FORM NO.

10E
[See rule 21AA]

Form for furnishing particulars of income under section 192(2A) for the year
ending 31st March, 20_____ for claiming relief under section 89(1) by a
Government servant or an employee in a [company, co-operative society, local
authority, university, institution, association or body]

1. Name and address of the employee :

2. Permanent account number :

3. Residential status :

Particulars of income referred to in rule 21A of the Income-tax Rules, 1962,

during the previous year relevant to assessment year_______.

Rs.

1.(a) Salary received in arrears or in advance in

accordance with the provisions of sub-rule
(2) of rule 21A.

(b) Payment in the nature of gratuity in respect

of past services,extending over a period of
not less than 5 years in accordance with the
provisons of sub-rule (3) of rule 21A.

(c) Payment in the nature of compensation from

the employer or former employer at or in
connection with termination of employment
after continuous service of not less than
3 years or where the unexpired portion of
term of employment is also not less than
3 years in accordance with the provisions
of sub-rule (4) of rule 21A.

(d) Payment in commutation of pension in

accordance with the provisions of sub-rule
(5) of rule 21A.

2. Detailed particulars of payments referred

to above may be given in Annexure I, II,
IIA III or IV, as the case may be.

-------------------------
Signature of the employee

Verification

I,___________ do hereby declare that what is stated above is true to the best of
my knowledge and belief.

Verified today, the ___________ day of _________ 20_____.

Place : _________ _________________________
Date : _________ Signature of the employee

ANNEXURE I
[See item 2 of Form No. 10E]

Arrears of advance salary

1. Total income (excluding salary received :

in arrears or advance).

2. Salary received in arrears or advance :

3. Total income (as increased by salary :

received in arrears or advance).
[Add item 1 and item 2]

4. Tax on total income :

[as per item 3]

5. Tax on total income :

[as per item 1]

6. Tax on salary received in arrears or :

advance.
[Difference of item 4 and item 5]

7. Tax computed in accordance with :

Table "A".
[Brought from column 7 of Table 'A"]

8. Relief under section 89(1) :

[Indicate the difference between the
amounts mentioned against items 6
and 7]

TABLE "A"
[See item 7 of Annexure I]

--------------------------------------------------------------------------------
Previous Total income Salary recieved Total Tax Tax Differ-
year(s) of the in arrears or income on total on ence in
relevant advance relating of the income total tax
previous year to the relevant relevant (as income [Amount
(Rs.) previous year previous column 2 (as per under
as mentioned year column column 6
in column 1 mentioned 4) minus
 (Rs.) in colu.1 amount
[Add colm. under
(2) and column
(3)] 5]
(Rs.) (Rs.) (Rs.) (Rs.)
--------------------------------------------------------------------------------
1 2 3 4 5 6 7
--------------------------------------------------------------------------------

--------------------------------------------------------------------------------

Note : In this Table, details of salary received in arrears or advance relating

to different previous years may be furnished.

ANNEXURE II

[See item 2 of Form No. 10E]

Gratuity

Past services extending over a period of 5 years or more but less than 15 years

1. Gratuity received :

2. Total income (including gratuity) :

3. Tax on total income mentioned against item 2 :

4. Average rate of tax applicable on total income :

(Divide amount mentioned against item 3 by
amount mentioned against item 2)

5. Tax payable on gratuity by applying the average :

rate of tax (Multiply average rate of tax
mentioned against item 4 with amount of gratuity
mentioned against item 1)

6. Total income of two previous years immediately : (i)

preceding the previous year in which gratuity is
received (ii)

7. Add one-half of the gratuity mentioned against : (i)

item 1 in the total income of each of the two
preceding previous years mentioned against (ii)
item 6

8. Tax on total income of each of the preceding : (i)

previous years mentioned against item 7. (ii)

9. Average rate of tax on the total income of each of : (i)

the two preceding previous years as increased by
of gratuity calculated for that year as mentioned (ii)
against item 7

[Divide the amounts mentioned against items 8(i)

 and 8(ii) by the amount mentioned against items
7(i) and 7(ii) respectively].

[Link] of average rates of tax mentioned against :

item 9 [Add the averages of tax mentioned against
items 9(i) and (ii) and divide it by 2].

[Link] payable on gratuity by applying the average of :

average rates of tax.
(Multiply the average against item 10 by the
amount of gratuity mentioned against item 1)

[Link] under section 89(1) :

(Indicate the difference between the amounts
mentioned against items 11 and 5)

ANNEXURE IIA
[See item 2 of Form No. 10E]

Gratuity

Past services extending over a period of 15 years and more

1. Gratuity received :

2. Total income (including gratuity) :

3. Tax on total income mentioned against item 2 :

4. Average rate of tax applicable on total income :

*(Divide amount mentioned against item 3 by
amount mentioned against item 2)

5. Tax payable on gratuity by applying the average :

rate of tax
(Multiply average rate of tax mentioned against
item 4 with amount of gratuity mentioned against
item 1)

6. Total income of three previous years immediately :

preceding the previous year in which gratuity is
received (i)
(ii)
(iii)

7. Add 1/3rd of the gratuity mentioned against :

item 1 in the total income of each of the three
preceding previous year mentioned against
item 6 (i)
(ii)
(iii)

8. Tax on total income of each of the preceding :

previous years mentioned against item 7 (i)
(ii)
(iii)

9. Average rate of tax on the total income of each of : (i)

 the three preceding previous years as increased by (ii)
1/3rd of gratuity calculated for that year as
mentioned against item 7 (iii)
[Divide the amounts mentioned against items 8(i),
8(ii) and 8(iii) by the amount mentioned against
items 7(i), 7(ii) and 7(iii) respectively]

[Link] of average rates of tax mentioned against :

item 9 [Add the averages of tax mentioned against
items 9(i) to (iii) and divide it by 3]

[Link] payable on gratuity by applying the average of :

average rates of tax
(Multiply the average against item 10 by the
amount of gratuity mentioned against item 1)

[Link] under section 89(1) :

(Indicate the difference between the amounts
mentioned against items 11 and 5).

ANNEXURE III

Compensation on termination of employment

Condition : After continuous service of three years and where unexpired portion
of term of employment is also not less than three years

1. Compensation received :

2. Total income (including compensation) :

3. Tax on total income mentioned against item 2 :

4. Average rate of tax applicable on total income :

(Divide amount mentioned against item 3 by amount
mentioned against item 2)

5. Tax payable on compensation by applying the average :

rate of tax
(Multiply average rate of tax mentioned against
item 4 with amount of compensation mentioned
against item 1)

6. Total income of three previous years immediately :

preceding the previous year in which compensation
is received. (i)
(ii)
(iii)

7. Add 1/3rd of the compensation mentioned against :

item 1 in the total income of each of the three (i)
preceding previous years mentioned against item 6 (ii)
(iii)

8. Tax on total income of each of the preceding : (i)

previous years mentioned against item 7 (ii)
(iii)
9. Average rate of tax on the total income of each of :
the three preceding previous years as increased by (i)
1/3rd of compensation calculated for that year as (ii)
mentioned against item 7 (iii)

[Divide the amounts mentioned against items 8(i),

8(ii) and 8(iii) by the amount mentioned against
items 7(i), 7(ii) and 7(iii) respectively]

10. Average of average rates of tax mentioned against :

item 9
[Divide by three, the total of averages of tax
mentioned against items 9(i) to (iii)]

11. Tax payable on compensation by applying the :

average of average rates of tax
(Multiply the avberage against item 10 by the
amount of compensation mentioned against item 1)

12. Relief under section 89(1) :

(Indicate the difference between the amounts
mentioned against items 11 and 5)

ANNEXURE IV

Commutation of pension

1. Amount in commutation of pension received :

2. Total income (including amount in commutation :

of pension)

3. Tax on total income mentioned against item 2 :

4. Average rate of tax applicable on total income :

(Divide amount mentioned against item 3 by
amount mentioned against item 2)

5. Tax payable on amount in commutation of pension :

by applying the average rate of tax
(Multiply average rate of tax mentioned against
item 4 with amount in commutation of pension
mentioned against item 1)

6. Total income of each of three previous years : (i)

immediately preceding the previous year in which (ii)
amount in commutation of pension is received (iii)

7. Add 1/3rd of the amount in commutation of pension :

mentioned against item 1 in the total income of (i)
each of the three preceding previous years (ii)
mentioned against item 6 (iii)

8. Tax on total income of each of the preceding :

previous years mentioned against item 7 (i)
(ii)
 (iii)

9. Average rate of tax on the total income of each of : (i)

the three preceding previous years as increased by (ii)
1/3rd of the maount in commutation of pension (iii)
calculated for that year as mentioned against
item 7 [Divide the amount mentioned against items
8(i), 8(ii) and 8(iii) by the amount mentioned
against item 7(i), 7(ii) and 7(iii) respectively]

10. Average of average rates of tax mentioned against :

item 9
[Divide by three, the total of averages of tax
mentioned against items 9(i) to (iii)]

11. Tax payable on amount in commutation of pension by :

applying the average of average rates of tax
(Multiply the average against item 10 by the amount
in commutation of pension mentioned against item 1)

12. Relief under section 89(1) :

(Indicate the difference between the amounts
mentioned against item 11 and 5)