Design By: Jignesh.Pamar.

:MONTHLY INCOME STATUS:

Email: jiguparmar@yahoo.com

Exemption 10.00% 20.00%

Man 150000 300000 500000
Female 180000 300000 500000
Enter Necessary Data For Income Tax Calculation Sr.Citizan 225000 300000 500000
1. Enter Perticular Year's Income Tax Exemption Limit.
2. Your Salary Details and Personal Details
HRA Received in Salary Yes
For Housing Loan House Self Occupied
Accomaodation provided by Your company

Salary Brakup APR MAY JUN JUL

Basic
HRA
Transport Allowance/Conveyance
Child Education
Grade/Special Allowance
Arrears
LTA
Leave Encashment
Performance Incentive
Medical Reimbursement
Food Coupons
Telephone Reimbursements
Car Reimbursement
Internet Expense
Driver Salary
Others
Others
TOTAL SALARY (Gross Salary) 0 0 0 0
Monthly Deduction
TDS
Other Deduction
Income Tax Paid From Salary
Professional Tax
Employee's PF Contribution
Net Salary 0 0 0 0

Other Income
House/Property income (Enter Loss as negative) 0
Interest on Housing Loan (For Tax exemption) 0
Other Income(interest,etc)
Total of Other Inconme
Capital Gain Tax(From Stocks) 0
Less : Exemptions (Section 10&17)
Actual Rent paid as per rent receipts
HRA Exemption (sec10(13A)) 0 0 0 0
Child Education Allowance (sec10(14)) 0 0 0 0
Medical Reimbursement (sec17(2)) 0 Submit Medical Bills No
Transport Allowance (sec10(14)) 0 0 0 0
LTA (sec10(5)) 0
Food Coupons 0
Telephone Reimbursement 0
Car Expenses Reimbursement (sec10(14)) 0 0 0 0
Internet expense 0
Driver Salary 0 0 0 0
Other Reimbursement 0
Total of Exemption(Section 10&17)
Deductions under chapter 80C
LIC Premium
Employee's contribution to PF 0
PPF
NSC 0
Insurance premium 0
ChildrenTution Fees paid 0
Housing Loan Principal repayment 0
Infrastructure Bonds(MF,ULIP,FD.etc) 0
Fixed Deposit for 5 yrs. or more 0
Others 0
Total of Section 80C 0
Pension Fund (80 CCC)
Total Deduction under Section 80C & 80CCC 0
Deductions under chapter VIA
80D (Medical insurance premium) 0
80E (Interest on Loan for Higher Education) 0
80U (Handicapped person)(Perment Disability) 0
80D (Medical insurance premium) for Parents 0
80DDB(Medical Treatment forSpecified Diseases) 0 Did treatment on Sr.Citizen
80DD(Medical Handicapped Dep) 0 Handicapped <80%
80G(Donation to Approved Charity/Fund) 0
80GG(Rent Deduction if HRA not Received) 0 0 0
Other Deduction 0
Total Deductions under chapter VIA
Agricultural Income
Personal Details

Name of the Assessee Middle Name

Father's Name
Date of The Birth Senior Citizen
Phone No Ward No
Address Flat/Door No./Block No.
Road / Street / Post Office
Town / City /Municipality
Your Pan No Residential Status
Type of Return Original If Revised Enter Receipt No
Employer Detail
Name of the Your Employer
Details of Tax Deducted at Source from Salary [As per Form 16 ] TDS
Details of Tax Deducted at Source on Interest [As per Form 16 A ] Amt Paid/credit
Advance Tax Payment & Self AsseTax Payments
Advance Tax &Self Assessment Tax Payments Adv.Tax Name of Bank

Advance Tax &Self Assessment Tax Payments Self.Asse.Tax Name of Bank

Tax Consumption Total Tax Liability

Gross Salary 0 Tax on Income
Income from other Heads 0 Capital Gain Tax(From Stocks)
Accomodation perquisites 0 Surcharge on Tax
Professional Tax 0 Eduaction Cess
Exemption(Section 10&17) 0 Total Tax Liability
Gross Total Income 0
Deduction under Section 80C & 80CCC 0 Income Tax Paid From The Salary
Deductions under chapter VIA 0
Taxable Income 0 Balance Tax Paybale
Net Taxable Income After Added Ag Income 0
LY INCOME STATUS: Year 2009 Date: 6-Dec-09

30.00% Place of Residence NonMetro Balance Tax Payable

Male/Female/Sr.Citizen Male Gross Income
No of Children 0 Net Taxable Income
Used Car to Travel Office Yes Engine Cap <1600cc
Driver for Car No
Choise Allowance Travel Allowance
No Loan taken before 1st Apr 1999 No
No If living in Company Accomodation population of City >4 lacks? No 0

AUG SEP OCT NOV DEC JAN FEB MAR

0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0
 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

No

Middle Name Last Name

Senior Citizen Mail ID

Ward No
Name of premises/Building/Village
Area/ Locality
State Gujarat PIN No

Residence Asses.Year 2009 2010 Finas.Year 2010

nter Receipt No Date of Receipt
 TIN No PAN No Type of Employer
Surcharge 0 Education Cess Total Tax Deposited
Date of Credit Total Taxdeducted Amount out of Claim This year

Date Serial of Challan No Amount

Date Serial of Challan No Amount

x Liability Ag Income Summary

0 Tax on Aggrigate Income 0
0 Rebate in respect of Agricultural Income 0
0 Tax on Total Income 0
0
0

0
 0
0
0
19200

12 MONTH Metro
NonMetro
0
0 Male
0 Female
0 Sr.Citizan
0 0
0 1
0 2
0 Yes Yes
0 No No
0 <1600cc
0 >1600cc
0 Travel Allowance
0 Vehicle Maint Allo
0 <80%
0 >80%
0 Sr.Citizan
0
0

0
0
0
0
0
0

0
0
0
0
0

0
0
 0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0

Original
2011 Revised

Residence
Non-Residence

Resident but not ordinarily Resident

Govt
PSU
Other
FORM INDIAN INCOME TAX RETURN
ITR-1 [For Individual having Income from Salary/Pension/family pension & Interest]
(Please see Rule 12 of the Income-tax Rules, 1962)
(Also see attached instructions)

First name Middle name Last name

0 0 0
PERSONAL INFORMATION

Flat /Door/Block No. Name Of Premises/Building/Village

0 0

Road/Street/Post Office Area/Locality

0 0

Town/City/District State Pin code

0 Gujarat 0

Email Address 0 (STD Code) - Phone Number ( )

Designation of Assessing Officer (Ward/Circle) Return Filed Under Section-
FILING STATUS

0 [Please see instruction number-9(i)]

Whether original or Revised return? (Tick) √ √ Original

If revised, enter Receipt No and Date of filing 0
original return (DD/MM/YYYY) 0

Residential Status (Tick) √ ### √ Resident ### Non-Resident

1 Income chargeable under the Head 'Salaries'
2 Income chargeable under the Head 'Other Sources' (Interest)
a Family pension 2a
b Interest 2b 0
INCOME & DEDUCTIONS

c Total (2a+2b)
3 Gross Total Income (1+2)
4 Deductions under chapter VIA (Section
a 80C 0 e 80DD 0 I 80GG 0
b 80CCC 0 f 80DDB 0 j 80GGA
c 80CCD g 80E 0 k 80GGC
d 80D 0 h 80G 0 l 80U 0
m Deductions (Total of a to i)
5 Total Income (3-4m)
6 Net Agricultural Income (Enter only if greater than Rs.5,000)
7 Aggregate Income' (5+6)
8 a Tax Payable on 'Aggregate Income'
b Rebate in respect of Net Agricultural income
TAX COMPUTATION

9 a Tax Payable on total Income (8a - 8b) 9a -

b Surcharge on 9a 9b -
c Education Cess on (9a + 9B) 9c -
 TAX COMPUTATION
d Total Tax, Surcharge and Education cess payable (9a + 9b + 9c)
10 Relief under Section 89 10 -
11 Relief under Section 90/91 11 -
12 Balance Tax Payable (9d-10-11)
Do not write or stamp in this ares (Space for bar code) 13 a Interest Payable U/s 234A
b Interest Payable U/s 234B
c Interest Payable U/s 234C
d Total Interest Payable
(13a+13b+13c)
14 Total Tax and Interest Payable
(12+13d)
For office Use only
Receipt No.

Date

15 Taxes Paid
a Advance Tax (from item 23) 0
TAXES PAID

15a
b TDS (column 7 of item21+column 7 of item 22) 15b 0
c Self Assessment Tax (from item 23) 15c 0
d Total Taxes paid (15a+15b+15c)
16 Tax payable(14-15d)(enter if 14 is greater than 15d, else leave blank)
17 Refund (15d-14) (enter if 15d is greater than 14, also give Bank account details below)
REFUND

18 Enter your bank account number (mandatory in case of refund)

19 Do you want your refund by √ Cheque, or deposited directly into your bank account? (tick as ap

20 In case of direct deposit to your bank account give additional details

MICR Code Type of Account (tick as applicable)

21 Details of Tax Deducted at Source from Salary [As per Form 16 issued by Employer(s)]
Income
Tax Deduction Account Deduction
Sl Namee and address of the chargeable
No Number(TAN) of the under
Employer under the
TDS ON SALARY

Employer Chapter VI-A

head salaries
(1) (2) (3) (4) (5)

0 0 0 0

22 Details of Tax Deducted at Source on Interest [As per Form 16 A issued by Deductor(s)]
Tax Deduction Account
Sl Namee and address of the Date of Payment
No Number(TAN) of the Amount paid/ credited
Deductor /Credit
Deductor
TEREST
 Tax Deduction Account
Sl Namee and address of the Date of Payment
No Number(TAN) of the Amount paid/ credited
Deductor /Credit
Deductor
TDS ON INTEREST (1) (2) (3) (4) (5)

0 0 0 12/30/1899

NOTE Enter the total of column (7) of 22 in Sl.No.15b of TAXES PAID

23 Details of Advance Tax and Self Assessment Tax Payments
Date of Deposit
Sl No Name of Bank & Branch BSR Code
(DD/MM/YYYY)
TAX PAYMENTS

(i) 0 30-Dec-99
(ii) 0 30-Dec-99
(iii)
(iv)
(v)
NOTE Enter the total of Advance tax and Self Assessmen tax in Sl.No.15a and 15c of TAXES PAID
24 Other Information (Transactions reported through Annual Information Return) (Please see instruction num
Sl. Code Amount (Rs.) Sl. Code Amount (Rs.)
a 001 004
b 002 005
c 003 006
25 Tax-exempt interest income (for reporting purposes only)
26 E-filing Acknowledgement Number

VERIFICATION

I,
declare that to the best of my knwledge and belief, the information given in the return thereto is correct and complete
and other particulars shown therein are truly stated and in accordance with the provisions of the Income Tax Act, 1961
Income-tax for the previous year relevant to the Assessment Year 2007-08

Place Date 12/6/2009 Sign here

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

If TRP is entitled for any reimbursement from the Government, amount thereof (to be filled by TRP)
 N Assessment Year
ily pension & Interest]
, 1962) 2009 - 2010
PAN

0 0
ding/Village Date of Birth (DD/MM/YYYY)

12/30/1899

Employer Category (Tick) √

Govt. PSU Others

Sex (Tick) √

0 √ Male Female

ne Number ( ) 0
led Under Section- 1 1
nstruction number-9(i)]

Revised ###

FALSE Resident but not ordinarily Resident

1 0
###

0
2c 0
3 0

0
4m 0
5 0
6 0
7 0
8a 0
8b 0
-
-
-
 9d 0
-
-
12 0
ayable U/s 234A 13a 0
ayable U/s 234B 13b 0
ayable U/s 234C 13c 0
est Payable 13d
0
Interest Payable 14
0
Seal and signature of receiving official

0
0
0
15d 0
16 0
17 0

your bank account? (tick as applicable √ )

√ ### Savings ### Current

ued by Employer(s)]

Tax payable (incl.

Total tax Tax payable/
surch. And edn.
deposited refundable
Cess)

(6) (7) (8)

0 0 0

sued by Deductor(s)]
Amount out of
Date of Payment Total tax
(6) claim for this
/Credit deposited
year
 Amount out of
Total tax
(6) claim for this
deposited
year
(5) (6) (7)

12/30/1899 0 0

Serial Number of Challan Amount (Rs.)

0 0
0 0

15a and 15c of TAXES PAID

urn) (Please see instruction number-9(ii) for code)
Sl. Code Amount (Rs.)
007
008
009
25

solemnly
n thereto is correct and complete and that the amount of total income
sions of the Income Tax Act, 1961, in respect of income chargeable to

ve further details as below :

unter Signature of TRP

t thereof (to be filled by

###TRP)
28