FORM NO 4A
[See chapter XII-C of the Income-tax Act, 1961 and rule 11EE of the Income-tax Rules]
Statement under the simplified procedure
HEAD: 0021 INCOME-TAX – SIMPLIFIED PROCEDURE
NAME (SURNAME FIRST) (IN BLOCK LETTERS)|
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|FINANCIAL YEAR [|1|9|9|6|—-|1|9|9|7|]|
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|RESIDENTIAL ADDRESS|
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|BUSINESS ADDRESS (IN BLOCK LETTERS)|
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|STATUS*|INDIVIDUAL|||HINDU UNDIVIDED FAMILY|||||
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|NATURE OF BUSINESS OR VOCATION*|
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RETAIL TRADE|||EATING PLACE|||TAILORING|||HAIR CUTTING||||
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TYPING|||PHOTOCOPYING|||REPAIR WORK|||WASHING CLOTHS||||
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OPERATING/HIRING/LEASING TRANSPORT VEHICLE|||||||||||||||||
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ANY OTHER VOCATION – SPECIFY||||||||||||||||||||||||
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|DEEMED INCOME FROM BUSINESS OR VACATION :|||||||[|Rs.|4|9|3|3|0|]|
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|INCOME FROM SOURCES OTHER THAN BUSINESS OR |||||||Rs.|||||
|VOCATION CHARGEABLE TO TAX [NOT EXCEEDING Rs. 5,0000||||||||||
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|DIDUCTION UNDER SECTION 80L in respect of income from dividend ,|||||Rs.|||||
|Interest on bank deposits and on other specified deposits and such securities |||||||||||
|[NOT EXCEEDING Rs. 5,000]|||||||||||
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|NET INCOME FROM SOURCES OTHER THAN BUSINESS OR |||||Rs.|||||
|VOCATION [8 MINUS 9]|||||||||||
|TAX PAYABLE [Rs. 1,400 plus 20% OF AMOUNT AT (10)]|||||Rs.|||||
Vrification
[I, …………….(name in full and block letters) **son/daughter/wife/karta/member of Hindu undivided family hereby declare that what is stated is true to the best of my knowledge and belief.
I further declare that I have not been assessed to income-tax for any assessment year commencing on or before 1st April, 1992.
I also hereby declare that my income during the financial year 1996-97 from the business or vocation mentioned at item 6 does not exceed forty-nine thousand three hundred and thirty rupees and I do not have any income exceeding Rs. 5,000 from sources other than business or vocation mentioned above.
Date …………………… …………………………………………………
Place ………………….. (Name and signature)
Note:
*Tick the one which is applicable.
**Strike out whichever is not applicable.
Paid in cash/by cheque/draft No ……….. dated………..
Rupee ………………………….. Rs. ……………………………
[in words] [in figures]
into …………………………….. Branch of ……………………
[Name of the bank]
…………………………………………………………………………
Signature of the person making the payment|FOR USE INTHE RECEIVING BANK|
|RECEIVED PAYMENT
Serial No. In Scroll
Cheque/draft tendered on
Cheque/draft realised on
Signature of chashier|
|STAMP OF THE BANK]|