SAHAJ

FORM

INDIAN INCOME TAX RETURN

[For Individuals having Income from Salary / Pension / Income from One House Property (excluding loss brought forward from previous years) / Income from Other Sources (Excluding Winning from Lottery and Income from Race Horses)] (Please see rule 12 of the Income-tax Rules,1962) (Also see attached instructions)

ITR-1

Assessment Year

2012-13
First Name Middle Name Last Name Status I - Individual Road / Street Area / Locallity Date of birth (DD/MM/YYYY) 00/00/0000 Pin Code Sex (Select) M-Male PAN

PERSONAL INFORMATION

Flat / Door / Building

Town/City/District

State

Email Address Income Tax Ward / Circle

Mobile no

(Std code) Phone No

Employer Category (if in employment) OTH Return filed under section [Pl see Form Instruction] 11-BeforeDueDt Date

FILING STATUS

Whether original or revised return? If revised, enter Original Ack no / Date If u/s 139(9)-defective return , enter Original Ack No If u/s 139(9)-defective return , enter Notice No Residential Status

O-Original

RES - Resident

If u/s 139(9)defective return , enter Notice Date Nil Tax Balance Tax Status 1 2 3 4 System Calculated 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 7 8 9 10 0 0 13 14 15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 Income from Salary / Pension (Ensure to fill Sch TDS1) Income from one House Property 2 3 INCOME & DEDUCTIONS Income from Other Sources (Ensure to fill Sch TDS2)

4 Gross Total Income (1+2+3) 5 Deductions under Chapter VI A (Section) 5a a 80 C 5b b 80 CCC 5c(i) c(i) 80 CCD (Employers Contribution) 80 CCD (Employees / Self Employed 5c(ii) c(ii) Contribution) 5d d 80 CCF 5e e 80 D 5f f 80 DD 5g g 80 DDB 5h h 80 E 5i i 80 G 5j j 80 GG 5k k 80 GGA 5l l 80 GGC 5m m 80 U 6 6 Deductions (Total of 5a to 5m) 7 Total Income (4 - 6) 8 Tax payable on Total Income 9 Education Cess, including secondary and higher secondary cess on 8 10 Total Tax, Surcharge and Education Cess (Payable) (8 + 9) 11 11 Relief under Section 89 12 12 Relief under Section 90/91 Balance Tax Payable (10 - 11 - 12) 13 14 Total Interest u/s 234A 234B 234C 15 Total Tax and Interest Payable (13 + 14)

TAX COMPUTATION

0 0 0

23

Details of Tax Deducted at Source from SALARY [As per FORM 16 issued by Employer(s)] Tax Deduction Name of the Account Number SI.No Employer (TAN) of the Employer (3) (1) (2) 1 2 3

Income charg eable under the head Salaries (4)

Total tax Deducted (5)

(Click + to add more rows to 23) TDS on Salary above. Do not delete blank rows. ) 24 Details of Tax Deducted at Source on Income OTHER THAN SALARY [As per FORM 16 A issued by Deductor(s)] Tax Deduction Account Number (TAN) of the Deductor (2) Amount out of (6) claimed for this year (7)

SI.No

Name of the Deductor

Unique TDS Certificate No.

Deducted Year

Total tax Deducted

(1) 1 2 3 4

(3)

(4)

(5)

(6)

(Click + to add more rows ) TDS other than Salary above. Do not delete blank rows. )

25 Sl No 1 2 3 4 5 6

Details of Advance Tax and Self Assessment Tax Payments Date of Credit into Govt Account (DD/MM/YYYY) Serial Number of Challan

BSR Code

Amount (Rs)

(Click '+' to add more rows ) Tax Payments. Do not delete blank rows. )

TAXES PAID

16 Taxes Paid PLEASE NOTE THAT CALCULATED FIELDS (IN WHITE) ARE PICKED UP FROM OTHER SCHEDULES AND ARE NOT TO BE ENTERED. For ex : The taxes paid figures below will get filled up when the Schedules linked to them are filled. a Advance Tax (from item 25) b TDS (Total from item 23 + item 24) 16a 16b 0 0 0 17 18 19 0 0 0

No 21 Select Yes if you want your refund by direct deposit into your bank account, Select No if you want refund by Cheque 22 In case of direct deposit to your bank account give additional details MICR Code Type of Account(As applicable) 26 Exempt income for reporting purposes only VERIFICATION son/daughter of I, solemnly declare that to the best of my knowledge and belief, the information given in the return thereto is correct and complete and that the amount of total income and other particulars shown therein are truly stated and are in accordance with the provisions of the Income-tax Act, 1961, in respect of income chargeable to Income-tax for the previous year relevant to the Assessment Year 2012-13 Place Date Sign here -> PAN 27 If the return has been prepared by a Tax Return Preparer (TRP) give further details as below: Identification No of TRP Name of TRP

REFUND

17 18 19 20

c Self Assessment Tax (item 25) 16c Total Taxes Paid (16a+16b+16c) Tax Payable (15-17) (if 15 is greater than 17) Refund (17-15) if 17 is greater than 15 Enter your Bank Account number

28

If TRP is entitled for any reimbursement from the Government, amount thereof (to be filled by TRP)

Schedule 80G Details of donations entitled for deduction under section 80G Donations entitled for 100% deduction without qualifying limit (IN CASE OF DONEE FUNDS SETUP BY GOVERNMENT AS DESCRIBED IN SECTION 80G(2), PLEASE USE PAN AS Name of Adress City or Town or State Code PinCode PAN of Donee Amount of Eligible donee District donation Amount of Donation 1 2 3 4 Total 80GA 0

0 0 0 0 0

Donations entitled for 50% deduction without qualifying limit Name of Address City or Town or State Code donee District 1 2 3 4 Total 80GB :

PinCode

PAN of Donee Amount of Eligible donation Amount of Donation 0 0 0 0 0 0

Donations entitled for 100% deduction subject to qualifying limit Name of Address City Or Town Or State Code donee District 1 2 3 4 Total 80GC :

PinCode

PAN of Donee Amount of Eligible donation Amount of Donation 0 0 0 0 0 0

Donations entitled for 50% deduction subject to qualifying limit Name of Address City Or Town Or State Code donee District 1 2 3 4 Total 80GD

PinCode

PAN of Donee Amount of Eligible donation Amount of Donation 0 0 0 0 0 0

Donations (A + B + C + D)