FOR INDIVIDUAL & OTHER TAXPAYERS (OTHER THAN COMPANY) That FORM OF RETURN OF INCOME UNDER THE INCOME TAX ORDINANCE, 1984 (XXXVI OF 1984) Be a Respectable Taxpayer Photograph of the Assessee ‘Submit roturn in due timo Avoid penalty ESSERE SESHEELSESSSEASSS=SESSS! [to be attested on the photograph} Put the tick (6) mark wherever applicable Universal Normal 1, Name of the Assesses. Mohammad Ahshanullah 2. TIN TIN: 262610189578 3. National ID No (if any) 2695 0459 2147 6 4 Date of Birth 5 Emal 6 Spouse's TIN or Name: ....... Sharmin Akter Liza (TIN: NIA) 7. (a) Circle: 230 (bj Taxes Zone..11 8 Residential Status. Non-resident 9. Name and address of the employer: United International university 10. Present Address: United International University, House# 80, Roadi#8/A, Dhanmondi, Dhaka 411, Telephone: Office: Mobil: Statement of income during the income year ended on .... 30/06/2017 Heads of Income Tk 1|/Salavies : u/s 21 (as per schedule 1) 7 2[Income from house property: uls 24 (as per schedule 2) 3] Agricultural income -uls 26 ‘dlincome from other source _ws 83(saving from bank) 78,760 {| Total income 78,750 6[ Tax leviable on total come 5,000) 7) Tax rebate: wis 44(2)(6) 5 1% = @| Tax payable (diference beiween serial 6 and 7) 5,000 g|Tax Payments Tk (@)_Tax deductedicollected at source. T [(b) Adjustment of Tax Refund (AY 202-13)( extra tax paid in 2016-2017 BOT. 6894) aoa 8,994] 0[Diference between serial 8 and 9 (if any] (3994) +11] Tax exempted & Tax free income : “i needed, please use separate sheet. Verification |, Mohammad Anshanullah father: Late Mohammad Ahshanullah TIN: 262610189578 solemnly declare that to the best fof my knowledge and belief the information given in this relurn and statements and documents annexed herewith is correct ang complete. Bee HAs Abr LLh Date Signature 3H [ay tetera An (Nome in biock eters) Designation ang ‘eal (for other than indivi) 4 Kirene AUSEAVIRGGStatement of assets and liabilities as on 30/06/17 1-108 TIN: 262670189578 Name of the Assess Mohammad Anshanullah | Tk 1 Non-Agricultural Property (at cost with legal expenses ) °3,230,000] LandiHouse property (Description & location of property) 2 Agricultural Property (at cost with legal expenses ) : | Land (Total land and location of land property) 3 Investments: BF Change. oF (2) Shares/Debentures (0) Saving Certiicate/Untt CertiicatelBond 2407000 240,000 (6) Deposit Pension Scheme 71250,000) 1,250,000 (4) Loan given to relatives 662,250 882,250 (e} Other deposit, 77.954 ar7954] 2,850,204] 4 Motor Vehicles (at cost) ‘Type of motor vehicle and Registration number 5 Jewellery (quantity and cost) : (Gold 75 Tola Marriage Gift-value unknown) , 6 Furniture (at cost) : 326,000 7 Electronic Equipment (at cost): 386,254 8 Cash asset Outside Business: (2) Cash in hand “495,000 (©) Cash at bank (c) Deposits 375,000 870,000 9 Any other assets: | Total assets 7,662,488| 10 Less Liabilities BF Change oF (a) Mortgages secured on property or land (b) Unsecured loans (6) Bank loan - ; (d) Other Loans- from Provident Fund - Total liabilities | 11 Net wealth as on last date of this income year 7,662,458| (Gitference between total assets & total liabilities) 12 Net wealth as on last date of previous income year 7,583,708 18 Accretion in wealth (aiference between serial no. 11 & 12) 78,750 14 Personal & Family Expenditure 18 Total accretion of wealth (total of serial 19 & 14) 78,750 16 Sources of Fund () Shown Return income 78,750] (i) Tax exempted/Tax free Income | (ii) Other receipts- excess of Capital gain aaa Total source of Fund =. 78,750 17 Difference (between serial 15 & 16) / | solemnly declare that to the best of my knowledge and belief the information given in the IT-10B is correct and complete. Shymed Att lbh, Mohammad Ahshanuliah Name & signature of the Assessee 2ateo3/17/26 }F— Assets and labities of sof, spouse (if shelhe isnot an assessee), minor children and dependant) to-be shown in the above statements. needed pease se separate shot,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 uls 75 of the Income Tax Ordinance, 1984 (2) Enclose where applicable: (i) Salary statement for salary Income; (ii) Deed or rental agreement (if any) for house property income't; (ii) Documents in support of any other income or liabilities shown (iv) Documents in support of investments made in any form; (v) Computation of income according to Income according to Income-tax ordinance, 1984; (vi) Provide evidence in support of tax payment. (3) Documents furnished to support the declaration should be signed by the assessee or his/her authorized (4) Assets and liabilities of self, spouse (if she/he is not an assessee), minor children and dependants) to be (©) If needed, please use separate sheet. (©) Please vist NBR's website waw.nbr-bd.org for further information. zi) * Acknowledgement Receipt of Income Tax Return Government of the People’s Republic of Bangladesh Office of the Deputy Commissioner of Taxes Taxes Circle: 230 Zone: 14 Name of the Assessee: Mohammad Ahshanullah Assessment Year: 2017-18 TIN: 262610189578 Total income shown in Return: Tk. 78,750 Tax paid: Tk. -3,994 Gross Wealth shown: Tk. 7,662,458 Net Wealth shown: — Tk. 7,662,458 Date of receipt of return Serial No. in return register Return submitted under section 828B/Normal Signature of Receiving officer with seal