Name: S.SAMUEL SELVARAJ B.SC,M.A.B.Ed I.T.calc.

p3
Particulars of LIC / ULIP / PLI
Annual
Policy Name of the Name of the insured & Amount
S.No Name of Policy Premium
Number Company Relationship Insured
Paid
1 767699929 LIC J.Premalatha Princess New Bima Gold 200000 10728

2 Wife

3 766050951 LIC S.Jashua Vijay Pradheep Jeevan Rakshak  200000 6858

4 Son

7
8
9
10
Total 17586

Particulars of N.S.C
S.No Name of Post Office Issue No N.S.C No Amount

Total 0
Details of Interest Accrued of N.S.C
Date of Purchase of Rate of
S.No N.S.C & Name of Post Office the NSC Interest Amount

Total 0
Particulars about the Payment of Tution Fees

Name of the Child Name of the school Date of Amount

S.No
and the course or college Payment Paid

Total 0
Details of Fixed Deposits

Period /
S.No Date Bank Receipt No Amount
years
Total 0
 INCOME TAX CALCULATION STATEMENT
FOR THE PERIOD FROM MARCH 2022 TO FEBRUARY 2023
ASSESSMENT YEAR 2023 - 2024

ENTER THE FOLLOWING DETAILS FIRST

Employee Name M.MYTHILI

Designation B.T. ASSISTANT
Address GHS SCHOOL, VAIKUNDHAM
District SALEM PINCODE 637103
Pan Number CEEPM5759L
CPS No

Employer Name
Designation HEADMASTER
Address GHS SCHOOL, VAIKUNDHAM
District SALEM PINCODE 637103
Tan Number CHEHO4188C
DATE STATION

NOTE
* (PAGE -4) ENTER YOUR PAY DRAWN DETAILS
*ALL PAGES ENTER YOUR EXTRA PAYMENT DETAILS IN "YELLOW" BOXES
*NOW YOUR IT FORM IS READY FOR PRINT IN A4 SHEET SIZE

S.SAMUEL SELVARAJ B.Sc, M.A. B.Ed

SCIENCE BT
PUMS SINGAIYANPUDUR
KINATHUKADAVU
COIMBATORE
Old Regime
PIN: 642109
Mail : samuelselvaraj1964@gmail.com
Mobile : 8903913946
 INCOME TAX CALCULATION STATEMENT
FOR THE PERIOD FROM MARCH 2022 TO FEBRUARY 2023
ASSESSMENT YEAR 2023 - 2024
Name, Designation & Address of the Employee Name, Designation & Address of the Employer
M.MYTHILI 0
B.T. ASSISTANT HEADMASTER
GHS SCHOOL, VAIKUNDHAM GHS SCHOOL, VAIKUNDHAM
SALEM PINCODE 637103 SALEM PINCODE 637103
PAN CEEPM5759L CPS No: 0 TAN CHEHO4188C
S.N Details of Salary paid and any other Income and Tax Deducted Amount Eligible Amount
1. GROSS SALARY INCOME : Including HRA, Honorarium Taxable allowances, Taxable Perquisities
(Excluding cash allowance if any
Rs. Rs. 924398
2. LESS : House Rent Allowance (Sec. 10(13A & Rule 2A) Rs.
A. Rent Paid RS. 12 X 12000 = 144000 Rs.
B. 10% of pay +DA RS. 86899 Rs.
C. (A - B) RS. 57101 Rs.
D. Actual HRA Received RS. 50200 Rs.
E. 40% of Pay +DA RS. 347595 Rs.
Least of the above C, D or E Rs. 50200 Rs. 50200
3 GROSS SALARY INCOME (1 - 2) Rs. 874198 Rs. 874198
a STANDARD DEDUCTION RS. 50000 (u/s 16 (ia) (all members elegible) Rs. 50000 Rs.
b PROFESSIONAL TAX (u/s 16 (iii) Rs. 2500 Rs.
LESS

Home Loan Interest on U/S 24(b) upto Rs. 2,00,000 and Rs. 30,000 for home
4 c improvement loan interest
Rs.
Rs.
d Conveyance Allowance (u/s 10 (14) Rs. Rs.
e Hill Allowance (u/s 10 (14)(ii) Rs. 0 Rs.
5 Aggregate of 4(a,b,c,d,e) Rs. 52500 Rs. 52500
6 GROSS SALARY INCOME : (3-5) Rs. Rs. 821698
7 ADD : Any other income (if any)., Bank Interest, NSC Interest etc., Rs. Rs. 0
GROSS TOTAL INCOME : (6+7)
8 Rs. Rs. 821,698
9 LESS : Deductions under chapter VI A U/S 80 C : As per details attached. (Note 4)
A. L.I.C. Premium (Note 3) / Postal Life insurance premium (PLI) Rs.
B. G.P.F / T.P.F Rs.
C. P.P.F Rs.
D. S.P.F 2K + F.B.F. Rs. 2160
E. Sukanya Samriddhi Scheme (செல்வ மகள், மகன் திட்டம்) Rs. 15000
F. R.P.F. Rs.
G. R.P.L.I. / NSC VIII Issue Rs. 56380
H. Stamp duty and Registration Charges (on New House Purchasing) Rs.
I. Repayment of Housing Loan (Principal) Rs.
J. Tuition fess (Please Refer Note No.2 in page No.3.) Rs. 20000
K. Equity Linked Savings Scheme (ELSS) Rs.
L. Subscription to Equity Shares / Debentures or / Units Rs.
M. Investments in term Deposits (of min 5 years) with a scheduled bank. Rs. 0
N. Subscription to notified bonds of Nabard Rs.
O. 5 years time deposit an a/c under Post office time deposit rules 1981 Rs.
P. deposit in an a/c under senior citizens savings scheme Rules 2004 Rs.
Q. U/s 80 CCC : Premium for Annuity Plans (OR) PENSION PLAN Rs.
R. U/s 80 CCD (1) : Contribution to Pension scheme of Employees (CPS subs + CPS Arrer Rs. 86900
TOTAL QUALIFIYING AMOUNT 9 (A to R) Rs. 180440 Rs. 150000
M.MYTHILI Page-2
U/s 80 CCE : Aggricate amount of Deduction u/s 80 C. 80 CCC and 80 CCD(1) is restricted to
9(I)
Rs. 1,50,000 by sec. 80 CCE
Rs. Rs. 150000

U/s 80 EE : - First Time home buyers (FY-2016-17) Tax deduction of Rs. 50000 on home loan
9(II) interest payments till repayment. (OR) 80EEA - First Time home buyers (FY-2021-22) Tax Rs.
deduction of Rs. 1,50,000 on home loan interest payments till repayment.

U/s 80 D : Medical Insurance premium +NHIS health fund Max Rs. 25,000 for employee or his
9(III) family and Max. Rs. 25,000 for employees's parents (Senior citizen 50,000) (Max Rs. 5000 for Rs. 3600
Pre health check up.

U/s 80 DD : Expenses on Medical treatment etc. and deposit made for maintanenance of
9(IV) handicapped dependents (Max Rs. 75,000) in case of severe disabilities Rs. 1,25,000/-. Rs.

U/s 80 DDB : medical Expenses towards treatment of himself, or a dependent relative for
9(V) specified diseases and ailments (amount actualy paid or Rs. 1,00000 whichever is less, ( senior Rs.
citizen Rs. 100000. )

9(VI) U/s 80 E : Repayment of interest on loan taken for higher Education (For self or for relatives Rs.
(spouse & children)
9(VII) U/s 80 G : Donation to approved funds and charitable institutions. Rs.

9(VIII) U/s 80 CCD (1B) : deduction up to Rs. 50,000/- for investment in NPS (National Pension Rs. 50000
Schene)

9(IX) U/S 80U DISABLITY/ HANDICAP (BELOW 80 % MIN 75,000 ABOVE 80% MAX 125000) Rs.

9(X) U/s 80 TTA : Deduction in respect of interest on deposit in savings Account (Max. 10,000) Rs.
9(XI) SUM OF 9(I) TO 9(X) Rs. 53600 Rs. 203600
TAXABLE INCOME (Rounded off to nearest ten rupees) 8-9(X) = Note: All DEDUCTIONS
10 UNDER COLUMN 9(I) TO 9(X) CANNOT EXCEED THE GROSS TOTAL INCOME Rs. Rs. 618,098

COMPUTATION OF TAX : Rounded off to nearest ten rupees. The basic exemption limit is Rs. 2,50,000/-
Table 1, Upto Rs.500000/- 100% Tax Rebate can claim (Rs.12500).
Rs. Rs. 618100
Taxable Income Income Tax Tax Working
Upto Rs. 2,50,000 NIL Rs. Nil
Rs. 2,50,00 - Rs. 500,000 5% of (the amount exceeding 2,50,000) Rs. 12500
Rs. 5,00,00 - Rs. 10,00,000 Rs. 12,500 + 20% of (the amount exceeding 5,00,000) Rs. 23620
Exceeding Rs. 10,00,001 Rs.1,12,500 + 30% of (the amount exceeding 10,00,000) Rs. 0
TOTAL Rs. 36120
11. Tax payable on Taxable Income (as per table 1 as above)
Rs. 36120
12. Less : REBATE of Rs.12500 for individuals having taxable income upto 5 lakhs (sec 87A) (In this form if
serial number 10 is less than Rs. 5 lakhs then you can less Rs. 12500 or the amount of tax payable Rs. Rs. 0
whichever is lower)

13. Tax payable on Taxable Income after rebate Rs. 12500 11-12 = Rs. Rs. 36120
14. ADD : Education cess @ 2% on the payable 2% of 13 Rs. Rs. 722
15. ADD : Secondary and Higher Education cess @ 2% on tax payable 2%of 13 Rs. Rs. 722
16. Total TAX Payable 13 + 14 +15 = Rs. 37564 Rs. 37564
17. LESS : Rebate u/s 86, 89, 90 or 91 Rs. 16000 Rs. 16000
18. LESS : Pre paid taxes (Advance tax TDS) + 4%Cess Rs. 640 Rs. 640
19. Balance of Income Tax to be deducted 16 - 17 -18 = Rs. Rs. 20924
CERTIFICATE
1. Certified that I am occupying the house allotted by the accommodation controller /PWD/TNHB on
payment of rent of Rs. per month.
2. Certified that I am occupying rental house and paying monthly rent of Rs. 12000 per month.
3. Certified that I am paying sum of Rs. 65292 towards L.I.C. premium and the policies alive.
4. Certified that I am paying sum of Rs. is being by me towards a C.T.D. and the
Cumulative Time is for 10/15 years.
Station : 0 Signature :
Date : 0 Designation : B.T. ASSISTANT
M.MYTHILI Page : 3

Particulars of LIC / ULIP / PLI

Name of the Amount Annual

S.No Policy Number Name of the insured & Relationship Name of Policy
Company Insured Premium Paid

1 65292
2
3
4
5
6
7
8
9
10
Total 65292

Particulars of N.S.C

S.No Name of Post Office Issue No N.S.C No Amount

56380

Total 56380

Details of Interest Accrued of N.S.C

Date of Purchase of the Rate of
S.No N.S.C & Name of Post Office Amount
NSC Interest

Total 0

Particulars about the Payment of Tution Fees

Name of the Child Name of the school Date of Amount

S.No
and the course or college Payment Paid

20000

Total 20000

Details of Fixed Deposits (BANK)

Period /
S.No Date Bank Receipt No Amount
years
Total 0
 INCOME PARTICULARS FOR THE YEAR 2022 - 2023 ASSESSMENT YEAR 2023 - 2024
Name M.MYTHILI Designation: B.T. ASSISTANT CPS No: 0
Office: GHS SCHOOL, VAIKUNDHAM
Pay and allowances Official deductions from the salary
HILL
SPF/ SPF PROF.
Month & Year Pay SP / PP GP DA HRA MA SA Bonus ALLOW TOTAL CPS FBF NHIS CPS Arr PLI I.T I.T Cess
2000 TAX
ANCE
Mar-22 53500 16585 4100 300 0 74485 7009 70 110 300 1405 0
Apr-22 53500 16585 4100 300 0 74485 7009 70 110 300 0 1405 0 0 0
May-22 53500 16585 4100 300 0 74485 7009 70 110 300 0 1405 0 0 0
Jun-22 53500 16585 4100 300 0 74485 7009 70 110 300 0 1405 0 0 0
Jul-22 53500 18190 4100 300 0 76090 7169 70 110 300 0 1405 0 0
Aug-22 53500 18190 4100 300 0 76090 7169 70 110 300 0 1405 1250 0 0
Sep-22 53500 18190 4100 300 0 76090 7169 70 110 300 0 1405 0 0
Oct-22 55100 18734 4300 300 0 78434 7383 70 110 300 0 1405 0 0
Nov-22 55100 18734 4300 300 0 78434 7383 70 110 300 0 1405 4000 160
Dec-22 55100 0 18734 4300 300 0 78434 7383 70 110 300 0 1405 4000 160
Jan-23 55100 0 20938 4300 300 0 80638 7604 70 110 300 0 1405 4000 160
Feb-23 55100 0 20938 4300 300 0 80638 7604 70 110 300 0 1405 1250 4000 160
Total 650000 0 0 218988 50200 3600 0 0 0 922788 86900 840 1320 3600 0 16860 2500 16000 640
ARREARS Drawn Particulars
DA Arr 1 1610 1610 161
DA Arr 2 0 0
Incent.Ar 0 0
EL Surr. 0
Sel.Gr.Arr. 0 0
Pongal 0

0 0

TOTAL 650000 0 0 220598 50200 3600 0 0 0 924398 87061 840 1320 3600 0 16860 2500 16000 640

Pay,PP,SP.GP DA Total 10% of Pay +DA 40% of Pay +DA

650000 218988 868988 86899 347595
Signature of the Assessee Head of the office