National Board of Revenue

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

For office use
Serial no. in return register Return of Income
Volumn no. in return register For Individual & Other
Date of return submission Assessee (without Company)

1 Name of the Assessee:

2 National Identification Number/Passport Number (If no NID):

3 TIN:

4 (a) Circle: (b) Tax Zone:

5 Asssessment Year: 6 Resident Status: Resident Non-resident

7 Tax payer Status (tick one) : Individual ✔ Firm Hindu Undivided Family Other

8 Tick on the box below for getting special benefit:

A gazetted war-wounded freedom fighter Female Third Gender Disabled person

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

9 Date of birth (DDMMYYYY) 10 Name of Spouse:

TIN if spouse is an Assessee:

11 Address:

Telephone: Mobile:
e-mail:

12 If employed, employer’s name (Latest employer's name in case of multiple employment):

13 (a) Name of Organizaion:

(b) Business Identification Number (BIN):

14 Name & TIN of Partners/Members in case of Frim/Association of person (If needed, please use separate sheet):
Particulars of Income and Tax during the income year ended on
Name of the Assessee: 0
TIN: 0 0 0 0 0 0 0 0 0 0 0 0

Particulars of Total Income Amount ৳

1 Income from Salaries (annex Schedule 1) -

2 Income from Rent (annex Schedule 2) -

3 Agricultural income (annex Schedule 3) -

4 Income from business (annex Schedule 4) -

5 Capital gains -

6 Income from Financial Assets (Bank interest/profit, Dividend, Securities etc.) -

7 Income from other sources (Royalty, License fee, Honorarium, Fees, Govt. Incentive etc.) -

8 Share of income from firm or AOP -

9 Income of minor or spouse under section (if not assessee) -

10 Foreign income -

11 Total income (aggregate of 1 to 10) -

Tax Computation Amount ৳

12 Gross tax on taxable Income -

13 Tax rebate (annex Schedule 5) -

14 Net tax after tax rebate (12-13) -

15 Minimum tax -

16 Tax Payable (Higher of 14 and 15) -

17 (a) Net wealth surcharge (if applicable)

(b) Environmental surcharge (if applicable) -

18 Delay Interest, Penalty or any other amount under the Income Tax Act (if any) -

19 Total amount payable (16+17+18) -

Particulars of Tax Payment Amount ৳

20 Tax deducted or collected at source (attach proof) -

21 Advance tax paid (attach proof) -
22 Adjustment of tax refund [mention assessment year(s) of refund] -
23 Amount paid with return (attach proof) -
24 Total amount paid and adjusted (20+21+22+23) -
25 Deficit or excess -

26 Tax exempted/Tax free income (attach particulars) -

List of documents furnished with this Return

Verification
I, 0

Father/Husband,

TIN: 0 0 0 0 0 0 0 0 0 0 0 0
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.

Place: Signature
Date: 0
Designatiom & Seal (for other than individual)
 People's Republic of Bangladesh
National Board of Revenue
(Income Tax Office)

Acknowledgement Receipt/ Certificate of Return Of Income

Assessment Year: 0

Name of the Assessee: 0

National Identification Number/Passport Number (If no NID): 0

TIN: 0 0 0 0 0 0 0 0 0 0 0 0

Circle : 0 Tax Zone : 0

Total income shown ৳ -

Total tax paid ৳ -

Serial no. in return register

Volumn no. in return register

Date of return submission

Seal of Tax Office Signature and seal of the official receiving the return
 Schedule 1
Particulars of income from Salaries
a. This part is applicable for employees receiving Salary under Govt. pay scale
Name of the Assessee: 0
TIN: 0 0 0 0 0 0 0 0 0 0 0 0
Tax exempted Taxable Income
Sl. Particulars Income ৳
Income ৳ ৳
1 Basic pay
Arrear pay (if not included in taxable income
2
earlier)
3 Special allowance
4 House rent allowance
5 Medical allowance
6 Conveyance allowance
7 Festival Allowance
8 Allowance for support staff
9 Leave allowance
10 Honorarium/ Reward/Fee
11 Overtime allowance
12 Baishakhi Allowance
13 Interest accrued on provident fund
14 Lamp grant
15 Gratuity
16 Others, if any
17 Total

b. This part is applicable for employees other than employees receiving Salary under Govt. pay scale

Sl. Particulars Income ৳ Income ৳

1 Basic pay
2 Allowances
3 Advance Salary
4 Gratuity, Annuity, Pension or similar benefits
5 Perquisites
6 in lieu of or in addition to salary or wages
7 Income from Employees' share scheme
8 Accomodation benefits
9 Car benefits
10 Any other benefits provided by employer
11 Employer's contribution to recognized provident fund
12 Others
13 Total salary income (aggregate of 1 to 12) -
14 Exempted Salary (As per 6th schedule Part 1) -
15 Total Income from Salary (13-14) -
 Schedule 2
(Annex this Schedule to the return of income if you have income from house property)

Name of the Assessee: 0

TIN: 0 0 0 0 0 0 0 0 0 0 0 0

Location and
Total Rent Income Computation Amount ৳ Amount ৳
Description of property
1 Rent receipt or Annual Value (whichever is higher)
2 Advance rent receipts
3 Value of any benefits (in addition to 1 & 2)
4 Adjusted advance rent
5 Vacancy Allowance
6 Total Rent Income (1+2+3)-4-5
7 Allowable Deductions
(a) Repair, Collection, etc.
(b) Municipal or Local Tax
(c) Land Revenue
(d) Interest on Loan/Mortgage/Capital Charge
(e) Insurance Premium
(f) Other, if any
8 Total Admissible deductions
9 Income from house property (06-08)
10 Incase of partial ownership, the share of income

Schedule 3
(This part is applicable for Agricultural income)

Name of the Assessee: 0

TIN: 0 0 0 0 0 0 0 0 0 0 0 0

Nature of Agriculture:

Summary of Income Amount ৳

1 Sale/Turnover/Receipts
2 Gross Profit
3 General Expenses, Selling Expenses, Land Revenue, Rates, Interest of Loan, Insurance
Premium and Other expenses
4 Net profit (2 minus 3) -
 Schedule 4
(To be annexed to return by an assessee having income from business or profession)

Name of the Assessee: 0

TIN: 0 0 0 0 0 0 0 0 0 0 0 0

Name of Business/Profession:
Nature of Business/Profession:
Address:

Summary of Income Amount ৳

1 Sale/Turnover/Receipts
2 Gross Profit
3 General, Administrative, Selling and Other expenses
4 Bad debt expense
5 Net profit (2-3-4) -

Summary of Balance Sheet Amount ৳

6 Cash and Bank balance
7 Inventory
8 Fixed Assets
9 Other Assets
10 Total Assets -
11 Opening Capital
12 Net profit
13 Drawing during the income year
14 Closing Capital (11+12-13) -
15 Liabilities
16 Total Capital & Liabilities -

Schedule 5
To be annexed to return by an assessee claiming investment tax credit (attach proof)

Name of the Assessee: 0

TIN: 0 0 0 0 0 0 0 0 0 0 0 0

Particulars of rebatable investment, contribution, etc.

Particulars of Income Amount ৳

1 Life insurance premium or Contractual "Deferred Annuity" paid in Bangladesh
2 Contribution to deposit pension/Monthly Saving scheme (not exceeding allowable limit)
3 Investment in Govt. securities, Unit certificate, Mutual fund, ETF or 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 contribution and employer’s contribution to Recognized Provident Fund
7 Contribution to approved Pension Fund
8 Contribution to Benevolent Fund and Group Insurance Premium
9 Contribution to Zakat Fund
10 Others, if any
11 Total invetment (aggregate of 1 to 10) -
12 Amount of Tax Rebate -
 IT-10 BB (2023)
Statement of expenses relating to Lifestyle
(applicable for all Individual Assessee)

Name of the Assessee: 0

TIN: 0 0 0 0 0 0 0 0 0 0 0 0

Sl. Particulars of Expenses (Annual) Amount ৳ Comments

1 Expenses for food, clothing and other essentials
2 Housing expense
3 Personal Transport Expenses
4 Utility expenses (Electric bill, Gas, Water, Telephone, Mobile, Internet etc.)
5 Education Expenses
6 Personal Expenses for local & foreign travel, vacation etc.
7 Festival and Other special expenses
8 Tax deducted/collected at source (with tax deducted from profit of saving -
certificate) and tax & surcharge paid based on last year tax return)
9 Interest paid on personal loan received from Institution & other source
Total -

Verification

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

Signature and date

 National Board of Revenue
www.nbr.gov.bd
IT-10 B (2023)
Statement of Assets, Liabilities and Expenses
as on…. 00-Jan-00

To Whom It May Concern

1 All Public Servant
2 If the amount of total asset in home and abroad exceeds Taka 40,00,000.
3 The amount of total asset does not exceed Taka 40,00,000 but owns a motor car in any time or has made an
investment in a house property or an apartment in the city corporation area or owns assets outside Bangladesh
or being a shareholder director of a company.

4 Every individual assessee, being a non-resident Bangladeshi and individual assessee, being a non-
Bangladeshi, shall submit the statement only in respect of assets located in Bangladesh.

Name of the Assessee: 0

TIN: 0 0 0 0 0 0 0 0 0 0 0 0

1 Sources of fund:
(a) Total income shown in return (sl. no.11 of state. of total income) Tk. -
(b) Tax Exempted Income Tk. -
(b) Receipt of Gift and others Tk. -
Total Sources of fund Tk. -
2 Net wealth at the last date of the previous income year Tk. -
3 Sum of Source of fund and net wealth at the last date of the previous income year (2+3) Tk. -
4 (a) Expenses relating to Lifestyle (as per IT-10BB) Tk. -
(b) Gift/Expenses/Loss not mentioned in IT-10BB Tk. -
Total Expenses and Loss Tk. -
5 Net wealth at the last date of this financial year (3-4) -

6 Personal liabilities outside business

(a) Institutional liabilities Tk. -
(b) Non-institutional liabilities Tk. -
(c) Other liabilities Tk. -
Total liabilities outside business Tk. -

7 Gross wealth (5+6) Tk. -

* if needed attach separate sheet

8 Particular of assets
(a) Aggregate Business capital and liabilities Tk.
Less: Business liabilities Tk.
Business capital Tk. -

(b) Director's shareholdings in limited companies Tk. -

(c) Business capital of Partnership Firm Tk. -

(d) Non-agricultural property/land/building (cost price with legal exp./acquired price/building cost/invetment)
Description, location and size of agricultural property Tk. -

(e) Agricultural property (cost price/acquired price)

Description, location and size of agricultural property Tk. -

(f) Financial assets

(i) Share/Debenture/Bond/Securities/Unit Certificate etc. Tk.
(ii) Savings certificate/Deposit Pension Scheme Tk.
(iii) Loan given Tk.
(Mention name and TIN of loan receiver)
(iv) Fixed Deposit/Term Deposit Tk.
(v) Provident Fund or Other Fund (if any) Tk.
(vi) Other investment Tk.
Total Financial assets Tk. -

(g) Motor car(s) (cost value) Tk.

Mention type of motor vehicle and Registtration number
(h) Ornaments (mention quantity) Tk.

(i) Furniture and electronic items Tk.

(j) Other assets (except assets mentioned in sl. k) Tk.

(k) Cash, Bank and fund outside business Tk.

9 Total Assets Tk. -

Verification

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

0
Name of Assessee and Signature
Date:
 Tax calculation
Name:
TIN:
For the year ended on 00-Jan-00
Amount ৳

A. Total taxable income as per return -

B. Calculation of Tax: Income Tax

On First slab Tk. - 0% -
On Next slab Tk. - 5% -
On Next slab Tk. - 10% -
On Next slab Tk. - 15% -
On Next slab Tk. - 20% -
On the Rest Income Tk. - 25% -
- -

C. Calculation of Tax Rebate:

i 3% on total income Tk. -
ii 15% on actual investment (Schedule-5) Tk. -
iii Maximum 10 Lac Tk. 1,000,000
Tax Rebate (Lower of i, ii and iii) Tk. -

D. Net Tax Payable (B-C) Tk. -

E. Minimum Tax
i Minimum tax as per Finance Act 2023 Tk. -
ii Minimum tax U/S-163(2)Kha of ITA 2023 Tk. -
iii Minimum tax U/S-163(5)Ka of ITA 2023 Tk. -
Minimum Tax (Higher of i, ii and iii) Tk. -

F. Final Tax Payable (Higher of D & E) Tk. -

G. Tax Paid:
AIT against salary Tk. -
AIT against WPPF Tk. -
AIT against Car Tk. -
AIT against dividend Tk. -
AIT against Bank Interest Tk. - -

H. Balance Tax Payable/refundable Tk. -