FOR INDIVIDUAL & OTHER TAXPAYERS (OTHER THAN COMPANY)

FORM OF RETURN OF INCOME UNDER THE INCOME TAX IT-11GA

ORDINANCE, 1984 (XXXVI OF 1984)

Be a Respectable Taxpayer
Submit return in due time
Avoid penalty

Put the tick () mark wherever applicable

Self Universal Self√ Normal

1. Name of the Assessee: MD. AZHARUL ISLAM

2. National ID No (if any) : 2692985060437

3. UTIN (if any): - -

4. TIN: 3 6 5 9 5 0 8 4 1 7 2 8

5. (a) Circle:
Tax Circle 262 (Salary) (b) Taxes Zone: 12, DHAKA

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

Individual
8. Status:  Firm o Association of Persons o Hindu Undivided Family o
9. Name of the employer/business (where applicable): Bangladesh University of professionals

10 Wife/Husband's Name (if assessee, please mention TIN): Kulsuma Akter, 213571403364

11. Father's Name: MD. RAFIQUL ISLAM

12. Mother’s Name: LAILA AKHTER

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

Day Month Year

14. Address (a) Present: Bangladesh university of Professionals (BUP),

Mirpur Cantrorment, Dhaka-1205.

(b) Permanent: 60/9/D-7, Hazi Idris Ali Sarder Road, Dhalpur,

North Jatrabari, Dhaka-1204.
......................................................................…

15 Telephone:Office/Business : 88 02 8000368 Residential: 01916145990

16. VAT Registration Number (if any): .........................................................................…

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 Statement of income of the Assessee

Statement of income during the income year ended on 30 June 2020

Serial no. Heads of Income Amount in taka

1 Salaries : u/s 21 (as per schedule 1) 287,391.59
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 (Interest from Saving Certificate & DPS) 76,240.00
10 Total (Serial 1 to 9) 363,631.59
11 Foreign Income: / Gain on Sale of Share -
12 Total income (Serial 10 and 11) 363,631.59
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: 5,002
(a) Tax deducted/collected at source Tk. 5,002.00
(Please submit supporting documents/statement)

(b) Advance tax u/s 64/68 (Please attach challan ) Tk.

(c) Tax paid on the basis of this return (u/s 74) Tk.
(Please attach challan/pay order/bank draft/cheque)
PO No. Dated:
(d) Adjustment of Tax Refund (if any) Tk.
Total of (a) (b), (c) and (d) Tk.
17 Difference between serial 15 and 16 (if any)
18 Tax exempted & Tax free income 180,796.08
19 Income tax paid in the last assessment year -
*If needed, please use separate sheet.

Verification

I MD. AZHARUL ISLAM father/husband MD. RAFIQUL ISLAM

UTIN/TIN: 365950841728 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 :

Signature
MD. AZHARUL ISLAM
(Name in block letters)
Designation and
Seal (for other than individual)

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 SCHEDULES SHOWING DETAILS OF INCOME

Name of the Assessee: MD. AZHARUL ISLAM TIN 3 6 5 9 5 0 8 4 1 7 2 8

Schedule-1 (Salaries)

Amount of Amount of Net taxable

Pay & Allowance Income exempted income income
(Tk.) (Tk.) (Tk.)
Basic pay 173755.33 0.00 173755.33
Special pay 6671.21 0.00 6671.21
Deress allowance 10238.00 0.00 10238.00
Conveyance allowance 12336.29 12336.29 0.00
House rent allowance 99065.88 92394.67 6671.21
Medical allowance 22233.93 18479.33 3754.60
Servant allowance 0.00 0.00 0.00
Leave allowance 0.00 0.00 0.00
Profit Bonus 32379.90 0.00 32379.90
Overtime allowance 24512.13 0.00 24512.13
Bonus / Ex-gratia 25238.00 2500.00 22738.00
Other allowances 0.00 0.00 0.00
Employer’s Contribution to Recognized 55085.79 6671.21
Provident Fund from SGS 61757.00
Interest accrued on Recognized Provident
Fund 0.00 0.00 0.00
Deemed income for transport facility 0.00 0.00 0.00
Deemed income for free
furnished/unfurnished accommodation 0.00 0.00 0.00
Other, if any (Utilities & telephone) 0.00 0.00 0.00
Net taxable income from salary 468187.67 180796.08 287391.59

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 = NIL
3. Net income ( difference between serial 1 and 2)

3
 Schedule-3 (Investment tax credit)
(Section 44(2)(b) read with part ‘B’ of Sixth Schedule)

1. Life insurance premium Tk.

2. Contribution to deferred annuity Tk.
3. contribution to Provident Fund to which Provident Fund Tk.
Act,1925 applies
4. Self contribution & employer’s contribution to BUP- 13793.10 Tk. 13,793.00
Recognized Provident Fund
5. Contribution to Super annuation Fund Tk.
6. Investment in approved debenture or debenture stock, Tk.
Stock or Shares -
7. Contribution to deposit pension scheme Tk. 154,770.00
8. Contribution to Benevolent Fund and group insurance premium Tk. -
9. Contribution to Zakat Fund Tk.
10. Others, if any ( give details ) Tk.
Total Tk. 168,563.00
*Please attach certificates of investment.

List of documents furnished

1. Copy of salary certificate 6.

2. Copy of bank balance proof 7.

3. Tax calculation sheet 8.

4. Cash Flow Statement 9.

5. 10.

*Incomplete return is not acceptable

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 IT-10B
Statement of assets and liabilities (as on 30 June 2020)

Name of the Assessee: MD. AZHARUL ISLAM TIN 3 6 5 9 5 0 8 4 1 7 2 8

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

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

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

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) Shares/Debentures Tk. 20,000.0
(b) Saving Certificate/Unit Certificate/Bond Tk. 700,000.00
(c) Prize bond/Savings Scheme/DPS Tk. 430,000.00
(d) Loans given/FDR (O/B + Addition) Tk.
(e) Other Investment (Gifted to wife - Saving Certificate
& DPS - Amount = 314000 Taka)
Total = Tk. 1,150,000.00

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

6. Jewellery (quantity and cost) : Tk. -

Gift as gold
7. Furniture (at cost) : OB: Tk. -

8 Electronic Equipment (at cost) : OB: Tk. -

9 Cash asset Outside Business:

(a) Cash in hand Tk. 350,000
(b) Cash at bank Tk. -
(c) Other deposits Tk. -
Total = Tk. 350,000.00
1,500,000.00

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 B/F = Tk. 1,500,000.00

10. Any other assets Tk. -

(With details)

Total assets Tk. 1,500,000.00

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. 1,500,000.00
(difference between total assets & total liabilities)

13. Net wealth as on last date of previous income year Tk. 1,350,000.00

14. Accretion in wealth (difference between serial no. 12 & 13) Tk. 150,000.00

(a)Family Expenditure & Gifted Amount to Wife:(Total expenditure as per Form IT 10 BB)Tk. 394,427.67
(b) Number of dependant children of the family:
w
1 1
Adult Child

16. Total accretion of wealth (total of serial 14 & 15) Tk. 544,427.67

17. Sources of Fund :

(i) Shown Return Income Tk. 363,631.59

(ii) Tax exempted/Tax free Income Tk. 180,796.08
(iii) Other receipts Tk.
(iv) Loss on Sale of old car TK.
Total source of Fund = Tk. 544,427.67

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

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

MD. AZHARUL ISLAM

Name & signature of the Assessee
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.

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 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: MD. AZHARUL ISLAM TIN 3 6 5 9 5 0 8 4 1 7 2 8

Serial No. Particulars of Expenditure Amount of Tk. Comments

1 Personal and fooding expenses Tk. 50000.0
2 Tax paid including deduction at source of the last financial Tk. 5002.0
year
3 Accommodation expenses Tk. 0.0
4 Transport expenses Tk. 10425.7
5 Electric Bill for residence Tk. 0.0
6 Wasa Bill for residence Tk. 0.0
7 Gas Bill for residence Tk. 0.0
8 Telephone Bill for residence Tk. 0.0
9 Education expenses for children Tk. 0.0
10 Gifted to my wife this year (Savings Certificate & DPS) Tk. 314000.0
11 Festival and other special expenses, if any Tk. 15000.0
12 Total Family Expenditure & Gifted Amount to Wife Tk. 394427.7

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

MD. AZHARUL ISLAM

Name & signature of the Assessee
Date
*If needed, please use separate sheet.

" ........................................................................................................................................................…

Acknowledgement Receipt of Income Tax Return

Name of the Assessee: MD. AZHARUL ISLAM Assessment Year: 2020-2021

UTIN/TIN: 3 6 5 9 5 0 8 4 1 7 2 8 Tax Circle: 262 (Salary) Taxes Zone:12, Dhaka

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 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 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 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 assesse 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. 363,631.59 Tax paid : 5,002

Net Wealth of Assessee : Tk. 1,500,000.00

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

Nature of Return : Self Universal Self√ Normal

officer with seal