National Board of Revenue IT-11GA2016
www.nbr.gov.bd
Schedule 24B if you have income from house property
Schedule 24C if you have income from business or profession
Schedule 24D if you claim tax rebate
Assessment Year
2 0 2 2 ─ 2 3 Yes No √
Name of the Assessee: M √ F
5 Twelve-digit TIN: 6 Old TIN
7 8 Zone: 11 Dhaka.
Resident Non-resident √
A person with
A gazetted war-wounded freedom fighter A person with disability
Aged 65 years or more A parent/legal guardian of a person with disability
Date of birth (DD-MM-YYYY) Income Year
6 1 9 7 9 2022 to 2023
13
14 15
16 17
18 19
20 21
22 23
3 4 Gender (tick one) YUJI NAKAMURA
RETURN OF INCOME
For an Individual Assessee
The following schedules shall be the integral part of this return and
Photo
must be annexed to return in the following cases:
Schedule 24A if you have income from Salaries
PART I
Basic information
1 2
Return submitted under section 82BB? (tick one)
Under Section 91
211525643223 N/A
Circle:
9 Resident Status (tick one)
227 (Company)
If employed, employer’s name: International Manpower Development Organization (IM) Japan
10
Tick on the box(es) below if you are:
10A 10B
10C 10D
11 12
0 4 0
Contact Telephone: E-mail:
National Identification Number: Business Identification Number(s)
Spouse Name Spouse TIN (if any)
Father’s Name: YOSHIO NAKAMURA Mother’s Name: YONEKO KAWAMITU
Present Address: Flat No-4N House-22, Road-11, Block-k,
Baridhara Diplomatic Zone, Gulshan,
Dhaka, PO : 1212
Permanent Address: 12-19, 3chome, Ginowan,
Ginowan-shi, Okinawa-ken, Japan
TIN: 2 1 1 5 2 5 6 4 3 2 2 3
Amount ৳
24 S.21 1,218,387
25 S.22
26 S.24
27 S.26
28 S.28
29 S.31
30 S.33
31
32 S.43
33
34 1,218,387
Amount ৳
35 118,677
36 -
37 118,677
38 -
39
40
41 118,677
42
43
44 -
45 118,677
46 118,677
47 -
48 364,516
Income of minor or spouse under section 43(4)
PART II
Particulars of Income and Tax
Particulars of Total Income
Salaries (annex Schedule 24A)
Interest on securities
Income from house property (annex Schedule 24B)
Agricultural income
Income from business or profession (annex Schedule 24C)
Capital gains
Income from other sources
Share of income from firm or AOP
Advance tax paid (attach proof)
Foreign income
Total income (aggregate of 24 to 33)
Tax Computation and Payment
Gross tax before tax rebate
Tax rebate (annex Schedule 24D)
Net tax after tax rebate
Minimum tax
Net wealth surcharge
Interest or any other amount under the Ordinance (if any)
Total amount payable
Tax deducted or collected at source (attach proof)
Adjustment of tax refund [assessment year 2021-2022]
Amount paid with return (attach proof)
Total amount paid and adjusted (42+43+44+45)
Deficit or excess (41-46)
Tax exempted income
TIN: 2 1 1 5 2 5 6 4 3 2 2 3
49
50 Yes No
51 Yes No
52
IT-10B2016 IT-10BB2016
Other Statements, documents ect. Attached ;
(A) Tax Calculation Sheet; (I) Transfer Letter.
(B) Treasury Challan Copy; (J) Release Order.
(C) Work Permit; (K) Board Resolution.
(D) Passport Copy ; and
(E) VISA Copy
(F) Resignation Letter Copy
(G)Power of Attorney.
(H) TIN
Name: Biki Das, ITP Signature:
Date of Signature (DD-MM-YYYY) Place of Signature : Dhaka
Date of Submission (DD-MM-YYYY) Tax Office Entry Number
Verification and signature
PART III
Instruction, Enclosures and Verification
Particulars of Total Income
1. Statement of assets, liabilities and expenses (IT-10B2016) and statement of life style expense (IT-
10BB2016) 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
If you are a parent of a person with disability, has your spouse
availed the extended tax exemption threshold? (tick one)
Are you required to submit a statement of assets, liabilities and
expenses (IT-10B2016) under section 80(1)? (tick one)
Schedules annexed
(tick all that are applicable)
53 Statements annexed
(tick all that are applicable)
54
For official use only
Return Submission Information
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.
Representative
2 0 2 3
√
√
24A √ 24B 24C 24D
2 0 2 3
National Board of Revenue IT-11GA2016
Assessment Year
2 0 2 2 ─ 2 3 Yes No √
Name of the Assessee: M √ F
Twelve-digit TIN: Old TIN
Circle : 227 (Company)
Total income shown (serial 34) ৳ 1,218,387
Amount payable (serial 41) ৳ 118,677 Amount paid and adjusted (serial 46) ৳
Date of Submission (DD-MM-YYYY) Tax Office Entry Number
Signature and seal of the official receiving the return
Date of Signature Contact Number of Tax Office
118,677
www.nbr.gov.bd
ACKNOWLEDGEMENT RECEIPT OF
RETURN OF INCOME
Return under section 82BB? (tick one)
Gender (tick one) YUJI NAKAMURA
211525643223
Taxes Zone-11, Dhaka.
Under Section 91
2 0 2 3