Form for furnishing details of income under section 392(4)(a) for the purposes of making deduction where income is chargeable under the head "Salaries"

Sl. No.

Part A: Particulars ofthe employee

1.

Name

(refer Note 1)

2.

Address

(refer Note 2)

3.

Permanent Account Number

4.

Residential Status

(refer Note 3)

5.

Tax Year

PART B

Particulars of Income under head “Salaries” due or received from any other employer(s) for the purpose of section 392(4)(a)(i)

Sl.

No

.

Name

of other

employ

er (s)

Permane

nt

Account

Number

of other

employer

(s)

Tax

Collection

and

Account

Number

of other

employer(

s)

Period of

employme

nt

Particulars of salary as defined in

section 16, 17 and 18, paid or due

to be paid to the employee during

the year

Total

of

column

s 6, 7

and 8

Amount

deducted

in respect

of life

insurance

premium,

provident

fund

contributio

n, etc., to

which

section 123

applies

(give

details)

Total

amount

of tax

deducte

d during

the year

[enclose

certificat

e issued

under

section

395(4)]

Total

amount

of salary

excludin

g

amounts

required

to be

shown

in

columns

7 and 8

Total

amount of

house rent

allowance

,

conveyan

ce

allowance

and other

allowance

s to the

extent

chargeabl

e to tax

[See

Schedule

III (Table

S. No. 11)

read with

rule 279

and

Schedule

III (Table:

Sl. No.

12) and

Schedule

III (Table:

Sl. No.

13)]

Value of

perquisite

s and

amount of

accretion

to

employee

‘s

provident

fund

account

(give

details in

the

Annexure

)

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

PART C

Details of particulars for the purpose of section 392(4)(a)(iii), (iv) and (v)

Sl.

No.

Particulars

1.

Loss under the head “Income from house property”

Amount of loss

Details

(a)

(b)

2.

Details of any other income chargeable to tax under any other head of income, (not being a loss except “loss under house property” reported in Table no. 1 above) –

Income chargeable to tax under head

Nature of Income

Amount of income received/ credited

Any other relevant details

(a)

(b)

(c)

(d)

3.

Details of other Tax Deducted at Source –

Section under

which tax

deducted at

source

Name of

deductor

Address

of

deductor

Tax

Deduction

and

Collection

Account

Number of

deductor

Amount

of tax

deducted

Amount of

income

received/

credited

Whether

amount

mentioned in

column (f) is

included in Sl.

No. 2 above

(Yes/ No)

Any other

relevant

details

(a)

(b)

(c)

(d)

(e)

(f)

(g)

(h)

4.

Details of Tax Collected at Source –

Section under which tax collected at source

Name of

collector

Address

of

collector

Tax

Deduction

and

Collection

Account

Number of

collector

Amount of

tax collected

Any other

relevant

details

(a)

(b)

(c)

(d)

(e)

(f)

Value of rent-free accommodation or value of any concession in rent for the accommodation provided by the employer

(give basis of computation) <[See rule 15]>

Where

accommodation

is unfurnished

Where accommodation is furnished

Rent, if any,

paid by the

employee

Value of

perquisite

(column 1

minus column

6 or column 5

minus column

6 as may be

applicable)

Value as if

accommodation

is unfurnished

Cost of

furniture*

OR hire

charges, if

hired from

a third

party

Perquisite

value of

furniture

(12% of

column 3)

OR actual

hire charges

payable

Total of

columns 2

and 4

(1)

(2)

(3)

(4)

(5)

(6)

(7)

Whether any conveyance

facility has

been provided

by the

employer free

or at a concessional rate, or where

the employee

is allowed the

use of one or

more motor

cars owned or

hired by the

employer, the estimated

value of

perquisite

(give details)

[See rule 15]

Remuneration

paid by

employer for

Domestic

and/or

personal

services

provided to

the employee

(give details)

[See rule 15]

Value of free

or

concessional

passages on

home leave

and other

travelling to

the extent

chargeable to

tax (give

details)

[See rule 278

read With

Schedule III

(Table S. No.

8)]

Estimated value

of any other

benefit or

amenity provided

by the employer,

free of cost or at

concessional rate

not included in

the preceding

columns (give

details), e.g.,

supply of gas,

electricity or

water for

household

consumption,

free educational

facilities,

transport for

family, etc. [See

rule 15]

Employer's

contribution

to

recognised

provident

fund in

excess of

12% of the

employee's

salary [See

Schedule

XI – Part

A]

Interest

credited to

the assessee's

account in

recognised

provident

fund in

excess of the

rate fixed by

the

Central

Government

[See

Schedule XI

– Part A]

Total of

columns 7 to

13 carried to

column 8 of

Part B of this

Form

(8)

(9)

(10)

(11)

(12)

(13)

(14)