Income tax return of Mr. Takeuchi San for the AY 2021-2022

IT-11GA2016 RETURN OF INCOME For an Individual Assesse F to Non-resident Schedule 24A if you have income from Salaries Schedule 24B if you have income from h ouse property Schedule 24C if you have income from business or profession Return submitted under section 82BB? (tick one) Yes No 03 Old TIN: N/A Zone: 11 PART I Basic information Assessment Year: 05 Twelve-digit TIN: 716117951280 The following schedules shall be the integral part of this return and must be annexed to return in the following cases: photo Schedule 24D if you have investment and claim tax rebate (Under Section - 91) Name of the Assessee: Kotaro Takeuchi 04 Gender: M - 01 02 06 07 Circle: 222 (Company) 08 22 NID/ Passport: TK6728665 17 21 14 Spouse Name: N/A 15 09 Resident Status (tick one) Resident E-mail: N/A 23 Business Identification Numbers: N/A 18 Present Address: House # 133, 5th Floor, Road # 4, Block # A, Gulshan, Banani, Dhaka, 1213. 19 Permanent Address: 51-28, Ishizuka, Harue-cho, Sakai-shi, Fukui-ken, Japan. 20 Contact Telephone: N/A Spouse TIN (if any): N/A 16 Father’s Name: Kenichi Takeuchi Mother’s Name: Reiko Takeuchi 13 If employed, employer’s name: Nippon Signal Company Limited A parent of a person with disability Date of birth (DDMMYYYY) 11 12 Income Year 10 Tick on the box(es) below if you are: 10A A gazetted war-wounded freedom fighter 10B A person with disability 10C Aged 65 years or more 10D 2020 2021 2 0 2 0 2 1 0 9 0 8 1 9 8 0 P articulars of Total Income Amount Tk. 48 Tax exempted income 312,999 46 Total amount paid and adjusted (42+43+44+45) 116,180 47 Deficit or excess (refundable) (41-46) - Advance tax paid (attach proof) - 44 Adjustment of tax refund (from assessment year 2020-2021) - - 45 Amount paid with return (attach proof) - Interest or any other amount under the Ordinance (if any) - Total amount payable 84,341 Tax deducted or collected at source (attach proof) 116,180 43 41 42 40 Net wealth surcharge - T ax Computation and Payment Amount Tk. 35 Gross tax before tax rebate 84,341 Tax rebate (annex Schedule 24D) - 39 36 38 37 Net tax after tax rebate 84,341 Minimum tax Foreign income - Total income (aggregate of 24 to 33) 1,028,943 Share of income from firm or AOP - Income of minor or spouse under section 43(4) S.43 - Capital gains S.31 - 30 Income from other sources S.33 - Agricultural income S.26 - 28 Income from business or profession (annex Schedule 24C) S.28 - 27 Income from house property (annex Schedule 24B) S.24 - PART II Particulars of Income and Tax TIN 24 Salaries (annex Schedule 24A) S.21 1,028,943 25 Interest on securities S.22 - 34 31 32 33 26 29 1 6 1 1 7 9 5 1 2 8 0 7 (A) Tax Calculation Sheet; (B) Treasury Challan copy; (C) Work Permit; (D) Passport Copy; (E) Tin Certificate; (F) Power of Attorney; (G) Resignation Letter & NOC; and (F) Previous Tax Clearance Certificate. For official use only Return Submission Information Date of Submission (DD– MM –YYYY) Tax Office Entry Number Other statements, documents, etc. attached: Verification and signature 55 Verification I solemnly declare that to the best of my knowledge and belief the information given in this return and statements and documents annexed or attached herewith are correct and complete. Name : Kotaro Takeuchi Signature: Date of Signature (DDMMYY) Place of Signature: 54 53 Statements annexed (tick all that are applicable) 52 Schedules annexed (tick all that are applicable) 50 If you are a parent of a person with disability, has your spouse availed the extended tax exemption threshold? (tick one) Yes No 51 Are you required to submit a statement of assets, liabilities and expenses (IT-10B) under section 80(1)? (tick one) Yes No PART III TIN 49 Instructions 1. Statement of assets, liabilities and expenses (IT-10B) and statement of life style expense (IT-10BB) must be furnished with the return unless you are exempted from furnishing such statement(s) under section 80. 2. Proof of payments of tax, including advance tax and withholding tax and the proof of investment for tax rebate must be provided along with return. 3. Attach account statements and other documents where applicable Instruction, Enclosures and Verification 24A IT - 10BB IT - 10B 2 0 2 1  24B 24C 24D 7 1 6 1 1 7 9 5 1 2 8 ✓ ✓ 0 Signature and seal of the official receiving the return Date of Signature Contact Number of Tax Office (2) The return of income required to be filed by a company assessee under the Ordinance shall be in the following form and verified in the manner indicated therein: Amount payable (serial 41): 84,341 Amount paid and adjusted (serial 46): Tk. 1,16,180 Amount of net wealth shown in IT10B: N/A Amount of net wealth surcharge paid: Nil Date of Submission (DD– MM –YYYY) Tax Office Entry Number Total income shown (serial 34): 10,28,943 Individual ACKNOWLEDGEMENT RECEIPT OF RETURN OF INCOME Assessment Year Return under section 82BB? (tick one) Yes No Name of the Assessee : Kotaro Takeuchi Twelve-digit TIN : 716117951280 Old TIN : N/A Circle: 222 (Companies) Taxes Zone : 11 2 0 2 0 2 1 2 0 2 1 01 Assessment Year: 2020-2021 02 Tax exempted Taxable (B) (C = A-B) SCHEDULE 24A Particulars of income from Salaries Annex Schedule to the return of income if you have income from Salaries Amount (A) TIN : 716117951280 Particulers 03 Basic pay 04 Special pay 05 Arrear pay (if not included in taxable income earlier) 06 Dearness allowance 07 House rent allowance / Rent free accommodation 08 Medical allowance 09 Pension contribution 10 Leave fare assisstance 11 Allowance for support staff 12 Leave allowance / Country allowance 13 Honorarium/Reward/Fee/ Recreation & Refreshment 14 Overtime allowance 15 Bonus / Ex-gratia / School Fees for Kids 16 Other allowance (Club members fee) 17 Employer's contribution to a recognized provident fund 18 Interest accrued on a recognized provident fund 19 Deemed income for transport facility 20 Deemed income for free furnished/ unfurnished accommodation 21 Other, if any (give detail) : Leave fare assistance 22 Total All figures of amount are in taka (Tk.) As per computation sheet Name: Kotaro Takeuchi Signature & Date: A B C D E=(A*C)+(B*D) F G=E-F Basic pay 96,000 107500.00 4.03 5.97 1,028,943 - 1,028,943 House rent 25,000 25000.00 4.03 5.97 250,075 250,075 - Conveyance 2,500 2500.00 4.03 5.97 25,008 25,008 - Medical 2,000 5000.00 4.03 5.97 37,916 37,916 - Overseas Allowance - - Other, if any (give detail) - Total Taxable Income 1,341,942 312,999 1,028,943 Stair of Income Rate of Taxability Amounts of Tax First 300,000 0% - Next 100,000 5% 5,000 Next 300,000 10% 30,000 Next 328,943 15% 49,341 Next 20% - Balance 25% - Total Tax Liability 1,028,943 84,341 Tax Already Paid by Challan 116,180 Previous Year Adjustment - Balance/ (Excess Paid) (31,839) Amount of Exempted income (TK.) Net Taxable Income ( Tk.) Calculation of Tax Liability Tax calculation: Tax Calculation of Mr. Kotaro Takkeuchi (Technician Expert-Chemicals) Computation of Taxable Income & Net Tax Liability Source of Income: Salaries_ U/S- 21 Income Year 2020-2021 Assessment Year: 2021-2022 Pay & Allowance BDT BDT Months Amount of Income TK.