| Part IX |
| Annual Statement of
Deduction of Income Tax from Salary |
| [ See rule 44(1) ] |
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| Employer's Profile |
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| Year ending on 30th
June, |
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Zone/LTU/MTU Code |
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Circle Code |
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National Tax Number |
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| Name |
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(In block letters) |
| Address |
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(In block letters) |
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| Telephone |
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(i) |
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(ii) |
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Fax |
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(City code and number) |
E-mail |
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| Please mark (ü)
in the relevant box |
| Status |
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Type of Pension Fund / Scheme |
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Type of Provident Fund / Scheme |
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Type of Gratuity Fund / Scheme |
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Type of Benevolent Fund / Scheme |
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Type of Superannuation Fund /
Scheme |
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| Federal
Government |
001 |
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Government |
001 |
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To which Provident Fund Act, 1925
applies |
001 |
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Recognized / approved under the
Sixth Schedule to the Income Tax Ordinance, 2001 |
001 |
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Central Employees Benevolent
Fund |
001 |
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Recognized / approved under the
Sixth Schedule to the Income Tax Ordinance, 2001 |
001 |
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| Provincial
Government |
002 |
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A scheme applicable to all
employees of the employer and approved
by the CBR |
002 |
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Recognized / approved under the
Sixth Schedule to the Income Tax Ordinance, 2001 |
002 |
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Applicable to all employees of the
employer and approved by the CBR |
002 |
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Under the Group Insurance Act,
1969 |
002 |
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Any other |
002 |
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| Local
Authority |
003 |
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A scheme approved by the CBR for
the purpose of clause (12) of Part 1 and 2nd Schedule to the Income Tax
Ordinance, 2001 |
003 |
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Any other |
003 |
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Any other |
003 |
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Any other |
003 |
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| Statutory
body or Corporation |
004 |
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Any other |
004 |
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| Any
other |
005 |
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| I,
_________________________________________________, holder of NIC No.
_________________________ in my capacity as as Self / Member or Partner of
Association of persons / Principal Officer / Trustee/ Representative of the
Taxpayer named above do hereby solemnly declare that to the best
of my knowledge
and belief the information given in this Statement is
correct, complete and in accordance with the provisions of the Income
Tax Ordinance, 2001 and Income
Tax Rules, 2002. |
| (The alternative in
the verification, which is not applicable, should be scored out)` |
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| Date |
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Signature |
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(dd/mm/yyyy) |
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| Please see filling instructions at the back page. |
| Filling Instructions |
| 1. |
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Use additional sheets, wherever required |
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| 2. |
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Serial number on page 3 to 8 of this form refers
to the serial number of each employee given at page 2 of this form. |
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| 3. |
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Column(s) left blank is/are considered as
"Not Applicable" or "Zero" value, as the case may be. |
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| 4. |
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This form
can be modified by deleting the columns that are not applicable in case of
any particular employer. However, the column number of the remaining columns
should not be re-numbered. |
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| 5. |
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The code numbers of various items referred to in
this form are as under: |
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(a) |
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Nature of employment code (more than one code can
be used) |
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(b) |
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Motor vehicle usage code |
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001 |
President of Pakistan |
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001 |
Exclusively for business or office held use |
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002 |
Provincial Governor |
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002 |
Exclusively for private or personal use |
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003 |
Judge of a Supreme Court of Pakistan |
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003 |
Partly for
business or office held use and partly for private and personal use |
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004 |
Retired judge of a Supreme Court of Pakistan |
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005 |
Widow of a judge of a Supreme Court of Pakistan |
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006 |
Judge of a High Court |
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(c) |
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Type of accommodation or housing code |
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007 |
Retired judge of a High Court |
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001 |
Un-furnished |
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008 |
Widow of a judge of a High Court |
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002 |
Furnished |
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009 |
Minister of Federal Government |
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010 |
Member/personnel of Armed Forces of Pakistan |
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(d) |
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Location of accommodation or housing code |
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011 |
Chief of Staff of Pakistan Armed Forces |
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001 |
Metropolitan Corporation |
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012 |
Corps Commander |
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002 |
Municipal Corporation |
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013 |
Member/Personnel of Territorial Forces |
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003 |
Cantonment Board |
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014 |
Personnel of National Service of Pakistan |
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004 |
Islamabad Capital Territory |
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015 |
Officer of the Pakistan Navy |
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005 |
Others |
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016 |
Junior Commissioned Officer or Other Ranks |
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017 |
Families and dependents of "shaheeds" belonging to
Pakistan Armed Forces or Civil Armed Forces of Pakistan |
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(e) |
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Conveyance ownership code |
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001 |
Owned or hired by employer |
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018 |
Pilot, flight engineer or navigator of Pakistan Army, Air Force
or Navy, Civil Aviation Authority or a Pakistani Air Line |
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002 |
Owned or hired by employee |
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019 |
Public servant |
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(f) |
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Conveyance maintenance code |
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020 |
Employee of an undertaking engaged in transport of passengers or
carriage of goods |
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001 |
Owned or hired by employer |
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002 |
Owned or hired by employee |
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021 |
Full time
teacher/researcher qualifying for reduction in tax |
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022 |
Civilian employee of the Federal Government including civilian
paid from Defence Estimates |
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(g) |
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Conveyance usage code |
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001 |
Exclusively for business or office held use |
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023 |
Rendering services outside Pakistan |
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002 |
Exclusively for private or personal use |
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024 |
Locally
recruited in Pakistani
Missions Abroad |
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003 |
Partly for
business or office held use and partly for private and personal use |
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025 |
Others |
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| Page - 2 |
| Employee's Profile |
| Employee serial
number |
Name |
Residential address |
National tax number |
National identity card number |
Nature of employ-ment Code |
Minimum of the basic time scale |
Employ-ment period (Months) |
| (More than one code can be used) |
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| 001 |
002 |
003 |
004 |
005 |
006 |
007 |
008 |
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| Page - 3 |
| Employee serial
number |
Pay, wages or other remuneration |
Perquisites |
| Pay,
wages, special pay, dearness
pay or other remuneration *1 |
Leave encashment preparatory to retirement |
Gratuity |
Motor vehicle |
Value of petrol as reduced by
amount recovered from employee |
| Paid in Pakistan |
Receipi-ent employee or regular employee
director |
Received by the employee first time from present
or past employer |
Amount |
Usage code |
Depreciation or rental and/or
running and maintenance cost borne by the employer |
Cost of acquiring the motor
vehicle or value at the commencement of lease |
Number of persons entitled to use the vehicle |
Amount paid by the employee to the employer for use of
motor vehicle provided |
Value of motor vehicle as reduced
by amount recovered from employee |
| (Yes/No) |
(Yes/No) |
(Yes/No) |
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| 009 |
010 |
011 |
012 |
013 |
014 |
015 |
016 |
017 |
018 |
019 |
020 |
021 |
022 |
| *1 |
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Including bonus, commission, ex-gratia, fee,
honorarium, leave pay, overtime, payment in lieu of leave or work condition
supplements |
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| Page - 4 |
| Employee serial
number |
Perquisites |
| Accommodation or housing (including self hiring
etc.) |
Utilities |
Value of Medical treatment
and / or
hospitalization or reimbersment
thereof in accordance with the terms of employment |
Value of services of
house keeper, driver,
gardner, orderly or other domestic servant as
reduced by amount recovered from employee |
Value of special perquisites given
outside Pakistan |
Value of special perquisites given
specifically to meet wholly
and necessarily the performance of the duties |
| Furnished
/ un-furnished code |
Land area (Sq. Yds) |
Covered area (Sq. Yds) |
Loca-tion code |
Annual value |
Rent recovered from employee |
Value of accommodation or housing
as reduced by amount recovered from employee |
Value of gas, water and
electricity as reduced by amount recovered from employee |
Value of telephone as reduced by
amount recovered from employee |
| 023 |
024 |
025 |
026 |
027 |
028 |
029 |
030 |
031 |
032 |
033 |
034 |
035 |
036 |
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| Page - 5 |
| Employee serial
number |
Perquisites |
Allowances |
| Value
of rations in kind as reduced by amount recovered from employee |
Value of transport provided free
of cost or at concessional rate as reduced by amount recovered from employee |
Markup on loan given
by employer at 'nil'
or 'below the benchmark' rate
of profit after July 01, 2002 |
Value of any other perquisite as reduced by amount recovered from
employee, including *2 |
Travel or leave fare assistance (In accordance with the terms of employment or 3rd wage award
for newspaper employees) |
Special * 4 |
Children education, compensatory,
flying, submarine, ration, conservancy, sumptuary, superior judicial and transfer |
Medical |
| Local |
Foreign |
| Amount |
Actual
expenditure incurred on fare by the employee |
Given once in two years for self
and *3 |
Actual
expenditure incurred on fare by the employee |
| 037 |
038 |
039 |
040 |
041 |
042 |
043 |
044 |
045 |
046 |
047 |
048 |
| *2. |
Obligation
of employee towards employer waived off by employer, obligation of employee towards another
person paid by employer, property
transferred by employer, services
provided by employer, etc. |
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*3. |
Once in
three years for the members of the house hold and dependents |
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*4. |
Specifically
to meet expenses wholly and necessarily incurred in performance of the duties
of an office or employment of profit or Paid by the Government for
rendering services outside Pakistan |
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| Page - 6 |
| Employee serial
number |
Allowances |
Payment or reimbursed of any
expenditure of the employee other than those relating to performance of
duties |
Shares, issued under employee
share scheme |
| Special
additional |
Rent |
Conveyance |
Utilities (Electricity, water and
gas) |
Any other |
