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Back English Bangla

National Board of Revenue

IT-11GA (2023)
www.nbr.gov.bd

For Office Use

Serial No. of Return Register

FORM OF RETURN OF INCOME FOR
Volume No. of Return INDIVIDUAL PERSON
Register

Date of Return Submission 12/8/2024

1. Name of the Taxpayer: Md. Moniruzzaman Moni

2. National ID No. / Passport No. (If No 19864794515203145

NID):

3. TIN: 2 2 8 0 1 4 2 0 3 2 2 2

4. (a) Circle Circle-252 (b) Taxes Zone: 12, Dhaka

5. Assessment Year: 2024-2025 6. Residential Status: Resident Non-resident

7. Taxpayer’s Status: Individual Firm Hindu Undivided Family Others

8. Tick (✓) on the box for getting special benefit:

A gazette war-wounded Female Third Gender Disable Person

freedom fighter

Aged 65 years or more A parent of a person with disability

9. Date of Birth (DD MM YYYY):

2 7 0 1 1 9 8 6

10. Wife/Husband's Name: Nusrat Nadira Moon

TIN (if spouse is a Taxpayer):

11. Address: 59/2, Road- 3, Block- A, Aftabnagar R/A, Rampura, Dhaka

Telephone: 01700868807 Mobile: 01700868807 e-mail: [email protected]

12. If employed, employer’s name (latest employer’s name in case of multiple employment): Power Grid Bangladesh PLC

13. (a) Name of Organization:

(b) Business Identification number (BIN):

14. Name and TIN of Partners / Members in case of Firm / Association of Persons:

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Statement of Income and Tax during the Income Year ended on 30/6/2024

Name of the Taxpayer: Md. Moniruzzaman Moni TIN: 2 2 8 0 1 4 2 0 3 2 2 2

Particulars of Income Amount in Taka

1. Income from Employment (annex Schedule 1) 8,83,680

2. Income from Rent (annex Schedule 2) 0

3. Income from Agriculture (annex Schedule 3) 0

4. Income from Business (annex Schedule 4) 0

5. Income from Capital Gain 0

6. Income from Financial Assets (Bank Interest, Dividend, Securities Profit etc) 0

7. Income from Other Sources (Royalty, License Fees, Honorarium, Govt. Incentive 0
etc.)

8. Share of Income from Firm or AoP 0

9. Income of Minor or Spouse (if not Taxpayer) 0

10. Taxable Income from Abroad 0

11. Total Income (Aggregate of Serial 1 to 10) 8,83,680

Tax Computation Amount in Taka

12. Gross Tax on Taxable Income 50,052

13. Tax Rebate (annex Schedule 5) 22,723

14. Net Tax after Rebate (12 – 13) 27,329

15. Minimum Tax 5,000

16. Tax Payable (Higher of 14 and 15) 27,329

17. (a) Net Wealth Surcharge (if applicable) 0

(b) Environmental Surcharge (if applicable)

18. Delay Interest, Penalty or any other amount Under Income Tax Act (if any) 0

19. Total Amount Payable (16 + 17 + 18) 27,329

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Particulars of Tax Payment Amount in Taka

20. Tax Deducted or Collected at Source (attach proof) 0

21. Advance Tax paid (attach proof) 0

22. Adjustment of Tax Refund (mention assessment year(s) of refund) 0

23. Tax Paid with this Return (attach proof) 35,369

24. Total Tax Paid and Adjusted (20 + 21 + 22 + 23) 35,369

25. Excess Payment (24 - 19) 8,040

26. Tax Exempted / Tax Free Income (attach proof) 4,73,400

List of Documents Furnished with this Return

(Online submission requires no attachment)

Verification

I Md. Moniruzzaman Moni father / husband: Md. A. Salam TIN 2 2 8 0 1 4 2 0 3 2 2 2 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: Md. Moniruzzaman Moni

Date:12/8/2024 .....................................................
Signature
(Name in Block Letters)

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Schedule 1

Particulars of Income from Employment

a. This part is applicable for employees receiving salary under government pay scale.

Name of the Taxpayer: Md. Moniruzzaman Moni TIN: 2 2 8 0 1 4 2 0 3 2 2 2

Particulars Total Amount Exempted Amount (Taka) Taxable Amount

(Taka) (Taka)
1. Basic pay 7,57,440 0 7,57,440

2. Arrear Pay (if not included in taxable income earlier) 0 0 0

3. Special allowance 0 0 0

4. House Rent allowance 4,54,464 4,54,464 0

5. Medical allowance 6,312 6,312 0

6. Conveyance allowance 0 0 0

7. Festival allowance 1,26,240 0 1,26,240

8. Support Staff allowance

9. Leave allowance 0 0 0

10. Honorarium / Reward 0 0 0

11. Overtime allowances 0 0 0

12. Bangla Noboborsho allowances 12,624 12,624 0

13. Interest accrued on Provident Fund 0 0 0

14. Lump Grant 0 0 0

15. Gratuity 0 0 0

16. Others, if any (provide detail) 0 0 0

17. Total 13,57,080 4,73,400 8,83,680

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b. This part is applicable for employees other than employees receiving salary under government pay scale.

Name of the Taxpayer: Md. Moniruzzaman Moni TIN: 2 2 8 0 1 4 2 0 3 2 2 2

Particulars Income (Taka) Income (Taka)

1. Basic pay

2. Allowances

3. Advance / Arrear Salary

4. Gratuity, Annuity, Pension or similar benefit

5. Perquisites

6. Receipt in lieu of or in addition to Salary or Wages

7. Income from Employee’s Share Scheme

8. Accommodation Facility

9. Transport Facility

10. Any other Facility provided by Employer

11. Employer’s Contribution to Recognized Provident Fund

12. Others, if any (provide detail)

13. Total Salary Received (aggregate of 1 to 12)

14. Exempted Amount (as per Part 1 of 6th Schedule)

15. Total Income from Salary (13 – 14)

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Schedule-5
(Particulars of Investment Tax Credit)

Name of the Taxpayer: Md. Moniruzzaman Moni TIN: 2 2 8 0 1 4 2 0 3 2 2 2

Particulars of Rebatable Investment:

Serial Summary of Income Amount in Taka

No.

1. Life Insurance Premium or Contractual Deferred Annuity Paid in Bangladesh

2. Contribution to Deposit Pension Scheme

3. Investment in Government Securities, Unit Certificate, Mutual Fund, ETF or 0

Joint Investment Scheme Unit Certificate

4. Investment in Securities listed with Approved Stock Exchange

5. Contribution to Provident Fund to which Provident Fund Act, 1925 applies

6. Self & Employer’s Contribution to Recognized Provident Fund 1,51,488

7. Contribution to Super Annuation Fund

8. Contribution to Benevolent Fund / Group Insurance Premium

9. Contribution to Zakat Fund

10. Others, if any (provide detail) 0

11. Total Investment (aggregate of 1 to 10) 1,51,488

12. Amount of Tax Rebate 22,723

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IT- 10 BB (2023)

Statement of Expenses Relating to Lifestyle

(For Individual Person)

Name of the Taxpayer: Md. Moniruzzaman Moni TIN 2 2 8 0 1 4 2 0 3 2 2 2

Serial Particulars of Expenditure Amount of Taka Comments

No.

1. Personal and family fooding, clothing and other essentials 2,40,000

2. Housing Expense 4,20,000

3. Personal Transport Expense 0

4. Utility Expense (Electricity, Gas, Water, Telephone, Mobile, Internet etc. Bills) 56,200

5. Education Expense 0

6. Personal Expense for Local and Foreign Travel, Vacation etc. 0

7. Festival and Other Special Expense 5,00,000

8. Tax Deducted / Collected at Source (with TS on Profit of Sanchaypatra) and Tax 33,369
& Surcharge Paid based on Tax Return of Last Year

9. Interest Paid on Personal Loan Received from Institution & Other Source 0

Total: 12,49,569

Verification

I solemnly declare that to the best of my knowledge and belief the information given in this IT-10BB (2023) is correct and complete.

Md. Moniruzzaman Moni

Name & signature of the Taxpayer
Date: 12/8/2024

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IT-10B (2023)

Statement of Assets, Liabilities and Expenses (as on 30/6/2024)

To Whom It May Concern

All Public Servants.
If the amount of Total Asset at home and abroad exceeds Taka 50,00,000
The amount of Total Asset does not exceed Tk. 50,00,000 but owns a Motor Car in any time or Invested in any House Popery or
Apartment within the City Corporation area or Owns Assets outside Bangladesh or being a Shareholder Director of a Company.
Every Non-Bangladeshi and Non-Resident Bangladesh Natural Person shall submit the statement only in respect of Assets Located
in Bangladesh.

Name of the Taxpayer: Md. Moniruzzaman Moni TIN 2 2 8 0 1 4 2 0 3 2 2 2

1. Sources of Fund: Amount (Tk.) Amount (Tk)

(a) Total Income Shown in Return (Sl. No. 11 of Statement of Total Income) 8,83,680

(b) Tax Exempted Income (Please see Instruction Page) 4,73,400

(c) Receipt of Gift and Others 0

Total Source of Fund: 13,57,080

2. Net Wealth as on Last Date of Previous Income Year 7,11,115

3. Sum of Source of Fund and Previous Year’s Net Wealth (1 + 2) 20,68,195

4.

(a) Expense relating to Lifestyle (as per IT-10BB) 7,49,569

(b) Gift / Expenses / Loss Not Mentioned in IT-10BB 0

Total Expense and Loss: 7,49,569

5. Net Wealth at the Last Date of this Financial Year (3 – 4) 13,18,626

6. Personal Liabilities Outside Business

(a) Institutional Liabilities 0

(b) Non-Institutional Liabilities 0

(c) Other Liabilities 0

Total Liabilities Outside Business: 0

7. Gross Wealth (5 + 6) 13,18,626

8. Particulars of Assets (if needed attach separate sheet)

(a) Total Asset of Business 0

Less: Business Liabilities (Institutional & Non-Institutional) 0

(b) Director’s Shareholdings in the Companies 0

(c) Business Capital of Partnership Firm 0

(d) Non-Agricultural Property / land / House Property (Acquisition / Cost Value 0

with Legal Expense / Acquired Price / Building Cost / Investment)
Location and Description of Non-Agricultural Property (use separate sheet if
needed)

(e) Agricultural Property (Acquisition / Cost Value with Legal Expense) 0

Location and Description of Agricultural Property (use separate sheet if needed)

(f) Financial Assets:

(i) Share / Debenture / Bond / Securities / Unit Certificate etc. 0

(ii) Sanchaypatra / Deposit Pension Scheme 0

(iii) Loan Given (Mention Name & NID of Loan Receiver) 0

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(iv) Savings Deposit / Term Deposit 0

(v) Provident Fund or Other Fund (if any) 0

(vi) Other Investment 0

Total Financial Assets: 0

(g) Motor Vehicle(s) (Cost Value including Registration Expense) 0

(Mention Type and Registration Number of Motor Vehicle)

(h) Ornaments (Mention Quantity) 0

(i) Furniture and Electronic Items 0

(j) Other Assets (Except Assets Mentioned in Sl. k) 0

(k) Cash in Hand and Fund Outside Business

(i) Bank Balance 0

(ii) Cash in Hand 0

(iii) Others 0

Total Cash in Hand and Fund Outside Business: 0

Total Assests inside Bangladesh 0

9. Assets Outside Bangladesh 0

10. Total Assets in Bangladesh and Outside Bangladesh (8 + 9) 0

Verification

I solemnly declare that to the best of my knowledge and belief the information given in this IT-10B (2023) is correct and complete.

Md. Moniruzzaman Moni

Name & Signature of the Taxpayer
Date: 12/8/2024

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Instructions to fill up the Return Form

Instructions:
(1) This Return of Income shall be Signed and Verified by the Taxpayer or his Authorized Representative as prescribed in the
Income Tax Act, 2023
(2) Enclose where applicable:
(a) Salary statement for salary; Bank statement for interest; Certificate for interest on savings instruments; Rent agreement,
receipts of municipal tax & 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 & 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) Depreciation Chart claiming depreciation as per the Income Tax Act, 2023;
(c) Computation of Income according to the Income Tax Act, 2023.
(3) Enclose Separate Statement for::
(a) any income of the spouse of the Taxpayer (if she/he is not an Taxpayer), minor children and dependent;
(b) Tax exempted / Tax free Income.
(c) Income Exempted from Tax declared under Part 1 of the Sixth Schedule of the Income Tax Act, 2023.
(4) Documents furnished to support the declaration should be signed by the Taxpayer or his/her authorized representative.
(5) Furnish the following information:
(a) Name, address & TIN of the partners if the Taxpayer is a firm;
(b) Name of firm, address & TIN if the Taxpayer is a partner;
(c) Name of the company, address & TIN if the Taxpayer is a director.
(6) Assets and liabilities of self, spouse (if she/he is not a Taxpayer), minor children and dependant(s) to be shown in the IT-10B
(2023).
(7) Signature is mandatory for all Taxpayer or his / her authorized representative.
(8) For Individual Person, signature is also mandatory in IT-10B (2023) & IT-10BB (2023).
(9) If needed, please use separate sheet.

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Source Tax, AIT and Regular Tax Claim

[Attachment for serial no 20, 21, 22, 23 of IT-11GA(2023)]

Taxpayer Name: Md. Moniruzzaman Moni Assessment Year: 2024-2025

TIN 2 2 8 0 1 4 2 0 3 2 2 2 Total Claimed Amount: 35,369

Regular Tax (Before Return Submission)

Bank Branch Challan No Challan Date Challan Amount

Sonali Bank PLC Rampura T-28 01-08-2023 2,000

Mercantile Bank PLC Aftabnagar 2324-00072135111 05-09-2023 2,000

Mercantile Bank PLC Aftabnagar 2324-00103507141 03-10-2023 2,000

Mercantile Bank PLC Aftabnagar 2324-00151031771 02-11-2023 2,000

Mercantile Bank PLC Aftabnagar 2324-00195936721 29-11-2023 2,000

Mercantile Bank PLC Aftabnagar 324-00226838131 28-12-2023 2,000

Mercantile Bank PLC Aftabnagar 2324-00270617711 04-02-2024 3,514

Mercantile Bank PLC Aftabnagar 2324-00301952311 06-03-2024 3,514

Mercantile Bank PLC Aftabnagar 2324-00330627481 31-03-2024 5,335

Mercantile Bank PLC Aftabnagar 2324-00363821281 06-05-2024 5,335

Mercantile Bank PLC Aftabnagar 2324-00393897851 02-06-2024 5,335

Mercantile Bank PLC 336 2324-00423682071 30-06-2024 336

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