Form for claiming relief under section 157(1) of the Act in case of receipt of additional salary, or gratuity or Retrenchment Compensation or commutation of pension

Part- A

Basic Information

1.

Details of the assessee

(i)

Name

(refer Note 1)

(ii)

Address

(refer Note 2)

(iii)

Permanent Account Number

(iv)

Residential Status

(v)

Email ID

(vi)

Contact Number

2.

Tax Year (relevant tax year as in rule 73)

Part-B

3.

Relief admissible in case of receipt of additional salary (arrears or advance) or additional family pension

(i)

Attribution of the additional salary or family pension to the Tax Year to which it pertains

Sl.No.

Tax Year(s)

to which

the

additional

salary or

family

pension

relates

Amount of

additional

salary, etc.,

relating to

the Tax

Year

Total

Income

of the

Tax

Year

Tax

payable

on

Total

Income

Enhanced

Total

Income

of the

Tax Year

(B+C)

Tax

payable

on

Enhanced

Total

Income

Tax chargeable

on additional

salary, etc., if it

was received in

the Tax Year to

which it relates

(F-D)

A

B

C

D

E

F

G

(a)

(b)

(c)

(d)

(Repeat if

required)

TOTAL

TOTAL

(ii)

Total Income of the relevant Tax Year

(iii)

Tax payable on Total Income

(iv)

Reduced Total Income of the relevant Tax Year

[row 3(ii)-total of column B of row 3(i)]

(v)

Tax payable on Reduced Total Income of the relevant Tax Year

(vi)

Tax on the additional salary, etc., in the relevant Tax Year (i.e. in year of receipt) [row 3(iii)-row 3(v)]

(vii)

Is the tax on additional salary in row 3(vi) greater than the total of column G of3(i);

1. Yes

2. No

(viii)

Relief admissible only when row 3(vii) is Yes.

Relief = row 3(vi) - total of column G of row 3(i)

4.

Relief admissible in case of receipt of Gratuity (past services <15 Years)

(i)

Gratuity received during the

relevant Tax Year (herein referred as Y1for Row No 4)

(ii)

Calculation of Average rate of tax for Y2 and Y3

Tax

Year

Total

Income

Enchanced Total Income

[B+ ½ of4(i)]

Tax Payable on

Enchanced Total

Income

Average rate of

tax on Enhanced

Total Income

(D/C)

A

B

C

D

E

Y2 (Tax

Year

immediately

preceding

Y1)

Y3(Tax

Year

immediately

preceding

Y2)

Total

(iii)

Average of Average Rate of Tax ofY2 and Y3 [RA = ½ of total of column E of row 4(ii))]

(iv)

Total Income of the relevant Tax Year (Y1)

(v)

Tax payable on Total Income of Y1

(vi)

Average rate of tax on Total Income of Y1 [R1 = row 4(v) ’ row 4(iv)]

(vii)

Is R1 more than RA [row 4(vi) > row 4(iii)]

1. Yes

2. No

(viii)

Relief admissible only when

row 4(vii) is Yes. [Relief = row 4(i)*(R1-RA)]

5.

Relief admissible in cases of receipt of gratuity (past services >= 15 years)

(i)

Amount of Gratuity received

during the relevant Tax Year

(herein referred as Y1for Row No. 5)

(ii)

Calculation of average rate of tax for Y2 , Y3 and Y4

Tax

Year

Total

Income

Enchanced

Total Income

[B+1/3rd of

5(i)]

Tax Payable on

Enchanced Total

Income

Average rate of

tax on Enhanced

Total Income

(D/C)

A

B

C

D

E

Y2 (Tax Year

immediately

preceding

Y1)

Y3 (Tax Year

immediately

preceding

Y2)

Y4 (Tax Year

immediately

preceding

Y3)

TOTAL

(iii)

Average of average rates of tax on Enhanced Total Incomes of Y2,

Y3, and Y4 [RA =1/3rd of Total of column E of row 5(ii)]

(iv)

Total Income of the relevant Tax Year (Y1)

(v)

Tax payable on Total Income of Y1

(vi)

Average rate of tax on Total

Income of Y1. [R1= row 5(v) ’ row 5(iv)]

(vii)

Is R1 more than RA [row 5(vi) > row 5(iii)]

1. Yes

2. No

(viii)

Relief admissible only when row 5(vii) is Yes. [Relief = row

5(i)*(R1- RA)]

6.

Relief admissible in cases of receipt of Retrenchment Compensation

(i)

Amount of retrenchment

compensation received during the relevant Tax Year (herein referred as Y1for Row No. 6)

(ii)

Calculation of Average rate of tax for Y2 , Y3 and Y4

Tax

Year

Total

Income

Enchanced Total Income

[B+1/3rd of 6(i)]

Tax Payable on

Enchanced Total

Income

Average rate of

tax on Enhanced

Total Income

(D/C)

A

B

C

D

E

Y2 (Tax Year

immediately

preceding

Y1)

Y3 (Tax Year

immediately

preceding

Y2)

Y4 (Tax Year

immediately

preceding

Y3)

TOTAL

(iii)

Average of average rates of tax on Enhanced Total Incomes of Y2,

Y3, and Y4 [RA =1/3rd of Total of column E of row 6(ii)]

(iv)

Total Income of the relevant Tax Year (Y1)

(v)

Tax payable on Total Income of Y1

(vi)

Average rate of tax on Total

Income of Y1. [R1= row 6(v) † row 6(iv)]

(vii)

Is R1 more than RA [row 6(vi) > row 6(iii)]

1. Yes

2. No

(viii)

Relief admissible only when 6(vii) is Yes. [Relief = row 6(i)*(R1-

RA)]

7.

Relief admissible in cases of receipt of commutation of pension

(i)

Amount of commutation of pension received during the relevant Tax Year (herein referred as Y1for row no. 7)

(ii)

Calculation of average rate of tax for Y2 , Y3 and Y4

Tax

Year

Total

Income

Enchanced

Total Income

[B+1/3rd of

7(i)]

Tax Payable on

Enchanced Total

Income

Average rate of

tax on Enhanced

Total Income

(D/C)

A

B

C

D

E

Y2 (Tax Year

immediately

preceding

Y1)

Y3 (Tax Year

immediately

preceding

Y2)

Y4 (Tax Year

immediately

preceding

Y3)

TOTAL

(iii)

Average of average rates of tax on Enhanced Total Incomes of Y2,

Y3, and Y4 [RA =1/3rd of Total of column E of row 7(ii)]

(iv)

Total Income of the relevant Tax Year (Y1)

(v)

Tax payable on Total Income of Y1

(vi)

Average rate of tax on Total

Income of Y1. [R1= row 7(v) † row 7(iv)]

(vii)

Is R1 more than RA [row 7(vi) > row 7(iii)]

1. Yes

2. No

(viii)

Relief admissible only when row 7(vii) is Yes. [Relief = row

7(i)*(R1- RA)]

8.

Amount of receipt for which relief is claimed and relief admissible under section 157(1):

Sr.

No.

Nature of receipt

Amount of receipt

Relief admissible

(A)

(B)

(i)

Additional salary or family pension

[Total of Column B of3(i)]

[From 3(viii)]

(ii)

Gratuity (for past services < 15 Years)

[From 4(i)]

[From 4(viii)]

(iii)

Gratuity (for past services >=15 years)

[From 5(i)]

[From 5(viii)]

(iv)

Retrenchment compensation

[From 6(i)]

[From 6(viii)]

(v)

Commutation of pension

[From 7(i)]

[From 7(viii)]

(vi)

Any other receipt

(vii)

TOTAL [Sum of row 8(i) to row 8(vi)]

9.

Total relief admissible during the relevant tax year [Column B of row 8(vii)]

VERIFICATION

I,……………………………(name), holding Permanent Account Number, … … … … … … ., do hereby affirm that the information given above is correct and complete to the best of my knowledge and belief and is in accordance with the provisions of the Act.

Place Name:

Date … … … … … … … … . Signature: