Follow the pages one by one and keep on filling the cells shaded blue

1. Name of the Assessee: MD. GOLAM AZAM KHAN (MUKUL)

2. National ID No (if (any) : 489848882283

4. TIN: 489848882283 4 8 9 8 4 8 8 8 2 2 8 3

5 (a) Tax Circle 007

(b) Tax Zone Bogura

6. Assesment Year: 2020-2021

10 Wife's name: Mst. Laki khatun

11. Father's Name: MD. AMZAT ALI KHAN

Mother's Name: MST. FOZILA KHATUN

12. Present address: line:1 SIRAJGANJ 225 MW CCPP,

Line:2 SOYDABAD
Line:3 Sirajganj

13 Date of Birth 0 2 0 1 1 9 8 2
D D M M Y Y Y Y

14. Permanent address: line:1 Village:Jarila

Line:2 Post: Porabbari
Line:3 Dist:Sirajganj

15 Office Phone: N/A

Home Phone: N/A

16 Date of Tax Return 11/19/2020

NWPGCL
 FORM OF RETURN OF INCOME UNDER THE INCOME TAX ORDINANCE 1984
(XXXVI OF 1984)

FOR INDIVIDUAL & OTHER TAXPAYERS (OTHER THAN IT-11GA

COMPANY)

Be a Respectable Taxpayer
Photograph of the
Submit return in due time
Assessee
Avoid penalty

[to be attested on the

photograph]
Put the tick (√ ) mark where applicable
Self √ Universal Self Normal

1. Name of the Assessee: MD. GOLAM AZAM KHAN (MUKUL)

2. National ID No (if (any) : 489848882283

3. UTIN (if any): - -

4. TIN: 4 8 9 8 4 8 8 8 2 2 8 3

5. (a) Circle: 007 (b) Tax Zone: Bogura

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

8. Status: Hindu Undivided

Individual √ Firm Association of Persons Family
9. Name of the employer/business (where applicable): SOYDABAD

10. Wife/Husband's Name (if assessee, please mention TIN): Mst. Laki khatun

11. Father's Name: MD. AMZAT ALI KHAN

12. Mother's Name: MST. FOZILA KHATUN

13. Date of Birth (in case of individual): 0 2 0 1 1 9 8 2

Day Month Year

14. Address (a) Present: SIRAJGANJ 225 MW CCPP,

SOYDABAD
Sirajganj

(b) Permanent: Village:Jarila

Post: Porabbari
Dist:Sirajganj

15. Telephone: Office/Business: N/A Residential: N/A

1
16. VAT Registration Number (if any): N/A

1
 Statement of income of the Assessee
Statement of income during the income year ended on: 6/30/2020
Heads of Income Amount in taka
1. Salaries : u/s 21 (as per schedule 1) 650,283.00
2. Interest on Securities : u/s 22 0.00
3. Income from house property : u/s 24 (as per schedule 2) 0.00
4. Agricultural income : u/s 26 0.00
5. Income from business or profession : u/s 28 0.00
6. Share of profit in a firm : 0.00
7. Income of the spouse or minor child as applicable : u/s 43(4) 0.00
8. Capital Gains : u/s 31 0.00
9. Income from other source : u/s 33 (self-assessment attachment#6) 0.00
10. Total (Serial 1 to 9) 650,283.00
11. Foreign Income: 0.00
12. Total income (Serial 10 and 11) 650,283.00
13. Tax leviable on total income 30,028.30
14. Tax rebate: u/s 44(2)(b)(as per schedule-3) 24,385.61
15. Tax payable (difference between serial 13 and 14) 5,642.69
16. Tax Payments:
(a) Tax deducted/collected at source (Please submit supporting documents/statement)
(see self-assessment) Tk. 12839.00
(b) Advance tax u/s 64/68 (Please attach challan )
(see self-assessment) 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), (c) and (d) Tk. 12,839.00
17. Difference between serial 15 and 16 (if any) -7,196.31
18. Tax exempted & Tax free income Tk. 330,000.00
19. Income tax paid in the last assessment year Tk. 26,778.00

* if needed, please use separate sheet.

Verification

I am MD. GOLAM AZAM KHAN (MUKUL) father/husband MD. AMZAT ALI KHAN UTIN/TIN:
489848882283 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: NWPGCL, Dhaka

Date:
(MD. GOLAM AZAM KHAN (MUKUL))
SIRAJGANJ 225 MW CCPP,
SOYDABAD
Sirajganj

2
162570.75

24385.613
126000

2
 SCHEDULES SHOWING DETAILS OF INCOME

Name of the Assessee: MD. GOLAM AZAM KHAN TIN 4 8 9 8 4 8 8 8 2 2 8 3

Schedule-1 (Salaries)

Amount of
Amount of Income Net Taxable Income
Pay & Allowance exempted income
(Tk) (TK)
(TK)
Basic pay 262,920 262,920
Special pay -
Dearness allowance - -
Conveyance allowance 36,000 30,000 6,000
House rent allowance 105,168 300,000 -
Medical allowance - - -
Water/Sewerage allowance -
Electricity 11,284 11,284
Honorarium / Reward/ Fee - - -
WPF Bonus -
Bonus (Festival & Boishakh) 278,051 - 278,051
Power plant allowance 65,736 65,736
Employer’s Contribution to Recognized Provident Fund 26,292 26,292

Interest accrued on Recognized Provident Fund -

Leave Encashment -
Other, if any (give detail) F.A. / R.A. -
Net taxable income from salary 785,451 330,000 650,283

Schedule-2 (House Property Income)

Location and description of

Particulars Tk. Tk.
property
1. Annual rental income 0
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= 0
3. Net income ( difference between serial 1 and 2) 0

3
 4

3
 Schedule-3 (Investment tax credit)
(Section 44(2)(b) read with part 'B' of Sixth Schedule)
1. Life insurance premium Tk. -
2. Saving Certificate Tk. -
3. DPS Tk. 60,000.00
4. Self contribution & employer’s contribution to Tk. 26,292.00
5. Recognized
ContributionProvident Fund
to Super annuation Fund Tk.
6. Investment in approved debenture or debenture stock, Tk.
Stock or Shares
7. Contribution to deposit pension scheme Tk.
8. Contribution to Benevolent Fund and group insurance premium Tk.
9. Contribution to Zakat Fund Tk.
10. Others, if any ( give details ) (FDR) Tk.
Total Tk. 86,292.00

* Please attach certificates of investment.

List of documents furnished

1. DPS statement 6.

2. Statement of Income from NWPGCL for Assessment 7.

Year 2020-2021

3. Tax at source payment chalan from NWPGCL 8.

4. NID 9.

5. Photo Copy of TIN certificate 10.

Incomplete return is not acceptable

4
 IT-10B
Statement of assets and liabilities (as on 30-06-2019)

Name of the Assessee: MD. GOLAM AZAM KHAN (MU TIN: 4 8 9 8 4 8 8 8 2 2 8 3

1. (a) Business Capital (Closing balance) Tk.

(b) Directors Shareholdings in Limited Companies (at cost) Tk.
Name of Companies Number of shares

14 Decimal
khotian 728,
Dag: 1903;
2. Non-Agricultural Property (at cost with legal expenses) : Mouja Jarila Tk. 0.00 Unknown
Land/House property (Description & location of property)

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

Land (Total land and location of land property)

4. Investments:
(a) FDR Tk.
(b) Saving Certificate/Unit Certificate/Bond Tk.
(c) DPS Tk. 60,000.00
(d) Life Indsurence Tk.
(e) Other investment Tk. 192,886.00
Total= Tk. 252,886.00

5. Motor Vehicles (at cost): Tk. 164,663.00

Type of motor vehicle and registration number

6. Jewellery (quantity and cost):8 bhori (Wedding Gift) Tk. Value Unknown

7. Furniture (at cost) Nessary furnitur Tk. 550,000.00 (around)

0
8. Electronic Equipment (at cost) Tk. 350,000.00 (around)
Mostly Computer related equipments

9. Cash asset Outside Business:

(a) Cash in hand Tk. 1,607,209.00
(b) Cash at bank Tk. 0.00
 (c) Other deposits Tk.
Total= Tk. 1,607,209.00

5
B/F= Tk. 2,924,758.00

10. Any other assets Tk.

(Give details)

Total Assets Tk. 2,924,758.00

11. Less Liabilities

(a) Mortgages secured on property on land Tk.
(b) Unsecured loans Tk.
(c) Bank Loan Tk.
(d) Others Tk.

Total liabilities Tk. 0.00

12. Net wealth as on last date of this income year Tk. 2,924,758.00
(difference between total assets and total liabilities)

13. Net wealth as on last date of previous income year Tk. 2,264,475.00

14. Accretion in wealth (difference between serial no. 12 & 13) Tk. 660,283.00

15. (a) Family Expenditure: (Total expenditure as per From IT 10 BB) Tk. 320,000.00
(b) Number of dependant children of the family

2 1
Adult Child

16. Total accretion of wealth (total of serial 14 & 15) Tk. 980,283.00

17. Sources of Fund:

(i) Shown Return Income Tk. 650,283.00
(ii) Tax exempted/Tax free Income Tk. 330,000.00
(iii) Other receipts Tk.
Total source of fund= Tk. 980,283.00

18. Difference (between serial 16 & 17) Tk. 0.00 0

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

(MD. GOLAM AZAM KHAN (MUKUL))

 Date:

● Assets and liabilities of self, spouse (if she/he is not an assessee), minor children and dependant(s) to be shown
in the above statements.
● If needed, please use separate sheet.
6
 FORM Form No. IT-10BB
Statement under section 75(2)(d)(i) and section 80 of the Income Tax Ordinance, 1984
(XXXVI of 1984) regarding particulars of life stile

Name of the Assessee: MD. GOLAM AZAM KHAN (MU TIN 4 8 9 8 4 8 8 8 2 2 8 3

Serial Particulars of Expenditure Amount of Tk. Comments

No.
1. Personal and fooding expenses Tk. 320,000
2. Tax paid including deduction at source of the last Tk. -
financial year
3. Accommodation expenses Tk. -
4. Transport expenses Tk. -
5. Electric Bill for residence Tk. -
6. Wasa Bill for residence Tk.
7. Gas Bill for residence Tk. -
8. Treatment cost for family member Tk. -
9. Education expenses for children Tk.
10. Personal expenses for Foreign travel Tk.
11. Festival and other special expenses, if any Tk. -
Total Expenditure Tk. 320,000.00

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

(MD. GOLAM AZAM KHAN (MUKUL))

Date:
If needed, please use separate sheet.

Acknowledgement Receipt of Income Tax Return

Name of the Assessee: MD. GOLAM AZAM KHAN (MUKUL) Assessment Year: 2020-2021

UTIN/TIN 4 8 9 8 4 8 8 8 2 2 8 3 Circle: 007 Taxes Zone : Bogura

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 interest on
savings instruments; Rent agreement, receipts of municipal tax & 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 & balance
sheet for partnership income; Documents of capital gain; Dividend warrant for dividend
income; Statement of other income; Documents in support of investments in saving
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 assessee (if she/he is not an assessee), minor children and
dependant;
(b) tax exempted / tax free income.
(4) Fulfillment 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
dependant(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 I.T-10B & I.T-10BB.
(10) If needed, please use separate sheet.

Total income shown in Return: Tk. 980,283 Tax Paid: Tk.12839

Net Wealth of Assessee : Tk. 2,924,758

Date of receipt of return : Serial No. in return register

Nature of Return: Self Universal Self Normal

Signature of Receiving

8
 officer with seal

8
 Attachment#1

Explanation of Self-Assessment
Head Income Less cost Net Reference
BRTC 33% 0.00
Bank interest 0% 0.00
Profit from share market 100% 0.00
Income from consultancy 0% 0.00
Income from private 33% 0.00
university
0.00

Tax paid at source

Paid Tax (Tk.)
Tax at Bank 0
Tax paid at NWPGCL
Tax at BRTC clients
Total 0

Advanced tax paid

Paid Tax (Tk.)
Tax paid by NWPGCL 12,839
Tax paid by
Total 12,839

Profit from share market Tax exempted income:

Company name Profit Head Amount
ACI From Salary income 330,000
AGNISYSL Profit from Share -
AMCL(PRAN) Total: 330,000
DESCO
ECABLES
HEIDELBCEM
NPOLYMAR
NTLTUBES
SUMITPOWER
Total: 0

Amount Slab Rate Tax

Total income 650,283.00
0% on first Tk. 300000 650,283.00 300,000 0% -
5% on second Tk. 1,00,000 350,283.00 100,000 5% 5,000.00
10% on third Tk. 3,00,000 250,283.00 300,000 10% 25,028.30
- 20% -
25% -
rest 30% -
Total= 30,028.30