest 0