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 Year

2011-12
PAN CSIPS8961C

PERSONAL INFORMATION

First Name Robin Flat / Door / Building 6/5 Road / Street jak road Town/City/District ghaziabad

Middle Name

Last Name singh Status

I - Individual Area / Locallity shipra suncity Date of birth (DD/MM/YYYY) 13/05/1987

FILING STATUS

Email Address robin.sngh13@gmail.com Income Tax Ward / Circle RANGE-2 Whether original or revised return?

State Pin Code Sex (Select) 31-UTTAR 201014 M-Male PRADESH Mobile no (Std code) Phone No Employer Category (if in 9958592970 employment) OTH Return filed under section [Pl see Form Instruction] 11 - u/s 139(1) O-Original Date 1 2 3 4 153,980 0 5,850

If revised, enter Receipt no / Date RES - Resident Residential Status 1 Income from Salary / Pension (Ensure to fill Sch TDS1) Income from one House Property 2 3 Income from Other Sources (Ensure to fill Sch TDS2)

4 Gross Total Income (1+2c) 5 Deductions under Chapter VI A (Section) 5a a 80 C 5b b 80 CCC 5c c 80 CCD 5d d 80 CCF 5e e 80 D 5f f 80 DD 5g g 80 DDB 5h h 80 E 5i i 80 G (Eligible Amount) 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 13 Balance Tax Payable (10 - 11 - 12) 14 Total Interest Payable 15 Total Tax and Interest Payable (13 + 14) For Office Use Only Receipt No/ Date

11,760 0 0 0 10,000 0 0 0 0 0 0 0 0 21,760

TAX COMPUTATION

159,830 System Calculated 11,760 0 0 0 10,000 0 0 0 0 0 0 0 0 21,760 6 138,070 7 0 8 0 9 0 10

INCOME & DEDUCTIONS

0 0 13 14 15 Seal and Signature of Receiving Official 0 0 0

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Details of Tax Deducted at Source from SALARY [As per FORM 16 issued by Employer(s)] Tax Deduction Income charg Name of the Total tax Account Number SI.No eable under the Employer Deducted (TAN) of the head Salaries Employer (3) (4) (5) (1) (2) DELC06827C CHINTELS 0 0 1 2 INDIA 3 (Click + to add more rows to 23) TDS on Salary above. Do not delete blank rows. )

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Details of Tax Deducted at Source on Income OTHER THAN SALARY [As per FORM 16 A issued by Deductor(s)] Amount out Tax Deduction of Account Number Name of the Total tax SI.No (4) claimed (TAN) of the Deductor Deducted for Deductor this year (1) (2) (3) (4) (5) 1 2 3 4 (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 Deposit (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 c Self Assessment Tax (item 25) 16c 0 Total Taxes Paid (16a+16b+16c) 17 0 Tax Payable (15-17) (if 15 is greater than 17) 18 0 Refund (17-15) if 17 is greater than 15 19 52510623677 Enter your Bank Account number (Mandatory ) Yes 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 110036011 Savings MICR Code Type of Account(As applicable) 26 Exempt income for reporting purposes only (from Dividends, Agri. income < 5000) VERIFICATION ROBIN SINGH I, (full name in block letters), son/daughter of MAHESH KR. SINGH 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 2011-12 Place Date 02/01/2013 Sign here -> GHAZIABAD PAN CSIPS8961C 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 Counter Signature of TRP REFUND 17 18 19 20 21

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