Kh. Shafiqur Rahman

FORM OF RETURN OF INCOME UNDER THE INCOME TAX
ORDINANCE, 1984 (XXXVI OF 1984)
IT-11GA
FOR INDIVIDUAL AND OTHER TAXPAYERS

(OTHER THAN COMPANY)
Be a Respectable Taxpayer
Submit return in due time
Avoid penalty
Photograph of the
Assessee
(to be attested on
the photograph)
Put the tick () mark wherever applicable

Self
Universal Self
1. Name of the Assessee:
Normal
Khandakar Shafiqur Rahman

2
2. National ID No (if any):
3. UTIN (if any):

4. TIN:
e-TIN:
Firm
7. Residential Status: Resident
Association of Persons
/ Non-resident
UNIVERSAL FINANCIAL SOUTIONS LTD.
11. Father's Name:
Khandakar Siddiqur Rahman
12. Mother's Name:
Late Rowshan Ara Begum
Mrs. Rubana Rahman
13. Date of Birth (in case of individual) :
8
Day
Month
, Dhaka.
14. Address (a) Present:
62/A, Green Road, Dhanmondi, Dhaka.
N/A
15. Telephone: Office/Business:
Hindu Undivided Family
10. Wife/Husband's Name (if assessee, please mention TIN):
(b) Permanent:
12, Dhaka
9. Name of the employer/business (where applicable):
16. VAT Registration Number (if any):
(b) Taxes Zone:
2016-2017
6. Assessment Year:
6
-
252
5. (a) Circle:
8. Status: Individual
Residential:
N/A
7
Year
Statement of income of the Assessee

Statement of income during the income year ended on
Sl
30-Jun-16
Heads of Income
Amount in Taka
42,40,000.00
Salaries : u/s 21 (as per schedule 1)
Interest on Securities : u/s 22
Income from house property : u/s 24 (as per schedule 2)
Agricultural income : u/s 26
Income from business or profession : u/s 28
Share of profit in a firm :
Income of the spouse or minor child as applicable : u/s 43(4)
Capital Gains : u/s 31
Income from other source : u/s 33

42,40,000.00
10 Total (serial no. 1 to 9)
11 Foreign Income:
42,40,000.00
12 Total income (serial no. 10 and 11)

13 Tax leviable on total income
8,57,500.00
14 Tax rebate: u/s 44(2)(b)(as per schedule 3)
1,28,500.00
15 Tax payable (difference between serial no. 13 and 14)
7,29,000.00
3,149
Balance Tax U/S 74 Tk. 78,732 of 4% (U/S-73A) = 3,149
7,32,149.00
Net Tax Payable

16 Tax Payments:
(a) Tax deducted/collected at source
(Please submit supporting documents/statement)
Tk. 15,000
(b) Advance tax u/s 64/68 (Please attach challan )
Tk. 6,35,268.00
(c) Tax paid on the basis of this return (u/s 74)

(Please attach challan/pay order/bank draft/cheque)
Tk.
(d) Adjustment of Tax Refund (if any)
Tk.
81,881
Total of (a) (b), (c) and (d)
7,32,149.00
0
17 Difference between serial 15 and 16 (if any)

18 Tax exempted and Tax free income
19 Income tax paid in the last assessment year
* If needed, please use separate sheet.
Verification
Khandakar Siddiqur Rahman
I
father /husband
UTIN/TIN: 7 4 7 9 2 6 3 8 3 8 9 3 solemnly declare that to the best of my knowledge and
belief the information given in this return and statements and documents annexed herewith is correct
and complete.
Place: Dhaka
Date :
Signature
3
(Name in block letters)

Designation and Seal (for other than individual)
SCHEDULES SHOWING DETAILS OF INCOME

Name of the Assessee:
TIN
7 4 7 9 2 6 3 8 3 8 9 3
Schedule-1 (Salaries)
Amount of
Income
(Tk.)
Pay & Allowance
Amount of
exempted income
(Tk.)
29,40,000.00
Basic pay
Net taxable
income
(Tk.)
29,40,000.00
Special pay
Dearness allowance
Conveyance allowance
2,10,000.00
30,000.00
1,80,000.00
House rent allowance
6,30,000.00
3,00,000.00
3,30,000.00
Medical allowance
4,20,000.00
1,20,000.00
3,00,000.00
Servant allowance
Leave allowance
Honorarium / Reward/ Fee
Overtime allowance
4,90,000.00
Bonus / Ex-gratia
4,90,000.00
Other allowances
Employers contribution to Recognized
Provident Fund
Interest accrued on Recognized Provident
Fund
Deemed income for transport facility
Deemed income for free
furnished/unfurnished accommodation
Other, if any (give detail)
46,90,000.00
Net taxable income from salary
4,50,000.00
42,40,000.00
Schedule-2 (House Property income)

Location and
description of property
Particulars
Tk.
1. Annual rental income

2. Claimed Expenses :
Repair, Collection, etc.
Municipal or Local Tax
Land Revenue
Interest on Loan/Mortgage/Capital
Charge
Insurance Premium
Vacancy Allowance
Other, if any
Total =
Tk.
3. Net income ( difference between item 1 and 2)
Schedule-3 (Investment tax credit)

(Section 44(2)(b) read with part B of Sixth Schedule)
1. Life insurance premium
Tk.
2. Contribution to deferred annuity
Tk.
3. Contribution to Provident Fund to which Provident Fund

Act, 1925 applies
Tk.
4. Self contribution and employers contribution to

Recognized Provident Fund
Tk.
5. Contribution to Super Annuation Fund
Tk.
6. Investment in approved debenture or debenture stock,

Stock or Shares
Tk.
7. Contribution to deposit pension scheme
Tk.
8. Contribution to Benevolent Fund and Group Insurance premium
Tk.
9. Contribution to Zakat Fund
Tk.
10. Others, if any (Sanchaypatra)
Tk.
Total =
*Please attach certificates/documents of investment.
List of documents furnished

1. Statement of Salary
6.
2. AIT Deduction Documents
7.
3. BSP Certificate
8.
4. Car AIT Money Receipt
9.
5. Bank Statement
10.
Tk.
11,00,000.00
11,00,000.00
*Incomplete return is not acceptable
IT-10B
30-Jun-16
Statement of Assets and Liabilities (as on

TIN 7
4 7 9 2 6 3 8 3 8 9 3
1. (a) Business Capital (Closing balance)
Tk.
Tk.
(b) Directors Shareholdings in Limited Companies ( at cost)

Name of Companies
Number of shares
2. Non-Agricultural Property (at cost with legal expenses ) :

Land/House property (Description and location of property)
Tk.
3. Agricultural Property (at cost with legal expenses ) :

Land (Total land and location of land property)
Tk.
4. Investments:
(a) Shares/Debentures
Tk.
(b) Saving Certificate/Unit Certificate/Bond
Tk.
(c) Prize bond/ DPS
Tk.
(d) Loans given to wife
Tk.
(e) Other Investment
Tk.
41,00,000.00
Total =
5. Motor Vehicles (at cost) :
Dhaka Metro-GA-5173
Type of motor vehicle and Registration number
B/F
Tk.
41,00,000.00
Tk.
19,58,000.00
6. Jewellery (quantity and cost) :
B/F
Tk.
1,20,000.00
7. Furniture (at cost) :
B/F
Tk.
2,40,000.00
8. Electronic Equipment (at cost) :
B/F
Tk.
1,00,000.00
9. Cash asset Outside Business:

(a) Cash in hand & at bank
Tk.
(b) Cash at bank
Tk.
(c) Other deposits
Tk.
9
1,19,91,145.00
Total =
10
Tk.
1,19,91,145.00
Tk.
1,77,09,145.00
Tk.
Total assets
Tk.
1,77,09,145.00
Total liabilities
Tk.
B/F =
10. Any other assets
(With details)
11. Less Liabilities:

(a) Mortgages secured on property or land
Tk.
(b) Unsecured loans
Tk.
(c) Bank loan
Tk.
(d) Others
Tk.
12. Net wealth as on last date of this income year

(Difference between total assets and total liabilities)
Tk.
1,77,09,145.00
13. Net wealth as on last date of previous income year
Tk.
1,48,28,313.00
14. Accretion in wealth (Difference between serial no. 12 and 13)
Tk.
28,80,832.00
15. (a) Family Expenditure : (Total expenditure as per Form IT 10 BB)
Tk.
18,09,168.00
(b) Number of dependant children of the family:

Adult
Child
(c) Fees & Charges for Share Business
Tk.
16. Total Accretion of wealth (Total of serial 14 and 15)

17. Sources of Fund :
(i) Shown Return Income
Tk.
Tk.
42,40,000.00
(ii) Tax exempted/Tax free Income
Tk.
4,50,000.00
(iii) Other receipts
Tk.
Total source of Fund =
18. Difference (Between serial 16 and 17)
Tk.
46,90,000.00
46,90,000.00
Tk.
I solemnly declare that to the best of my knowledge and belief the information given in the IT-10B is
correct and complete.
Name & signature of the Assessee

Date
Assets and liabilities of self, spouse (if she/he is not an assessee), minor children and
dependant(s) to be shown in the above statements.
11
nil
Form No. IT-10BB
FORM
Statement under section 75(2)(d)(i) and section 80 of the Income Tax Ordinance, 1984
(XXXVI of 1984) regarding particulars of life style
Seria
l No.
TIN 7
Particulars of Expenditure
4 7 9 2 6 3 8 3 8 9 3
Amount of Tk.
Personal and fooding expenses
4,50,000.00
Tax paid including deduction at source of the

last financial year
6,50,268.00
Accommodation expenses
3,30,000.00
Transport expenses
72,500.00-
Electricity Bill for residence
Wasa Bill for residence
--
Gas Bill for residence
7,800.00
Telephone Bill for residence (Mobile Bill)
Education expenses for children
10
Personal expenses for Foreign travel
11
Festival and other special expenses, if any
Comments
Self Driven Vahicle
63,100.00
-1,23,000.00
-1,12,500.00
18,09,168.00
Total Expenditure with Tax
I solemnly declare that to the best of my knowledge and belief the information given in the
IT-10BB is correct and complete.

Name and signature of the Assessee
Date:
*If needed, please use separate sheet.

"
Acknowledgement Receipt of Income Tax Return

UTIN/TIN: 7 4 7 9 2 6 3
Circle:
12
Assessment Year:
252
2016-2017
Taxes Zone:
12, Dhaka
13
Instructions to fill up the Return Form
Instructions:
(1) This return of income shall be signed and verified by the individual assessee or person as
prescribed u/s 75 of the Income Tax Ordinance, 1984.
(2) Enclose where applicable:
(a) Salary statement for salary income; Bank statement for interest; Certificate for interest
on savings instruments; Rent agreement, receipts of municipal tax and land revenue,
statement of house property loan interest, insurance premium for house property
income; Statement of professional income as per IT Rule-8; Copy of assessment/
income statement and balance sheet for partnership income; Documents of capital gain;
Dividend warrant for dividend income; Statement of other income; Documents in
support of investments in savings certificates, LIP, DPS, Zakat, stock/share etc.
(b) Statement of income and expenditure; Manufacturing A/C, Trading and Profit & Loss
A/C and Balance sheet;
(c) Depreciation chart claiming depreciation as per THIRD SCHEDULE of the Income Tax
Ordinance, 1984;
(d) Computation of income according to Income tax Law;
(3) Enclose separate statement for:
(a) Any income of the spouse of the assessee (if she/he is not an assessee), minor children
and dependant;
(b) Tax exempted / tax free income.
(4) Fulfillment of the conditions laid down in rule-38 is mandatory for submission of a return
under "Self Assessment".
(5) Documents furnished to support the declaration should be signed by the assessee or his/her
authorized representative.
(6) The assesse shall submit his/her photograph with return after every five year.
(7) Furnish the following information:
(a) Name, address and TIN of the partners if the assessee is a firm;
(b) Name of firm, address and TIN if the assessee is a partner;
(c) Name of the company, address and TIN if the assessee is a director.
(8) Assets and liabilities of self, spouse (if she/he is not an assessee), minor children and
dependant(s) to be shown in the IT-10B.
"
Total income shown in Return:
Tk.
42,40,000.00
Net Wealth of Assessee :
Tk.
1,77,09,145.00
Date of receipt of return :

Nature of Return :
Self
Tax paid:
Tk.
7,32,149.00
Serial No. in return register:

Universal Self
Normal
Signature of Receiving
14
officer with seal
15
Masthan Maligai
TIN : 694485916602
Cash Flow Statement
(30-06-15)
Particulars
B/F
Gross Salary Income
Total Inflow
Taka
Taka
Taka
Less:
Family Expenses with Tax
Total Outflow
Net Cash/Bank balance
(Masthan Maligai)
Annexure -3
Md. Abdus Sobhan Miah

C/o. Office of the Prime Minister, Dhaka
TIN: 114005467902/Survey Circle-4
U/S-82BB
Statement of Share Income for the Year Ended 30th June,2014

Cost value of Securities :
1. Midway Securities Ltd.
a) BOID-9199:
b) BOID-9834:
Balance as on Cr./Dr.(Loan) :
a) BOID-9199:
b) BOID-9834:
Capital Gain :
a) BOID-9199:
b) BOID-9834:
Fees & Charges :
a) BOID-9199:
b) BOID-9834:
26,035,353
46,813
26,082,166
181,589
2,936
2,027,550
37,899
2,065,449
564
500
1,064
(Md. Abdus Sobhan Miah)
1/H-1/43 Mirpur, Dhaka

JASIM UDDIN BHUIYAN MONNO
TIN: 175367455472

1.
LankaBangla Securities:
2.
Midway Securities Ltd.
3.
a) BOID-9199:
b) BOID-9834:
6568606
###
24189953
12349
30770908
###
46,813
###
Annexure-1

U/S-82BB
Statement of Salary Income for the Year Ended 30th June,2014

a) Salary Income from Government Service :
Pay and Allowances
Basic Pay
Special pay
Dearness allowances
Conveyance allowances
House Rent allowances
Medical Allowances
Servent allowances
Leave allowances
Bonus / Ex-gratia
Other allowances
Other, if any (give detail) Expense Allowance
Net taxable income from salary(Govt. Service)
Amount of income Amount of exempted Net taxable income

(Tk.)
income (Tk.)
(Tk.)
480,000
480,000
72,000
72,000
8,400
36,000
8,400
36,000
80,000
80,000
12,000
688,400
12,000
208,400
480,000
b) Salary Income from Private Ltd. Company

Pay and Allowances
Basic Pay
Special pay
Conveyance allowances
House Rent allowances
Medical Allowances
Servent allowances
Leave allowances
Overtime allowance
Bonus / Ex-gratia
Other
allowances
Employer's
Contribution to Recognized Provident
Fund
Net taxable income from salary(Private Service)
Total Salary Income(a+b)
Amount of income Amount of exempted Net taxable income

(Tk.)
income (Tk.)
(Tk.)
1,200,000
60,000
600,000
60,000
1,200,000
30,000
240,000
60,000
200,000
30,000
360,000
-
200,000
2,120,000
330,000
1,790,000
2,808,400
538,400
2,270,000
Annexure-2

U/S-82BB
Statement of House Property Income for the Year Ended 30th June,2014
Location and description of property: Five storied Building at 35 Baishteki, Section-13,
Mirpur, Dhaka-1216
Ground Floor
1st Floor
2nd Floor
3rd Floor
4th Floor
4th Floor
@
@
@
@
Parking
TK. 6,000 X
TK. 6,000 X
TK. 6,000 X
Self Occupied
TK. 5,500 X
12 Months = TK.
12 Months = TK.
12 Months = TK.
= TK.
12 Months = TK.
Total
= TK.
144,000
144,000
144,000
Nil
66,000
498,000
Less:
25% for Repairs

TK.
124,500
Interest on Loan
TK.
Municipal Tax
TK.
39,137
Land Revenue
TK.
- TK.
Net House Property Income TK.
163,637
334,363
2 X
2 X
2 X
1 X
Statement of House Property Income for the Year Ended 30th June,2013
d 30th June,2013
Annexure-5

Statement Of Income for the year ended 30th June,2014
1. Income from House Property :
334,363
2. Income From Salary :
2,270,000
3. Income From Bank Interest :
11,034
4. Capital Gain
###
Total Taxable Income
2,615,397
Tax Calculation
1st
Next
Next
Next
Next
220,000
300,000
400,000
500,000
1,195,397
0%
10%
15%
20%
25%
Nil
30,000
60,000
100,000
298,849
Total
2,615,397
Tax
488,849
Total Tax Payable

Add : 10% Surcharge on PayableTax
Total Tax Payable
Less:AIT Deducted from Salary
AIT From Bank Interest
Balance Tax Paid by PO No.
488,849
48,885
537,734
238,956.00
1,655.00
240,611
297,123
#REF!
375,000.00 56,250.00
607768
1,195,397
#REF!
Date :
Deputy Commissioner of Taxes
Circle-64, Taxes Zone-03
Dhaka.
Subject: Payment of Tax.
Reference: JASIM UDDIN BHUIYAN MONNO, Son of Alhaj Md. Shahabuddin
Bhuiyan;1/H-1/43 Mirpur, Dhaka
TIN : 058-113-4795/Cir-64
E-TIN: 175367455472/Cir-64
Assessment Year: 2011-2012
P.O. No.-
1331812
Taka: 46,793/Date : 16-01-2014

Bank: Dutch-Bangla Bank Ltd.
Branch: Mirpur Branch, Dhaka
Please Acknowledge the Receipt
Thanks
(JASIM UDDIN BHUIYAN MONNO)
27
28
Statement of income of the Assessee

Statement of income during the income year ended on
Sl
Heads of Income
Amount in Taka
546,000.00
Salaries : u/s 21 (as per schedule 1)
Interest on Securities : u/s 22
Income from house property : u/s 24 (as per schedule 2)
Agricultural income : u/s 26
Income from business or profession : u/s 28
Share of profit in a firm :
Income of the spouse or minor child as applicable : u/s 43(4)
Capital Gains : u/s 31
Income from other source : u/s 33
10
Total (serial no. 1 to 9)
11
Foreign Income:
12
Total income (serial no. 10 and 11)
13
Tax leviable on total income
14
Tax rebate: u/s 44(2)(b)(as per schedule 3)
15
Tax payable (difference between serial no. 13 and 14)
16
30-Jun-13
671,000.00
Untaxed Income (U/S-19E )
1,217,000.00
0.00
1,217,000.00
149,400.00
14,400.00
135,000.00
8,237.00
Add : 10% Panalty on Tax of Untaxed Income

Total Tax Payable
Tax Payments:
(a) Tax deducted/collected at source
(Please submit supporting documents/statement)
Tk.
(b) Advance tax u/s 64/68 (Please attach challan )
Tk.
(c) Tax paid on the basis of this return (u/s 74)

(Please attach challan/pay order/bank draft/cheque)
Tk. 143,237.00
(d) Adjustment of Tax Refund (if any)
Tk.
Total of (a) (b), (c) and (d)
17
Difference between serial 15 and 16 (if any)
18
Tax exempted and Tax free income
19
Income tax paid in the last assessment year
143,237.00
143,237.00
0.00
Verification
0
0
I
father /husband
0
8
7
1
0
9
3
6
2
8
UTIN/TIN:
solemnly declare that to the best of my knowledge and
belief the information given in this return and statements and documents annexed herewith is correct
and complete.
Place: Dhaka
Date :
Signature
Md. Belal Uddin
29
(Name in block letters)

Designation and Seal (for other than individual)
30
SCHEDULES SHOWING DETAILS OF INCOME

TIN
0 0 0 - 0 0 0 0 0 0 0 0
Schedule-1 (Salaries)
Amount of
Income
(Tk.)
Pay & Allowance
Amount of
exempted income
(Tk.)
432,000.00
Basic pay
Net taxable
income
(Tk.)
432,000.00
Special pay
Dearness allowance
45,600.00
30,000.00
216,000.00
216,000.00
Conveyance allowance
House rent allowance
15,600.00
Medical allowance
Servant allowance
Leave allowance
Honorarium / Reward/ Fee
Overtime allowance
Bonus / Ex-gratia
72,000.00
72,000.00
Other allowances (Transport)
26,400.00
26,400.00
Employers contribution to Recognized

Provident Fund
Interest accrued on Recognized Provident
Fund
Deemed income for transport facility
Deemed income for free
furnished/unfurnished accommodation
792,000.00
Net taxable income from salary
246,000.00
546,000.00
Schedule-2 (House Property income)

Location and
description of property
Particulars
Tk.
1. Annual rental income

2. Claimed Expenses :
Repair, Collection, etc.
Municipal or Local Tax
Land Revenue
Interest on Loan/Mortgage/Capital
Charge
Insurance Premium
Vacancy Allowance
Other, if any
Total =
31
Tk.
3. Net income ( difference between item 1 and 2)
32
Schedule-3 (Investment tax credit)

(Section 44(2)(b) read with part B of Sixth Schedule)
1. Life insurance premium
Tk.
2. Contribution to deferred annuity
Tk.
3. Contribution to Provident Fund to which Provident Fund

Act, 1925 applies
Tk.
4. Self contribution and employers contribution to

Recognized Provident Fund
Tk.
5. Contribution to Super Annuation Fund
Tk.
6. Investment in approved debenture or debenture stock,

Stock or Shares
Tk.
7. Contribution to deposit pension scheme
Tk.
8. Contribution to Benevolent Fund and Group Insurance premium
Tk.
9. Contribution to Zakat Fund
Tk.
10. Others, if any
Laptop
Total =
*Please attach certificates/documents of investment.
List of documents furnished

1. Photocopy Salary Certificate
6.
2. Cash Flow Statement
7.
3. Income Statement
8.
4. A Photocopy of Deed of Land Purchase
9.
5. Photocopy of Purchase of a Laptop
10.
33
Tk.
96,000.00
Tk.
96,000.00
*Incomplete return is not acceptable
34
IT-10B
30-Jun-13
Statement of Assets and Liabilities (as on

TIN 0
0 0 - 0 0 0 - 0 0 0 0
1. (a) Business Capital (Closing balance)
Tk.
Tk.
(b) Directors Shareholdings in Limited Companies ( at cost)

Name of Companies
Number of shares
2. Non-Agricultural Property (at cost with legal expenses ) :

Land/House property (Description and location of property)
5 Decimal Land at Genda Mouga, Saver, Dhaka
(Total Cost with Registration)
Tk.
3. Agricultural Property (at cost with legal expenses ) :

Land (Total land and location of land property)
Tk.
4. Investments:
(a) Shares/Debentures
671,000.00
Tk.
(b) Saving Certificate/Unit Certificate/Bond
Tk.
(c) Prize bond/Savings Scheme
Tk.
(d) Loans given
Tk.
(e) Other Investment
Tk.
Total =
5. Motor Vehicles (at cost) :

Type of motor vehicle and Registration number
Tk.
Tk.
(Gift from Marriage)
6. Jewellery (quantity and cost) :

35 Tola
B/F
Tk.
7. Furniture (at cost) :
B/F
Tk.
180,000.00
Tk.
140,000.00
8. Electronic Equipment (at cost) :

9. Cash asset Outside Business:
(a) Cash in hand & at bank
B/F
Value Not Known
Tk.
(b) Cash at bank
Tk.
(c) Other deposits
Tk.
35
(Annexure-1)
Total =
36
Tk.
1,369,400.00
Tk.
2,360,400.00
Laptop
Tk.
96,000.00
Total assets
Tk.
2,456,400.00
Total liabilities
Tk.
B/F =
10. Any other assets
(With details)
11. Less Liabilities:

(a) Mortgages secured on property or land
Tk.
(b) Unsecured loans
Tk.
(c) Bank loan
Tk.
(d) Others
Tk.
12. Net wealth as on last date of this income year

(Difference between total assets and total liabilities)
Tk.
2,456,400.00
13. Net wealth as on last date of previous income year
Tk.
1,193,600.00
14. Accretion in wealth (Difference between serial no. 12 and 13)
Tk.
1,262,800.00
15. (a) Family Expenditure : (Total expenditure as per Form IT 10 BB)
Tk.
200,200.00
Tk.
1,463,000.00
Tk.
1,463,000.00
(b) Number of dependant children of the family:

2
Adult
Child
16. Total Accretion of wealth (Total of serial 14 and 15)

17. Sources of Fund :
(i) Shown Return Income
(ii) Tax exempted/Tax free Income
(iii) Other receipts
Tk.
1,217,000.00
(Perquisites) Tk.
246,000.00
Tk.
Total source of Fund =
Tk.
18. Difference (Between serial 16 and 17)
I solemnly declare that to the best of my knowledge and belief the information given in the IT-10B is
correct and complete.
0
Name & signature of the Assessee
Date
Assets and liabilities of self, spouse (if she/he is not an assessee), minor children and
dependant(s) to be shown in the above statements.
37
38
Form No. IT-10BB
FORM
Statement under section 75(2)(d)(i) and section 80 of the Income Tax Ordinance, 1984
(XXXVI of 1984) regarding particulars of life style
Seria
l No.
TIN 0
Particulars of Expenditure
0 0 - 0 0 0 - 0 0 0 0
Amount of Tk.
Comments
Personal and fooding expenses
92,000.00
Tax paid including deduction at source of the

last financial year
13,600.00
Accommodation expenses
66,000.00
Transport expenses
Electricity Bill for residence
Included With Rent
Wasa Bill for residence
Included With Rent
Gas Bill for residence
Included With Rent
Telephone Bill for residence (Mobile Bill)
Education expenses for children
10
Personal expenses for Foreign travel
11
Festival and other special expenses, if any (donation)
Living in Mother's Flat
3,600.00
25,000.00
200,200.00
Total Expenditure
I solemnly declare that to the best of my knowledge and belief the information given in the
IT-10BB is correct and complete.
0
Name and signature of the Assessee
Date:
*If needed, please use separate sheet.

"
Acknowledgement Receipt of Income Tax Return

UTIN/TIN: 0 0 0
Assessment Year:
0 0 0
Circle:
39
Taxes Zone:
40
Instructions to fill up the Return Form
Instructions:
(1) This return of income shall be signed and verified by the individual assessee or person as
prescribed u/s 75 of the Income Tax Ordinance, 1984.
(2) Enclose where applicable:
(a) Salary statement for salary income; Bank statement for interest; Certificate for interest
on savings instruments; Rent agreement, receipts of municipal tax and land revenue,
statement of house property loan interest, insurance premium for house property
income; Statement of professional income as per IT Rule-8; Copy of assessment/
income statement and balance sheet for partnership income; Documents of capital gain;
Dividend warrant for dividend income; Statement of other income; Documents in
support of investments in savings certificates, LIP, DPS, Zakat, stock/share etc.
(b) Statement of income and expenditure; Manufacturing A/C, Trading and Profit & Loss
A/C and Balance sheet;
(c) Depreciation chart claiming depreciation as per THIRD SCHEDULE of the Income Tax
Ordinance, 1984;
(d) Computation of income according to Income tax Law;
(3) Enclose separate statement for:
(a) Any income of the spouse of the assessee (if she/he is not an assessee), minor children
and dependant;
(b) Tax exempted / tax free income.
(4) Fulfillment of the conditions laid down in rule-38 is mandatory for submission of a return
under "Self Assessment".
(5) Documents furnished to support the declaration should be signed by the assessee or his/her
authorized representative.
(6) The assesse shall submit his/her photograph with return after every five year.
(7) Furnish the following information:
(a) Name, address and TIN of the partners if the assessee is a firm;
(b) Name of firm, address and TIN if the assessee is a partner;
(c) Name of the company, address and TIN if the assessee is a director.
(8) Assets and liabilities of self, spouse (if she/he is not an assessee), minor children and
dependant(s) to be shown in the IT-10B.
"
Total income shown in Return:
Tk.
1,217,000.00
Net Wealth of Assessee :
Tk.
2,456,400.00
Date of receipt of return :

Nature of Return :
Self
Tax paid:
Tk.
143,237.00
Serial No. in return register:

Universal Self
Normal
Signature of Receiving
41
officer with seal
42
Annexure -3

U/S-82BB
Statement of Share Income for the Year Ended 30th June,2014

1. LankaBangla Securities:
3.
a) BOID-9199:
b) BOID-9834:
Balance as on Cr./Dr.(Loan) :
3.
a) BOID-9199:
b) BOID-9834:
Capital Gain :
3.
a) BOID-9199:
b) BOID-9834:
Fees & Charges :
3.
a) BOID-9199:
b) BOID-9834:
Divident Income :
3.
a) BOID-9199:
b) BOID-9834:
8,102,896
26,035,353
46,813
34,185,062
(612,863)
181,589
2,936
(1,958,431)
2,027,550
37,899
107,018
357,817
564
500
358,881
Income
405,228
405,228
Tax
41,697
41,697
1/H-1/43 Mirpur, Dhaka

JASIM UDDIN BHUIYAN MONNO
TIN: 175367455472

1.
LankaBangla Securities:
2.
Midway Securities Ltd.
3.
a) BOID-9199:
b) BOID-9834:
6568606
###
24189953
12349
30770908
###
46,813
###

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FORM OF RETURN OF INCOME UNDER THE INCOME TAX

ORDINANCE, 1984 (XXXVI OF 1984)

FOR INDIVIDUAL AND OTHER TAXPAYERS

Put the tick () mark wherever applicable

1. Name of the Assessee:

Khandakar Shafiqur Rahman

2. National ID No (if any):

3. UTIN (if any):

7. Residential Status: Resident

UNIVERSAL FINANCIAL SOUTIONS LTD.

11. Father's Name:

Khandakar Siddiqur Rahman

12. Mother's Name:

Late Rowshan Ara Begum

Mrs. Rubana Rahman

13. Date of Birth (in case of individual) :

14. Address (a) Present:

62/A, Green Road, Dhanmondi, Dhaka.

15. Telephone: Office/Business:

Hindu Undivided Family

10. Wife/Husband's Name (if assessee, please mention TIN):

9. Name of the employer/business (where applicable):

16. VAT Registration Number (if any):

(b) Taxes Zone:

Statement of income of the Assessee

Salaries : u/s 21 (as per schedule 1)

Interest on Securities : u/s 22

Income from house property : u/s 24 (as per schedule 2)

Agricultural income : u/s 26

Income from business or profession : u/s 28

Share of profit in a firm :

Income of the spouse or minor child as applicable : u/s 43(4)

Capital Gains : u/s 31

Income from other source : u/s 33

10 Total (serial no. 1 to 9)

12 Total income (serial no. 10 and 11)

14 Tax rebate: u/s 44(2)(b)(as per schedule 3)

15 Tax payable (difference between serial no. 13 and 14)

Balance Tax U/S 74 Tk. 78,732 of 4% (U/S-73A) = 3,149

Net Tax Payable

(b) Advance tax u/s 64/68 (Please attach challan )

(c) Tax paid on the basis of this return (u/s 74)

(d) Adjustment of Tax Refund (if any)

Total of (a) (b), (c) and (d)

17 Difference between serial 15 and 16 (if any)

(Name in block letters)

SCHEDULES SHOWING DETAILS OF INCOME

Khandakar Shafiqur Rahman

Pay & Allowance

House rent allowance

Net taxable income from salary

Schedule-2 (House Property income)

1. Annual rental income

3. Net income ( difference between item 1 and 2)

Schedule-3 (Investment tax credit)

2. Contribution to deferred annuity

3. Contribution to Provident Fund to which Provident Fund

4. Self contribution and employers contribution to

5. Contribution to Super Annuation Fund