FORM NO 4A

 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)

FINANCIAL YEAR                              [

1

9

9

6

----

1

9

9

7

]

RESIDENTIAL ADDRESS

BUSINESS ADDRESS (IN BLOCK LETTERS)

STATUS*

INDIVIDUAL

HINDU UNDIVIDED  FAMILY

NATURE OF BUSINESS OR VOCATION*

RETAIL TRADE

EATING PLACE

TAILORING

HAIR CUTTING

TYPING

PHOTOCOPYING

REPAIR WORK

WASHING CLOTHS

OPERATING/HIRING/LEASING TRANSPORT VEHICLE

ANY OTHER VOCATION - SPECIFY

DEEMED INCOME FROM BUSINESS OR VACATION :

[

Rs.

4

9

3

3

0

]

INCOME FROM SOURCES OTHER THAN BUSINESS OR

Rs.

VOCATION CHARGEABLE TO TAX [NOT EXCEEDING Rs. 5,0000

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]

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.

Verification

[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]

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