Name of the Assessee: : ROOKSHANA AKTER

:
Status Individual
:
:
National ID No. (if any): 19927328507000007
: 1 1 1 1 1 1 1 1
:
UTIN (if any) : :
:
eTIN : 369721766749
: 2 2 2 2 2 2 2 2 2
:
Circle : : 048
Taxes Zone : : 03
:
Name of the employer/business (where applicable): : Acme Pharmaceuticals Limited
:
Wife/Husband's Name with TIN : : Aaaa Bbbb Cccc
TIN of Spouse : 3 3 3 3 3 3 3 3 3 3

Father's Name: : Md.Rafiqul Lslam

:
Mother's Name: : Rubia Akter
:
Date of birth 13/11/92
: 0 0 0 0 0 0 0
:
:
Address: Present : DDD DDD DDDD
: Shekhertek,Road#08,House#23/24,Mohammadpur.

Address: Permanent : House #40,Road #Ibrahim lean,Puraton babupara,Saidp

: GGG GGG GGGG

Telephone: Office/Business : : 01620707636

Residential/Personal Mobile : 01788039909

:
VAT Registration No. ( if any ) : : Not Applicable

Place : : Dhaka

Date : 22/11/20
 Male(M), Female(F), 65+(S), Disabled(D) or Freedom Fighter(F)

1 1 1

2 2

Please change to your Circle

Please change to your Zone

3 3

Present Address - Should be commensurate with your city corporation or place

3/24,Mohammadpur. on which your minimum tax calcutaion is related

aton babupara,Saidpur,Nilphamari.

Based on your residential address

Based on your date of Completion

A Name of the Assessee : Err:509
B eTIN : 369721766749

1 Tax Computation
Taxable
Total Income
Income
(Taka)
(Taka)
Basic Pay 175,680 175,680
House Rent Allowance 87,560 -
Unfurnished House Accommodation Y/N N -
Special Pay/Allowance -
Bonus 57,560 57,560
Medical Allowance/Actual Expenses for Managers 17,568 -
Medical exp for Heart,Kidney,Eye,Liver & Cancer Surgery Expenses -
Lunch/Entertainment Allowance -
Conveyance Allowance (Cash) 30,000 -
Conveyance Facilities (Car provided by Co.), Y/N N -
Children Education Allowance -
Holiday/Overtime Allowance 79,785 79,785
Leave Encashment -
Income from WPPF 6,233 -
Other allowances -
Interest Accrued on Provident Fund -
Provident Fund (Employer's Contribution) Y 17,568 17,568
TOTAL 471,954 330,593

Interest on Securities: u/s 22 - -

Income from house property: u/s 24 (as per schedule 2) - -
Agricultural income: u/s 26 - -
Income from business or profession: u/s 28 - -
Share of profit in a firm: - -
Capital Gains: u/s 31 - -
Income of the spouse or minor child as applicable: u/s 43(4) - -
Income from other sources: u/s 33
Interest on Bank Deposit 117 117
Dividend Income - -
Dividend from Mutual/Unit Fund - -
Other Income -
-
Net Income 472,071 330,710

Tax Exempted Income:

House Rent 87,560
Conveyance Allowance 30,000
Medical Allowance 17,568
WPPF 6,233
Interest Accrued on Provident Fund -
Dividend Income -
Tax Exempted Income 141,361

Income Tax
Male(M), Female(F), 65+(S), Disabled(D) or Freedo F Tax Rate Tax
Allowance for Physically/Mentally Challenged Children:
Number of children: 0

First Tk 330,710 0% -
 Next Tk - 5% -
Next Tk - 10% -
Next Tk - 15% -
Next Tk - 20% -
Balance Taka - 25% -
Tax on Regular Income -
Add: Tax deducted on Interest on Sanchaypatras -
Total Tax A -

Investment Allowance & Tax rebate

Taxable Income less Interest from Sanchay Patra 330,710
Investment made during the year (e.g. PF, DPS, PSP, Insurance) 35,136
Maximum Allowable Investment Limit for Tax Rebate 82,678

Computation of Tax Rebate on Eligible Amount 35,136

Income up to Taka 1,500,000/- 15% 5,270

Income if exceeded Taka 1,500,000/- 10% -
Tax Rebate on Investment 5,270 5,270

Maximum Tax Rebate B -

Tax as per above Calculation -

Have Cars > 1 OR Hosue Property > 8000sft N -

Minimum Surcharge on above Assets -
Surcharge on Net Wealth Taka 304,290 -
Minimum Surcharge on Net Wealth -
ADD: Surcharge on Wealth -

Income Tax -

Income Tax Payable (or Minimum Tax) DCC -

1st Time Online Submission? N 0

Tax Payable -

Return Submission after Deadlin Amount Rate Month

Interest for delayed submission of (645) 2% 0 -

Final Tax Payable -

Tax deducted at source/deposited vide challan

By the Company (Certificate to be enclosed) 633
Advance Tax Deposited -
Tax deducted at source, e.g. bank Interest, dividend, etc 12
Tax deducted at source from Income from Spouse, Minor Children -
Tax Deducted at source on Interest on Sanchay Patra -
Tax deposited vide Challan (Photocopy enclosed) -
Adjustment of Tax Refund -
Total Tax Paid 645
Balance Tax (Payable)/Refundable 645

2 Please Insert Tax deducted from salaries:

 Tax deducted from Salary
Tax deducted from WPPF 633
Tax deducted as per Salary Certificate Taka 633

3 Insert Advance Tax Payment, if any

Advance Tax for Personal Car Taka
-

4 Bank & FDR Details from July 01, 2019 to June 30, 2020
Interest Tax Closing
Bank & Account No Fm 01/07/19 Deducted Balance
To 30/06/20 by Bank 6/30/2020

Dutch Bangla Bank 117 12 41

Standard Chartered
HSBC
Eastern Bank Limited
AB Bank
FDR 1
FDR 2

Total - 117 12 41

5 Dividend Received during 01/07/2019 to 30/06/2020, if yes, please fill up below:

Gross Tax Net
Name of Company Dividend Deducted Received

-
-
-
-
-
-
-
-
Total - - -

Dividend Income from Mutual/Unit Fund during 01/07/2019 to 30/06/2020:

Gross Tax Net
Name of Fund Dividend Deducted Received

-
-
-
Total - - -

6 Interest Income, Encashment of BSP, DPS, etc. during 01/07/2019 to 30/06/2020:

Principal Gross Interest Tax
Particulars Encashed Fm 01/07/19 Deducted
If Any To 30/06/20 by Bank

BSP/Sanchay Patra Encashed

 3 Monthly Profit Based Sanchay Patras
Interest Income of 3MSP
Paribar Sanchaypatra
Interest Income of Paribar Sanchayapatra

Total - - -

DPS Encashed

Total - - -

7 Investment Related Information (Investment during 01/07/2019 to 30/06/2020)

Addition Encashed/ Investment
Investment Allowance During the FY Retired For Tax
Taka Taka Credit

Contribution to Provident Fund 35,136 35,136

Life Insurance Premium Paid -

Deposit Pension Scheme (DPS) - -
Savings Certificate/BSP Y - -
3 Monthly Profit Based Sanchay Pat Y - -
Paribar Sanchaypatra Y - -
Invesment in Shares / Debentures of Stock Exchanges -
Investment in Treasury Bond -
Electric Equipment-TV, Etc.
Contribution to Zakat and Other Funds - -

Total 35,136 - 35,136

8 Family and Personal Expenditure from 01/07/2019 to 30/06/2020 including Tax Payment
Particulars Amount

Personal and fooding expenses 80,000

Accommodation expenses/House Rent
Medical Expenses 40,000
Transport expenses
Electricity Bill for residence 5,000
Wasa Bill for residence 2,000
Gas Bill for residence
Telephone Bill for residence 5,000
Education expenses for children
Personal expenses for Foreign travel
Festival and other special expenses, if any 40,000
Life Insurance Premium Paid -
Contribution to Zakat and Other Fund -

Tax paid including deduction at source of the last financial year 645

House Repairing Expense

 Total Expenses 172,645

For the following sections Last Year's Return is Needed

1 Please insert Total Tax Deposited as per last Return below:

Total Tax Paid as per Last Return Taka

2 Please insert Tax Refundable, if any, as per last Return:

Amount of Tax Refundble as per Last Return Taka

3 Did you pay any tax with Last Tax Return? If yes, please insert the amount below:
Tax Paid with Last Return (Shortfall of deductions) Taka
Arrear Tax Paid between July 01, 2019 to June 30, 2020 Taka
Total -

4 Insert figures of Statement of Wealth/Assets as per Last Return and Current Year's
Investment
Balance as on Addition Encashed/ Balance as on
Particulars of Assets & Liabilitie 7/1/2019 During the FY Retired 6/30/2020
Taka Taka Taka Taka
Business Capital -
Directors shares in Companies -
Property (land, building, etc) Non Agricultural -
Agricultural Property -
Shares / Debentures - - -
Savings Certificate/Unit Certificate/Bond - - -
Prize Bond/Savings Scheme (DPS) - - -
Loans given -
Others Investment -
Vehicle -
Jewellery 250,000 250,000
Furniture 50,000 50,000
Electronic Equipment - -
Other Assets -
Total - 300,000 - 300,000
Cash in Hand 4,249 - 4,249
Cash at Bank 41 41
Gift Paid
Gift Received
Other - -
Total - 4,290 - 4,290
Total Assets - 304,290 - 304,290

Mortgages Secured on property or Land -

Unsecured Loans / PF Loan -
Bank loan -
Other Loan -
Total Liabilities - - - -
Net Wealth - 304,290 - 304,290
Other Issues:

1 Do you have any let out property, getting rental income? Insert information below.
Particulars Amount

1. Annual Rental Income

2. Claimed Expenses
Repairs, Collection, etc. R 25% -
Municipal or Local Tax
Land Revenue
Interest on Loan/Mortgage/capital Charges
Insurance Premium
Vacancy Allowance
Other, if any
Total of Expenses -

Net Income from House Rent -

2 Input for other Income, if any. The following actually needed separate calculation
Particulars Amount

Agricultural income: u/s 26 -

Income from business or profession: u/s 28 -

Share of profit in a firm: -

Capital Gains: u/s 31 -

Total -

3 Income from Spouse, Minor Children, etc., if Any

Interest Tax Net
Bank & Account No Fm 01/07/19 Deducted Interest
To 30/06/20 by Bank 6/30/2020

Bank/FDR -
Sanchayapatra

Total - - - -

4 Did you pay any money to Govt. Zakat Fund during 01/07/2019 to 30/06/2020? Or to the followi
Particulars Amount
 FORM OF RETURN OF INCOME UNDER THE INCOME TAX
IT-11GA
ORDINANCE, 1984, (XXXVI OF 1984)
FOR INDIVIDUAL AND OTHER TAXPAYERS
(OTHER THAN COMPANY)

Be a Respectable Tax payer

Submit return in due time Photograph of
Avoid penalty the Assessee
(to be attested on
the photograph
Put the tick (√) mark wherever applicable

Self Universal Self Normal

1. Name of the Assessee : ROOKSHANA AKTER

2. 19927328507000007
National ID No. (if any): 0 1 1 1 1 1 1 1 1 1 1 1

3. UTIN (if any) :

4. eTIN : 369721766749
2 2 2 2 2 2 2 2 2 2 2

5. (a) Circle : 048 (b) Taxes Zone: 03

6. Assessment Year: 2020-2021 7. Residential Status: Resident √ / Non-resident

8. Status: Individual √ Firm Association of Persons Hindu Undivided Family

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

10. Wife/Husband's Name with TIN : AAAA BBBB CCCC

3 3 3 3 3 3 3 3 3 3 3 3
11 Father's Name: Md.Rafiqul Lslam

12. Mother's Name: Rubia Akter

13. Date of birth 13/11/92 0 0 0 0 0 0 0

(in case of individual) Day Month Year

14. Address: (a) Present: DDD DDD DDDD

0
(b) Permanent: House #40,Road #Ibrahim lean,Puraton babupara,Saidpur,Nilphamari.
GGG GGG GGGG
15. Telephone: Office/Business : 01620707636 Residential: 01788039909

16. VAT Registration No. ( if any ) : Not Applicable

0 7 6 - 1 08 - 0 5 7 8

1
 Statement of income of the Assessee
Statement of income during the income year ended on June 30, 2020

SL No. Heads of Income Amount in Taka

1. Salaries: u/s 21 (as per schedule 1) 330,593
2. Interest on Securities: u/s 22 -
3. Income from house property: u/s 24 (as per schedule 2) -
4. Agricultural income: u/s 26 -
5. Income from business or profession: u/s 28 -
6. Share of profit in a firm: -
7. Income of the spouse or minor child as applicable: u/s 43(4) -
8. Capital Gains: u/s 31 -
9. Income from other source: u/s 33 117
10. Total (Serial no. 1 to 9) 330,710
11. Foreign Income: -
12. Total income (serial no. 10 and 11) 330,710
13. Tax leviable on total income -
14. Tax rebate: u/s 44(2)(b) (as per schedule 3) -
15. Tax payable (difference between serial 13 and 14) -
16. Tax payments:

(a) Tax deducted / collected at source Tk. … 645

(please attach supporting documents/statement)
(b) Advance tax u/s 64/68 [please attach challan(s)] 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. … -
Total of (a), (b), © and (d) 645

17. Difference between serial 15 and 16 (if any) (Refundable) (645)

18. Tax exempted & Tax free income 141,361
19. Income tax paid in the last assessment year -

If needed, please use separate sheet

Verification

I, XXXXXXXXXXXXXXXX, Father/husband XXXXXXXXXXXXXXXXX

UTIN/eTIN : XXXXXXXXXXX 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 : Dhaka
Date : 22/11/20

ROOKSHANA AKTER

2
 SCHEDULES SHOWING DETAILS OF INCOME

Name of the Assessee : ROOKSHANA AKTER eTIN : 369721766749

Schedule-1 (Salaries)

Amount of Amount of Net taxable 8

7
-
6

Pay & Allowance Income exempted Income Income

(Tk.) (Tk.) (Tk.)
Basic pay 175,680 - 175,680
Special pay - - -
Dearness allowance - - -
Conveyance allowance 30,000 30,000 -
House rent allowance 87,560 87,560 -
Medical allowance 17,568 17,568 -
Servant allowance - - -
Leave allowance - - -
Honorarium/Reward/Fee - - -
Overtime allowance 79,785 - 79,785
Bonus/Ex-gratia 57,560 - 57,560
Other allowance (Lunch/Entertainment/Children Educat - - -
Employer’s Contribution to
Recognized Provident Fund 17,568 - 17,568
Interest accrued on Recognized
Provident Fund - - -
Deemed income for transport facility - - -
Deemed income for free
furnished/unfurnished accommodation - - -
Other, if any (WPPF) 6,233 6,233 -
Net taxable income from salary 471,954 141,361 330,593

Schedule-2 (House Property income)

Location and Particulars Tk. Tk.

description of property
1. Annual rental income -
2. Claimed Expenses :
Repair, Collection, etc. -
Municipal or Local Tax -
Land Revenue -
Interest on Loan/Mortgage/Capital Charge -
Insurance Premium -
Vacancy Allowance -
Other, if any -
Total = -
3. Net income ( difference between item 1 -
and 2 )

3
 Schedule-3 (Investment Tax Credit)
(Section 44(2)(b) read with part ‘B’ of Sixth Schedule)
Total Allowable
Taka Taka
1. Life insurance premium - -
2. Contribution to deferred annuity
3. Contribution to Provident Fund to which Provident Fund
Act, 1925 applies
4. Self contribution and employer’s contribution to
Recognized Provident Fund 35,136 35,136
5. Contribution to Super Annuation Fund
6. Investment in approved debenture or debenture stock,
Stock or Shares - -
7. Contribution to deposit pension scheme (DPS) - -
8. Contribution to Benevolent Fund and Group Insurance premium
9. Contribution to Zakat Fund - -
10. Others, if any (Savings Certificate - BSP,etc.) - -
11. Others, if any
Total 35,136 35,136
Maximum Limit 330,710 25% 82,678
(Taxable Income less Interest on Sanchay Patra)
*Please attach certificates/documents of investment.

List of documents furnished

1 Certificate of Salary Income & Deduction of Tax

2 Bank Balance Certificate
3
4
5
6

*Incomplete return is not acceptable

4
 IT -10B

Statement of Assets and Liabilities as on June 30, 2020

Name of the Assessee : ROOKSHANA AKTER eTIN : 369721766749

1 1 0 - 4 3 4 1
1. (a) Business Capital (Closing balance) Tk. - 1
(b) Directors Shareholdings in Limited Companies (at cost) Tk. -
Name of Companies Number of shares

2. Non-Agricultural Property (at cost with legal expenses): Tk. -

Land /House property (Description and location of property)

3. Agricultural Property : (at cost with legal expenses): Tk. -

land (Total land and location of land property)

4. Investments :
(a) Shares / Debentures Tk. -
(b) Savings Certificate/Unit Certificate/Bond Tk. -
(c) Prize Bond/Savings Scheme (DPS) Tk. -
(d) Loans given Tk. -
(e) Others Investment Tk. -
Total Tk. -

5. Motor Vehicles (at cost): Tk. -

Type of motor vehicle and Registration number

6. Jewellery (quantity and cost): Tk. 250,000

7. Furniture (at cost) Tk. 50,000

8. Electronic Equipment (at cost) Tk. -

9. Cash Asset Outside Business:

(a)   Cash in Hand Tk. 4,249
(b)  Cash at Bank Tk. 41
(c)   Other deposits: Tk. -

Total Tk. 4,290

5
 B/F = 304,290
10. Any other assets : -
(Give details)

Total assets Tk. 304,290

11. Less Liabilities :

(a) Mortgages Secured on property or Land Tk. -
(b) Unsecured Loans Tk. -
(c) Bank Loan Tk. -
(d) Others Tk. -
Total Liabilities Tk. -

12. Net wealth as on last date of this income year Tk. 304,290
( Difference between total assets and total liabilities )

13. Net wealth as on last date of pervious income year -

14. Accretion in wealth (Difference between serial no. 12 and 13 ) 304,290

15. (a) Family Expenditure: ( Total expenditure as per Form IT 10 BB) Tk. 132,645
Gift Paid/(Received) -

( b) Number of dependent children of the family:

Adult Child

16. Total Accretion of wealth (Total of serial no. 14 and 15 ) 436,935

17. Sources of Fund :

(i) Shown Return Income Tk. 330,710
(ii) Tax exempted/ Tax free Income Tk. 141,361
(iii) Other receipts (Deemed Income) Tk. -
Self, Employer's PF Contribution &
Interest Accrued on PF Tk. (35,136)
Total sources of fund= Tk. 436,935

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.

ROOKSHANA AKTER
Date : 22/11/20

Ÿ Assets and liabilities of self, spouse (if she/he is not an Assessee), minor children and dependent(s)
to be showing in the above statements.
Ÿ If needed, please use separate sheet.
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

Name of the Assessee : ROOKSHANA AKTER eTIN : 369721766749

Serial Particulars of Expenditure Amount of Tk. Comments

No.
1 Personal and fooding expenses 80,000
2 Tax paid including deduction at source of the last
645
financial year
3 Accommodation expenses -
4 Transport expenses -
5 Electricity Bill for residence 5,000
6 Wasa Bill for residence 2,000
7 Gas Bill for residence -
8 Telephone Bill for residence 5,000
9 Education expenses for children -
10 Personal expenses for Foreign travel -
11 Festival and other special expenses, if any 40,000
12 Life Insurance Premium Paid -
- -
Total Expenditure 132,645

I solemnly declare that to the best of my knowledge and belief the information given in this IT-10BB
is correct and complete.

ROOKSHANA AKTER
Date : 22/11/20

Ÿ If needed, please use separate sheet.

………………………………………………………………………………………………………………………………………………

Acknowledgement Receipt of Income Tax Return

Name of the Assessee : ROOKSHANA AKTER Assessment Year: 2020-2021

eTIN : 369721766749 Circle : 048Taxes Zone : 03

7
 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 intereston 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 & 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 assesses (if she/he is not an assessee), minor children and dependent;
(b) any income from other sources, e.g., bank interest, divident, etc.
(c) tax exempted income.
(4) Fulfilment 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 assessee shall submit his/her photograph with return after every five year.
(7) Furnish the following information:
(a) Name, address & TIN of the partners if the assessee is a firm;
(b) Name of firm, address & TIN if the assessee is a partner;
(c) Name of the company, address & TIN if the assessee is a director.

(8) Assets and liabilities of self, spouse (if she/he is not an assessee), minor children and dependent(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 IT-10B & IT-10BB.
(10) If needed, please use separate sheet.

…………………………………………………………………………………………………………………………

Total income shown in Return: Tk . 330,710 Tax paid: Tk. 645

Net Wealth of Assessee : Tk. 304,290
Date of receipt of return : … Serial No. in return register ...

Nature of Return : Self Universal Self Normal

Signature of Receiving
officer with seal

8
 Fund Statement

Receipts Payments

Opening Balance: - Income Tax and Family Expenditure 132,645

- Cash - Contribution to Provident Fund 35,136
- Bank -
Net Change in Assets 300,000
Net Changes in Loan Position -
Total Income Cash 472,071 472,071
Less: Interest Accrued on Provident Fund - Contribution to Zakat & Other Fund

Gift Received - Gift Paid -

Closing Balance:
- Cash 4,249
- Bank 41
4,290
472,071 472,071

-
Interest on Securities: u/s 22
Income from house property: u/s 24 (as per schedule 2)
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