Salary Extract of the year 2020-21

Name: Ashwin Loyal Mendonca Designation:

PAN: Address:
SALARY (Rs) DEDUCTIONS (Rs)
MONTH BASIC DA HRA SFN Others TOTAL LIC KGID GI PT GPF NPS OTHERS IT

Mar-20 63000 10710 5040 78750 6000 360 200 7371

Apr-20 63000 10710 5040 78750 6000 360 200 7371 5000
May-20 63000 10710 5040 78750 6000 360 200 7371 5000
June-20 63000 10710 5040 78750 6000 360 200 7371 5000
July-20 64900 11033 5192 81125 6000 360 200 7593 5000
Aug-20 64900 18172 5192 88264 6000 360 200 8307 6000
Sep-20 64900 18172 5192 88264 6000 360 200 8307 6000
Oct-20 64900 18172 5192 88264 6000 360 200 8307 6000
Nov-20 64900 20119 5192 90211 6000 360 200 8502 10000
Dec-20 64900 20119 5192 90211 6000 360 200 8502 10000
Jan-21 64900 20119 5192 90211 6000 360 200 8502
Feb-21 64900 20119 5192 90211 6000 360 200 8502
DA Arrears 7139 7139 714
DA arrears
5841 5841 585
Any other arrears
(current year)

Total 771200 201845 61696 1034741 72000 4320 2400 97305 58000
Current Year
771200 201845 61696 1034741 72000 4320 2400 97305 58000
Total
Arrears (19-20)

Arrears (18-19)

Arrears (17-18)

Arrears (16-17)

Arrears (15-16)

Arrears (14-15)

Arrears (13-14)

Arrears (12-13)

Total 771200 201845 61696 1034741 72000 4320 2400 97305 58000
 Enter the follwing data to calculate your Income Tax
Name Ashwin Loyal Mendonca
Designation Enter Designation in Sheet 1
Address Enter Address in Sheet 1
Sex Old Regime New Regime

Enter 1 forOld Regime, 2 for New

1
Regime

PAN Enter PAN in Sheet 1

Total salary 1034741

Professional tax 2400

Actual H R A received 61696

Any other Income (NSC, SB, FD, etc, if any)

Deduction U/S 24(b) Interest on HBA Rs 2,00,000/- + Rs

50,000/- for home loan <35 lakh sanctioned in FY 2016-17 /
Rs 1,50,000/- for home loan <45 lakh sanctioned in FY
2019-20 u/s 80EEA

Deductions under Chapter VI A

Under section 80C, 80CCC and 80CCD

GPF

GIS 4320
LIC
KGID 72000
NPS U/S 80CCD 97305
Insurance plan of the LIC or any other insurer for receiving
pension from the fund U/S 80CCC

L I C/P L I/ Any other insurance premium paid other than

salary deduction
PPF 27089
NSC 8th issue purchase+NSC interest
HBA principal repayment
Tution fee paid for wards
Mutual fund
Medical insurance on self, spouce, children or parents U/S
16216
80D (Max. Rs 25,000 )

Expenses for handicapped dependents U/S 80 DD

( Max. Rs 75,000 and for severe disability Rs 1,25,000 )

Deduction in respect of maintenance including medical

treatment of specified disease or ailment for self or
dependents U/S 80DDB (Max. Rs 40,000 )

Interest paid for study loan U/S 80E

Donations to charitable institutions U/S 80G (100% or 50%

based on the type of donation)

Permanent physical disability exemptions U/S 80U

( Max. Rs 75,000 and Rs 1,25,000 for above 80% disability)

Interest on SB account U/S 80TTA(Max. Rs 10,000)

RGESS U/S 80CCG (50% deduction of the investment made,

if taxable income less than 12 lakh) Max. Rs. 50000

Actual House rent paid

Would you like to consider DA to calculate HRA
exemption (if yes enter 1, if no enter 0)

Enter the following details to generate Form 10E and 16

Date of generating 10E

Place of Issue (10E)
Date of Issue - Form 16
Designation of Assessing Officer (Ward/ Circle)
Name of the Employer

Designation and Address of the Employer

TAN of the Employer

Receipt No.s of original statements of TDS U/S(3)200
Quarter 1
Quarter 2
 Quarter 3
Quarter 4
Total taxable income of the relevant previous Financial Year
(19-20)

Total taxable income of the relevant previous Financial Year

(18-19)
Total taxable income of the relevant previous Financial Year
(17-18)
Total taxable income of the relevant previous Financial Year
(16-17)
Total taxable income of the relevant previous Financial Year
(15-16)
Total taxable income of the relevant previous Financial Year
(14-15)
Total taxable income of the relevant previous Financial Year
(13-14)
Total taxable income of the relevant previous Financial Year
(12-13)
Tax on total taxable income [upto 2.5 lakh - Nil, 2.5-5 lakh - 5%, 5-10 lakh - 20%, 10 lakh and
above 30%]

Tax on total taxable income [upto 2.5 lakh - Nil, 2.5-5 lakh - 5%, 5-7.5 lakh - 10%, 7.5-10 lakh - 15%,
10-12.5 lakh - 20%, 12.5-18 lakh - 25%, 15 lakh and above 30%]
 FORM NO.10E
(See Rule 21 AA)

FORM FOR FURNISHING PARTICULARS OF INCOME UNDER SECTION 192(2A) FOR THE YEAR ENDING 31ST MARCH 2015 FOR CLAIMING
RELIEF UNDER SECTION 89(1) BY A GOVERNMENT SERVANT OR AN EMPLOYEE IN A COMPANY, CO-OPERATIVE SOCIETY, LOCAL
AUTHORITY, UNIVERSITY INSTITUTION, ASSOCIATION OR BODY

1
Name of the Employee Ashwin Loyal Mendonca

Address of the Employee Enter in Sheet 1

Enter in Sheet 1

2 PAN Enter in Sheet 1

3 Residential Status Resident

PARTICULARS OF INCOME REFERRED TO IN RULE 21A OF THE INCOME TAX RULES, 1962, DURING THE PREVIOUS YEAR RELEVANT TO
ASSESSMENT YEAR 2010 - 2011

1)
(a) Salary received in arrears or in advance in accordance with the provisions of sub-rule (2) or rule 21A.

(b) Payments In the nature of gratuity in respect of past services extending over a period of not less
than 5 years In accordance with the provisions of sub-rule (3) of rule 21A.

(c) Payments in the nature of compensation from the employer or former employer at or in connection
with termination of employment after continuous service of not less than 3 years or where the
unexpired the provisions of sub-rule (4) of rule 21A.

(d) Payment in commutation of pension in accordance with the provision of sub-rule (5) of rule 21A.

Signature of the employee

VERIFICATION
I Ashwin Loyal Mendonca do hereby declare that what is stated above is true to the best
of my knowledge and belief.

Verified today the Enter in Sheet 2

Place : Enter in Sheet 2

Date : Enter in Sheet 2

 ANNEXURE I
(Section 2 of Form No. 10E)

ARREARS OR ADVANCE SALARY

1 Total taxable income (excluding salary received in arrears or advance) रु -

2 Salary received in arrears or advance रु -
Total taxable income (as increased by salary received in arrears or advance)
3 (item 1 + item 2) रु -

4 Tax on total income (as per item 3) रु -

5 Tax on total income (as per item 1) रु -
6 Tax on salary received in arrears or advance (item 4 - item 5) रु -
7 Tax computed in accordance with table A (Brought from column 7 of table A) रु -
8 Relief under section 89(1) (items 6 - item 7) रु -

Total income (as increased by

Salary received in
salary received in arrears or Tax on total income (as Tax on total income (as
Previous Financial Total income of the arrears or advance Difference in tax
advance) of the relevant previous per column 2) after per column 4) after
Year(s) relevant previous year relating to the relevant (column 6 - column 5)
year mentioned in column 1 Rebate Rebate
previous year
(column 2 + column 3)

1 2 3 4 5 6 7

19--20 रु - रु - रु - रु - रु - रु -

18--19 रु - रु - रु - रु - रु - रु -

17--18 रु - रु - रु - रु - रु - रु -

16--17 रु - रु - रु - रु - रु - रु -

15--16 रु - रु - रु - रु - रु - रु -

14--15 रु - रु - रु - रु - रु - रु -

13--14 रु - रु - रु - रु - रु - रु -

12--13 रु - रु - रु - रु - रु - रु -

Total रु - रु -

Note: In this table, details of salary received in arrears or advance relating to different previous years may be furnished

Date: Enter in Sheet 2

Place: Enter in Sheet 2 Signature

 Computation of Income Tax
Name: Ashwin Loyal Mendonca Sex: Old Regime Financial year:
Designation: Enter Designation in Sheet 1 Assesment year:
Address Enter Address in Sheet 1 PAN:
No. Particulars Amount
1 A. Gross salary (Basic+Arrears+Leave salary+SFN)
B. Add: Interest on NSC, SB, FD, etc, if any
C. Gross Income (C = A+B)
2 Less: HRA [U/S 10(13A)] Least of the following
(a) Actual H R A received रु 61,696
(b) Excess of Rent paid over 10% of salary रु -
(c) 40% of salary रु 308,480
Less: Standard deduction U/S 16
Less: Professional tax U/S 16(iii)
Deduction U/S 24(b) Interest on HBA Rs 2,00,000/- + Rs 50,000/- for home
Less: loan <35 lakh sanctioned in FY 2016-17 / Rs 1,50,000/- for home loan <45
lakh sanctioned in FY 2019-20 u/s 80EEA
3 Total income
4 Deduction U/S 80C,80CCC and 80CCD
GPF रु - PS U/S 80CCC रु -
GIS रु 4,320 NSC+Int रु -
LIC रु - HBA Principal repayment रु -
KGID रु 72,000 Tution fee paid for wards रु -
PPF रु 27,089 Mutual fund रु -
NPS रु 97,305
Less: Total of 4 [Max. Rs 1,50,000+50000(NPS U/S 80CCD(1b))] रु 200,714
5 Medical Insurance premium U/S 80D (Max. Rs 25,000) रु 16,216
Expenses for handicapped dependents U/S 80 DD ( Max. Rs 75,000 and for severe
disability Rs 1,25,000 ) रु -

Expenses in respect of maintenance including medical treatment of specified

disease or ailment for self or dependents U/S 80DDB (Max. Rs 40,000 ) रु -

Interest paid for study loan of wards [U/S 80E] रु -

Donation under U/S 80G (100% or 50% based on the type of donation) रु -
Permanent physical disability exemptions [U/S 80U] ( Max. Rs 75,000 and for
severe disability Rs 1,25,000 ) रु -
Interest on SB account U/S 80TTA(Max. Rs 10,000) रु -
RGESS U/S 80CCG (50% deduction of the investment made, if taxable income less
than 12 lakh) Max. Rs. 50000 रु -
Less: Total of 5
6 Total taxable income[3-(4+5+5(a))]
7 Tax on total taxable income [upto 2.5 lakh - Nil, 2.5-5 lakh - 5%, 5-10 lakh - 20%,
10 lakh and above 30%]
8 Tax rebate U/S 87A
9 BalanceTax
10 Education cess 4%
11 Total tax
12 Relief under section 89(1)
13 Total tax to be paid

Signature
14 Tax paid up to Jan 2021
15 Tax to be paid in the month of Feb 2021

Signature
2020-21
2021-22
Enter PAN in Sheet 1

Amount
रु 1,034,741
रु -
रु 1,034,741

रु -

रु 50,000
रु 2,400

रु -

रु 982,341

रु 200,000

रु 16,216
रु 766,130

रु 65,726

रु -
रु 65,726
रु 2,629
रु 68,355
रु -
रु 68,360

Signature
रु 58,000
रु 10,360

Signature
 FORM – 16
(see rule 31(1)(a))
Certificate under section 203 of the income tax act 1961 for tax deducted at source from income chargeable under the head salaries

Name and Address of the Employer Enter in Sheet 2

TAN of the Employer Name of the Employee Designation of the Employee

Enter in Sheet 2 Ashwin Loyal Mendonca Enter in Sheet 1
TDS circle where annual return/statement under section 206 is to be filed Enter in Sheet 2
PAN: Enter PAN in Sheet 1 Period : 1.4.2020 to 31.3.2021 Assessment year : 2021 - 2022
Summary of tax deducted at source
Quarter Receipt No.s of original statements of TDS U/S(3)200 Tax deducted Rs Tax remitted Rs
Quarter 1 NIL रु 10,000 रु 10,000
Quarter 2 NIL रु 16,000 रु 16,000
Quarter 3 NIL रु 22,000 रु 22,000
Quarter 4 NIL रु 10,000 रु 10,000
Total रु 58,000 रु 58,000
Details of Salary paid and any other income and tax deducted
1 Gross Salary रु 1,034,741
2 Less: Allowance to the extent exempt U/S 10 रु -
3 Balance (1-2) रु 1,034,741
4 Standard deduction U/S 16 रु 50,000
5 Less: Professional tax U/S 16(iii) रु 2,400
6 Less: Deduction U/S 24(b) in respect of interest on HBA रु -
7 Income chargeable under the head salaries (3-4-5-6) रु 982,341
8 Add : Any other income reported by employee रु -
9 Gross total income (5+6) रु 982,341
10 Deductions under chapter VI A
GPF रु - PS U/S 80CCC रु -
GIS रु 4,320 NSC+Int रु -
LIC रु - HBA Principal repayment रु -
KGID रु 72,000 Tution fee paid for wards रु -
PPF रु 27,089 Mutual fund रु -
Total [Max. Rs 1,50,000 +
NPS रु 97,305 रु 200,714
50000(NPS U/S 80CCD(1b))] रु 200,000
Medical Insurance premium [ U/S 80D] Max. Rs 15,000 रु 16,216
Expenses for handicapped dependents U/S 80 DD ( Max. Rs 1,00,000 ) रु -
Medical treatment for self or dependents U/S 80DDB (Max. Rs 40,000 ) रु -
Interest paid for study loan of wards [U/S 80E] रु -
Donation under U/S 80G (100% or 50% based on the type of donation) रु -
Permanent physical disability exemptions [U/S 80U] ( Max. Rs 1,00,000 ) रु -
Interest on SB account U/S 80TTA(Max. Rs 10,000) रु -
RGESS U/S 80CCG रु -
Aggregate of deductible amount under chapter VI A रु 216,216
11 Total income (9-10) रु 766,125
12 Tax on total income रु 65,726
13 Tax credit रु -
14 Balance Tax रु 65,726
15 Education cess 3% रु 2,629
16 Total Tax (14+15) रु 68,355
17 Relief under section 89(1) रु -
18 Total tax payable (16-17) रु 68,360
19 Less: Tax deducted at source रु 58,000
20 Tax payable/ refundable (18-19) रु 10,360

Certified that a sum of रु 58,000 has been deducted at source and paid to the credit of the Central Government. I further
certify that the information given above is true and correct based on the books of accounts, documents and other available records
 FORM – 16
(see rule 31(1)(a))
Certificate under section 203 of the income tax act 1961 for tax deducted at source from income chargeable under the head salaries

Signature of the person responsible for the deduction of tax

Date: Enter in Sheet 2 Full Name: Enter in Sheet 2