FORM NO. 10E [See rule 21AA]
Form for furnishing particulars of income under section 192(2A) for the year ending 31st March,2011 for claiming relief under section 89 by a Government servant or an employee in a company, co-operative society, local authority, university, institution, association or body
1. Name
2.Address
3. PAN
4. Status Indian Resident
Particulars of income referred to in rule 21A of the Income tax Rules, 1962, relevant to 2005-06, 2006-07, 2007-08, 2008-2009, 2009-10, 2010-11 and 2011-12 received during 2012-13
1. (a) Salary received in arrears or in advance during 2012-13 in accordance with the provisions of sub-rule (2) of rule 21A
(b) Payment 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 Not applicable
(c) Payment 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 portion of term of employment is also not less than 3 years in accordance with the provisions of sub-rule (4) of rule 21A
Not applicable
(d) Payment in commutation of pension in accordance with the provisions of sub-rule (5) of rule 21A Not applicable

2. Detailed particulars of payments referred to above may be given in Annexure I, II, IIA, III or IV, as the case may be

 

 Annexure-I
Verification

I do hereby declare that what is statedabove is true to the best of my knowledge and belief. Verified today

Date :

Signature of the employee

ANNEXURE -I
1. Current Year total net taxable Income excluding Salary received in Arrears or advance
2. Salary received in arrears or advance this year
3. Total income (as increased by salary received in arrears or advance)[Add item 1 and item 2]
4. Tax on Net Taxable income with arrears (as per item 3)
5. Tax on Net Taxable income without including arrears (as per item 1)
6. Tax on salary received in arrears or advance [Difference of item 4 and item 5]
7. Tax computed in accordance with Table "A" [Brought from column 7 of Table "A"]
8. Relief under section 89(1) [Indicate the difference between the amounts mentioned against items 6 and 7]
TABLE "A" [See item 7 of Annexure I]
Previous Year(s) Total Net Taxable income of the relevant previous year Salary received in arrears or advance relating to the relevant previous year as mentioned in col.(1). Total income (as increased by salary received in arrears or advance) of the relevant previous year mentioned in col.(1) [Add Col.(2) and (3) Tax on total income [ As per Col.(2)] Tax on total income [ As per Col.(4)] Difference in tax [Amount under col.(6) minus amount under col.(5)]
1
2
3
4
5
6
7
2005-06
2006-07
2007-08
2008-09
2009-10
2010-11
2011-12
          Total