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I General Information :
1 Name ARYASUNAN
2 Whether Gazetted No
3 Sex Female
4 Designation LPSA
5 Office / Department
AUPS SREEK
SREEKRISHN
6 Whether residing in rented house No
7 (a) PAN : ANPA!"#$A
8 Name % Address of &mp'oer
SAH
VASUDE
SREEKRISHN
" irc'e of fi'ing *ncome +ax ,eturn #a$%3&'(%
-ON+. O 0* PA1 DA
-A,. 2!34 2!24! 1275
FORMAT FOR THE PREPARATION OF INCCALCULATION STATEMENT FOR 201
(5) +AN )
FILL
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+O+A A,,&A,S ,&&*9&D
esti;a'/0onus
15 Surrender ea;e Sa'ar ,ecei;ed
+ota'
(i) Actua HRA !"c"i#"$ %"a!& !
!
(ii) R"'t ai$ i' "c"** +, 10 +, *aa!&(Pa& . /A))
(iii) 40 +! 50 +, *aa!& acc+!$i' t+ t" E+&""* L+cati+' No+&M
A!icutu!a I'c+" I, A'&
I'c+" F!+ H+u*" P!+"!t& I, A'&
E't"!tai'"'t A+a'c"
III Recoveries & Other Payments :
Number Subscription
1 P ontri5ution P18736 !
Other A''o
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17 S* Premium >!!!
18 G*S Premium 24!!
20 * Premium (Direct Pament) !
21 * Premium (Sa'ar Deduction) !
P* !
22 0S !
23 !
25 Profession +ax Paid
2
I- aa/le% 0e-o$e 313""
I- aa/le% a-,e$ 313""
27 Pu5'ic P No ) *
28 NS
30 -utua' funds
31
32 &?uit shares % de5entures
33 ,epament of .ousing 'oan
*ncome +ax deducted fromSa'ar 0i'' 7pto 6an82!3#
*nterest on.ousing oan
&ductiona' expenses of chi'dren(for 2 chi'dren)
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34
35 !
39 GPA*S
@!Pension und(Annuit P'an of * or other *nsurer)
3 @!Dontri5ution to Pension scheme of entra' Go;t8 &mp'oees
I: OTHER E!"TIONS
37
38
40
41
42 "ontribution toPolitical Parties u#s $%GG"
43
44
45 R"i", u;* 78(1)
*n;estment in ong term *nfrastructure 0ond of *D0*B *** etc8 (For claiming addition deduction of up to Rs. 20000)
An other deductionsBifan
e'ical Insurance Premium u#s $% 6 (Acc (100 i' t" ca*" +, S"cia Fu'$* ? 50i' +t"! ca*"*)
e'uction inrespect of persons -ith 'isability :(R*< 50000;- +! R*< 5000;- a* t" ca*" a& =")
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A.A.V
RISHNAPURAM
APURAM
&nter Data in White ce''s
.NA!2$4#A
EEDEVI.K.M HM
AN NAM!UDIRI
APURAM
HRA AL
1 25* 33241 -A,. ! S&P+ !
ME TAX-15
* .P *S A9A*&D &N+&, +.& N7-0&, O &A9&,&&9AN+ -ON+.
DATA
ANNEXTURE
FORM10-E
FILL
WELCOME
WELCOME
Statement
PRINT ST
Statement DATA
ANNEXTURE
FORM10-E
PRINT STATEMENT
FORM-16
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1 25* 33241 AP,* ! O+O0 !
1 25* 33241 -A1 ! NO98 !
5 25* 35265 67N& ! D& !
5 25* 35265 671 ! 6AN !
5 25* 35265 A7G ! &0 !
5 25* 35265
5 25* 35265
5 25* 35265
* 25* 3613*
* 25* 3613*
* 25* 3613*
41"7*3
* *
* *
* * * *
*
432
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*
22**
*
*
421"*3
*
*
*
e,$o *
*
*
*
535** MARCH APRIL MAY JUNE JULY
IF PF-MONTHLY SUBSCRIPTIONIS CHANGED ENTER DETAILS
HERE
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6*** 3500 3500 3500 4000 4000
24** SEPT. OCTOB. NOV. DEC. JAN.
* 5000 5000 5000 5000 5000
*
*
*
*
2#!!
*
*
*
*
*
*
*
*
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*
!
3**
*
*
!
!
!
!
!
!
!
!
WELCOME
Statement DATA
ANNEXTURE FORM10-E
PRINT STATEMENT
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S +AC&N *N +.&
ATEMENT
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43>"!$
AUG.
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5000
53500
FEB.
5000
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Name : .R/.S!N.N.,.,0 Office/Institution/Department :
!et!er "a#ette$ : No %e& : 1emale .!PS SREE2RISHN.P!R.3PS. SREE2RISHN.P!R.
ALNPA0753A "HN.%4567.
MONTH OF @ILL PAY /A HR. TOT.3MAR 2014 20240 1251 47% 55468APRIL 2014 20240 1251 47% 55468MA% 2014 20240 1251 47% 55468UNE 2014 20240 145 47% 57497UL% 2014 20240 145 47% 57497
AU>< 2014 20240 145 47% 57497SEPT 2014 20240 145 47% 57497OCT< 2014 20240 145 47% 57497NO:< 2014 20240 145 47% 57497/EC< 2014 20740 15140 47% 5985%
AN< 2015 20740 15140 47% 5985%FE@< 2015 20740 15140 47% 5985%
TOTAL 68;%5/A.Pa& A!!"a!* !"c"i#"$ i' Ca* %
,"*ti#a A+a'c";@+'u* 44%%
Su!!"'$"! %
/A.Pa& A!!"a!* M"!"$ t+ Pances an$ Arrears of DA/pa. an$ ot!er a**o>ances)
3ess Profession Ta? u/s 16(iii)
e'uct : Interest on Housin* 3oan(Maximum Rs. 30000/- orRs. 200000/- as the case may be)
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&i,) E$ucationa* e&penses of c!i*$ren 0
&,)"AI% 400
&,i) An. ot!er item (specif.) 0 0
92200 92200 Totale'uctions u#s $%"
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(=) 70CCC ension fun$ (Annuit. p*an of I; or an. ot!er insurer) 0
(c) 70CC/ 0 0
($) 70CCE 92200 92200
(") 70CCF 0
(") 70/ 0
(,) 70// 0
() 70//@ 0
() 70E 0
(i) 70> Donation to certain fun$s? c!arita3*e institutions etc7: 0
(B) 70>>C ;ontri3utions to o*itica* arties 0
() 70U 0
Total 92200 92200
@ 426'04 35200
Income Ta? on Total Income : 3!"2!
Re3ate u/s @6A 2!!!
T+ta @6'0 720
10 292
11 Total Ta? 7872
1' ess Re*ief u/s @(i) !
14 9a*ance Ta& 7872
1 ess Ta& $e$ucte$ from t!e sa*ar. 3i** upto Ban '012 0
12 Ta? Payable7872 Signature of the &mp'oee:
*ace : %REECRI%+NAURAM %i8nature of t!e +ea$ of Office in case of N"O
Date: 01/'2/'012 %i8nature of t!e Officer in t!e case of "a#ette$ Officer7
;ontri3ution to pension sc!eme of ;entra* "o,t7emp*o.ees enterin8 t!e ser,ice on or after Ban7'001
The a**re*ate amount of 'e'uctions u#s $%"+ $%"""+$%""
shall not+ in any case e?cee' One 3a)h an' 1iftyThousan' Rupees
I'#"*t"'t i' L+' T"! I',!a*t!uctu!a @+'$* '+ti,i"$ =& t"
C"'t!a >+#t< =.''itional 'e'uction upto Rs, 4%%%%>
Medical Insurance remium u/s !0 ": (Acc7Fun$) (Ma&7 Rs7 12000/- or '0000/- as t!e case ma. 3e)
Maintenance an$ Me$ica* treatment of +an$icappe$ Depen$ent (Ma&7 Rs720000/- or 62000/- as t!e case ma. 3e)
Me$ica* treatment for certain specifie$ $isease or ai*ment(Ma&imum of Rs7 0000/- an$ Rs7 50000/- as t!e case ma. 3e)
Repa.ment of *oan taen for !i8!er e$ucation(Ma&imum of Rs7 0000/-)
e uct on nrespect o persons > t sa t. :(Rs7 20000/- or Rs7 62000/-
as t!e case ma.3e
Net Ta?able Income(Roun$e$ to nearest ten)
.'' E'ucational "ess(4 of ta& )
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DATA
a8e 4
DAA SHEE FR ARREARS RELIEF US 8
/ al9la,/o+ S,a$, F$om FY 2*** &2**1 ,o FY 2
AND Aeme+, Yea$ 2**1 & 2**2 ,o 2*14&
Em'lo:ee; S,a,9 Male o$ Female ema'e
DEAILS F A
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DATA
a8e 0
o,al I+ome -o$ ,e F/+a+/al Yea$ 2*1*&11
o,al I+ome -o$ ,e F/+a+/al Yea$ 2*11&12
o,al I+ome -o$ ,e F/+a+/al Yea$ 2*12&2*13
o,al I+ome Fo$ e F/+a+/al Yea$2*13&14
DEAILS F ARREARS REEIVED
A$$ea$ $ee/e% Fo$ ,e F/+a+/al Yea$ 2***&2**1
A$$ea$ $ee/e% Fo$ ,e F/+a+/al Yea$ 2**1&2**2
A$$ea$ $ee/e% Fo$ ,e F/+a+/al Yea$ 2**2&2**3
A$$ea$ $ee/e% Fo$ ,e F/+a+/al Yea$ 2**3&2**4
A$$ea$ $ee/e% Fo$ ,e F/+a+/al Yea$ 2**4&2**5
A$$ea$ $ee/e% Fo$ ,e F/+a+/al Yea$ 2**5&2**6
A$$ea$ $ee/e% Fo$ ,e Yea$ 2**6&2**7
A$$ea$ $ee/e% Fo$ ,e Yea$ 2**7&2**8
A$$ea$ $ee/e% Fo$ ,e Yea$ 2**8&2**"
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DATA
a8e 1
A$$ea$ $ee/e% Fo$ ,e Yea$ 2**"&2*1*
A$$ea$ $ee/e% Fo$ ,e Yea$ 2*1*&2*11
A$$ea$ $ee/e% Fo$ ,e F/+a+/al Yea$ 2*11&2*12
A$$ea$ $ee/e% Fo$ ,e F/+a+/al Yea$ 2*12&2*13
A$$ea$ $ee/e% Fo$ ,e F/+a+/al Yea$ 2*13&2*14
A,9al A$$ea$ Rel/e- U 8"1 E+,/,le%
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DATA
a8e '
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DATA
a8e 4
1
13& 2*14
*15
2*** 2*13
R. *
R. *
R. *
R. *
R. *
R. *
R. *
R. *
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R. *
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DATA
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R. *
E+,e$ Rel/e- 8"1 aa/le% /+ a+: $elea+,
R. * 2**4&2**5 * 2**3&2**4
R. * 2**5&2**6 * 2**2&2**3
R. * 2**6&2**7 * 2**1&2**2
R. * 2**7&2**8 * 2***&2**1
R. * 2**8&2**" *
R. * 2**"&2*1* *
R. * 2*1*&2*11 *
R. * 2*11&2*12 *
R. * 2!322!3$ *
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R. * 2!3$2!34 *
R. *
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ORM 15
orm
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DATA
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DATA
a8e 25
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ANNEXURE=TA9E-A
a8e 2
ANNESee /,em 2 o- Fo$m No.1*E?
Arrears or advance salary
Sl No. Pa$,/9la$ Amo9+, R.
1 o,al /+ome e@l9%/+= ala$: $ee/e% /+ a$$ea$ o$ a%a+e R. 3572**
2 Sala$: $ee/e% /+ a$$ea$ o$ a%a+e R. *
3 R. 3572**
4 a@ o+ ,o,al /+ome >a 'e$ /,em 3? R. 8"82
5 a@ o+ ,o,al /+ome >a 'e$ /,em 1? R. 8"82
6 a@ o+ ala$: $ee/e% /+ a$$ea$ o$ a%a+e >D/--e$e+e o- /,em 4 a+% /,em 5? R. *
7 a@ om'9,e% /+ ao$%a+e B/, a0le CAC >!$o9=, -$om ol9m+ 7 o- a0le A? R. *
8 R. *
A!LE CAC
>See /,em 7 o- A++e@9$e 1?
1 2 3 4 5 6 7
2***&*1 R. * R. * R. * R. * R. * R. *
2**1&*2 R. * R. * R. * R. * R. * R. *
2**2&*3 R. * R. * R. * R. * R. * R. *
2**3&*4 R. * R. * R. * R. * R. * R. *
2**4&*5 R. * R. * R. * R. * R. * R. *
2**5&*6 R. * R. * R. * R. * R. * R. *
2**6&*7 R. * R. * R. * R. * R. * R. *
2**7&*8 R. * R. * R. * R. * R. * R. *
2**8&*" R. * R. * R. * R. * R. * R. *
2**"&1* R. * R. * R. * R. * R. * R. *
2*1*&11 R. * R. * R. * R. * R. * R. *
2*11&12 R. * R. * R. * R. * R. * R. *
2*12&13 R. * R. * R. * R. * R. * R. *
2*13&14 R. * R. * R. * R. * R. * R. *
AL R. * R. * R. * R. * R. * R. *
S/=+a,9$e )&
Plae) SREEKRISHNAPURAM
Name )& ARYASUNANDA.A.V
o,al /+ome a /+$eae% 0: ala$: $ee/e% /+ a$$ea$ o$ a%a+e >A%% /,em 1a+% /,em 2?
Rel/e- 9+%e$ Se,/o+ 8"1 >I+%/a,e %/--e$e+e 0e,Bee+ ,e amo9+, me+,/o+e%a=a/+, /,em 6 a+% /,em 7?
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o,al /+ome o- ,e$elea+, '$e/o9
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/+ ol9m+ 1
R.
o,al /+ome a/+$eae% 0:
ala$: $ee/e% /+a$$ea$ o$
a%a+e o- ,e$elea+, '$e/o9:ea$ me+,/o+e% /+ol9m+ 1
R.
a@ o+ ,o,al/+ome >a'e$ ol9m+
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ANNEXURE=TA9E-A
a8e 50
Da,e )& 12515 De/=+a,/o+ )& LPSA
De'a$,me+, )& AUPS SREEKRISHNAPURAM
SREEKRISHNAPURAM
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ANNEXURE=TA9E-A
a8e 51
o' 3
>-a !
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ANNEXURE=TA9E-A
a8e 5'
24#
FORM %TATEMENT
FORM10-E DATA
FORM 15 E;OME
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FORM-10E
a8e 66
FRM N.1* E
> See $9le 21AA?
1 Name a+% De/=+a,/o+ o- ,e em'lo:eeARYASUNANDA.A.V
LPSA
2 PERMANEN AUN NUM!ER ALNPA*753A
$ RESIDENIAL SAUS PERMANEN RESIDEN
1a *
0
%
2 ANNEom'a+:o&o'e$a,/e o/e,:loal a9,o$/,: 9+/e$/,: /+,/,9,/o+ao/a,/o+ o$
0o%:?
Particulars of income referred to in rule 21A of the Incometa! Rules" 1#$2"during the
previous year relevant to assessment year 201%1&
Sala$: $ee/e% /+ a$$ea$ o$ /+ a%a+e /+ ao$%a+e B/, ,e '$o//o+ o-90&$9le 2 o- R9le 21A.
Pa:me+, /+ ,e +a,9$e o- =$a,9/,: /+ $e'e, o- 'a, e$/e e@,e+%/+= oe$ a'e$/o% o- +o, le ,a+ 5 :ea$ /+ ao$%a+e B/, ,e '$o//o+ o- 90&$9le
3 o- $9le 21A.
No,A''l/a0le
Pa:me+, /+ ,e +a,9$e o- om'e+a,/o+ -$om ,e em'lo:e$ o$ -o$me$ em'lo:e$a, o$ /+ o++e,/o+ B/, ,e$m/+a,/o+ o- em'lo:me+, a-,e$ o+,/+9o9 e$/e o-+o, le ,a+ 3 :ea$ o$ Be$e ,e 9+e@'/$e% 'o$,/o+ o- ,e$m o- em'lo:me+, /
alo +o, le ,a+ 3 :ea$
No,A''l/a0le
Pa:me+, /+ omm9,a,/o+ o- 'e+/o+ /+ ao$%a+e B/, ,e '$o//o+ o- 90&$9le 5 o- $9le 21A
No,A''l/a0le
De,a/le% 'a$,/9la$ o- 'a:me+, $e-e$$e% ,o a0oe ma: 0e =/e+ /+ A++e@9$eIIIIIAIII o$ IV a ,e ae ma: 0e.
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DATAANNEXTURE
FORM FORM 15
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FORM 19-PART @DS"" Ru" 31(1)(a)
Name an$ a$$ress of t!e Emp*o.er Name an$ Desi8nation of t!e Emp*o.eeSATHEEDEVI.K.M ARYASUNANDA.A.V
HM LPSA
AUPS SREEKRISHNAPURAM AUPS SREEKRISHNAPURAM
SREEKRISHNAPURAM SREEKRISHNAPURAM
PAN6 ALNPA0753A TAN 6 "HN.%4567.
erio$ Assessment ear
Ward3-pkdFrom To
2015-1601/04/14 31/03/15
/ETAILS OF SALAR% AN/ OTHER INCOME TAX /E/UCTIONS
1 >!+** Saa!& 421903
' ess A**o>ance to t!e e&tent un$er section 10 0
4 Net %a*ar. Income (1-') 421903
A$$ : An. ot!er income reporte$ 3. t!e emp*o.ee
(a) A8ricu*ture Income 0
(3) Income from !ouse propert. 0
Tota* 0
2 T+ta I'c+" (3-4) 421903
5 De$uctions : (Un$er section 15)
(a) Ta& on emp*o.ment 2500
(3) Entertainment a**o>ance 0
Tota* 5 (a3) 2500
6 Un$er section '
Interest on +9A 0
@ >!+** T+ta I'c+" 419403
Un$er section @0 - ;
a) I; ( i) %a*ar. De$uction 0
(ii) Direct a.ment 0
3) "F ;ontri3ution 53500
c) F ;ontri3ution 0
$) Arrear DA 0
e) %I 000
f) "I% 2400
8)"AI% 300
!) I 0
i) F9% 0
) +9A 0.00
) Tution Fee pai$ (imite$ to ' ;!i*$ren) 0
*) E
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11 Un$er section @0 - ;;D 5''00 0
Un$er %ection @0;;E-*imite$ to 120000 2200 2200
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OTHER /E/UCTIONS
1' Un$er section @0 - ;;F 0
1 Un$er section @0 - D 0
12 Un$er section @0 - DD 0
15 Un$er section @0 - DD9 0
16 Un$er section @0 - E 0
1@ Un$er section @0 - " 0
1 Un$er section @0 - U 0
'0 Un$er section @0 - ""; 0
'' Tota* $e$uction a$missi3*e 2200 2200
'4 35%203 35%200
24 Income taxpayable &%20
25 Educational Cess @ 3% 22
26 Total Tax Payable (24+25) &9&2
27 Less Relief u/s 89(i) 0
28 Balance Tax &9&2
29 Ta al!ead" #aid / deducted &9&2
3$ Balance Tax to be paid / refunded 0
DETI!" #$ T% DED&'TED D DEP#"ITED IT# 'ET! *#E,ET ''#&T
&ount 'ate of a"&ent
- *T+EE'E,-.- */' of ,*0'E,1 10'R
o!in in te ca#acit" of + do e!e" ce!tif"in tat su& of
Rs 8982 ei.t tou0and nine undred and ei.ty1to as een
deducted at sou!ce and #aid to te c!edit of te Cent!al oe!n&ent- fu!te! ce!tif" tat te
info!&ation ien aoe is t!ue and co!!ect ased on te oo of accounts: docu&ents and ote!
aailale !eco!ds-
*inatu!e of te #e!son
!es#onsile fo! deduction of ta
lace; *REE.R*+10R 1a&e; *T+EE'E,-.-
'ate; $
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E;OME%TATEMENT
ANNEXTURE DATA
FORM10-EForm
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