2

INDIAN INCOME TAX RETURN VERIFICATION FORM

Assessment Year

ITR-V
Name

'Where the data of the Return of Income in Benefits in Form (ITR-1 (SAHAJ), ITR-2, ITR-3, ITR-4, ITR-4S (SUGAM), ITR-5, ITR-6 transmitted electronically without digital signature' . (Please see Rule 12 of the Income-tax Rules, 1962)

2011 - 12

PERSONAL INFO RMATIONANDTHE DATEO FELECTRONIC TRANSMISSION i4 1:4

PAN
.

PRATIK PRAKASH PATIL

F.

ABPPP5827N Name Of Premises/Building/Village SHIVAJ1 HOUSING SOCIETY Area/Locality OPPOSITE VSSSK Ltd State MAHARASHTRA Pin 416416 Form No. which has been electronically transmitted (fill

Flat/Door/Block No PLOT NO 81/82.

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412 ... t.,)

Road/Street/Post Office MADHAVNAGAR ROAD

tA 59,

ITR -2

ap

Town/City/District SANGLI

the code) Status (fill the code)

Original or Revised

INDL

Designation of AO (Ward / Circle)

ITO WD 2(1), SANGLI/PNE/W/95/1 272381880090811

Original 09 - 08 - 2011 627526 115000 512526 0 58201 0 58201

E-fi ing Acknowledgement Number 1 2 3 w 0 z (...) p

. .

Date(DD/MM/YYYY) 1 2 3 3a 4 5 6 7a 7b 7c 7d 0 7e 8 9

Gross total income . Deductions under Chapter-V1-A Total Income a Current Year loss, if any Net tax payable Interest payable Total tax and interest payable Taxes Paid a b c d TDS TCS Self Assessment Tax Total Taxes Paid (7a+7b+7c +71I) . 0 60708 Advance Tax

4 5 6 7

w 0 64 z i-. T2 -t E-, i n 4

O (..)

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e
8 9

60708 0 2510

Tax Payable (6-7d)' Refund (7e-6) VERIFICATION

I, Pratik Prakash Patil

son/ daughter of

Prakash Patil

, holding permanent account number

ABPPP5827N

solemnly declare to the best of my knowledge and belief, the information given in the return and the schedules thereto which have been transmitted electronically by me vide acknowledgement number mentioned above is correct and complete and that the amount of total income/ fringe benefit's 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 and fringe benefits chargeable to income-tax for the previous year relevant to the assessment year 2011-12. I further declare that I am making this return in my capacity as and I am also competent to make this return and verify it. Sign here ,. ;1 3,..2 ....L1 Date 09-08-2011 Place Sangli

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

For Office Use Only

Receipt No Date Seal and signature of receiving official

Filed from IP address

117.200.219.158

, II

I.

en

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.1 .

.. . . ErV 112

1,p. 111 ....

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L.

ABPPP5827NO22723818800908111564C9A7059064294A017C9085839BC386641 FCD

Please furnish Form ITR-V to "Income Tax Department - CPC, Post Bag No - 1, Electron'c City Post Office, Bangalore - 560100, Karnataka", by ORDINARY POST ONLY within 120 days from date of transmitting the data electronically. Form ITR-V shall not be received in any other office of the Income-tax Department or in any other manner. The receipt of this ITR - V at ITD - CPC will be sent to you at this e- mail address sachinpatil@pcpatil.com

DECLARATION OF ASSETS AND LIABILITIES FORM 1

A. ASSETS AND LIABILITIES OF MEMBER

Name of the Member Father's Name Permanent Address

PRATIK PRAKASHBAPU PATIL Late Shri Prakashrao Vasantrao Patil 'Shri Sai' Shivaji Housing Society, Madhavnagar Road, Opp. VSSSK, SANGLI - 416416 (Maharashtra)

Delhi Address

AB-77, Shahjahan Road, New Delhi-110011

Party affiliation Date of Election 7.

Indian National Congress 16th May 2009

Date of taking oath/making affirmation in the House in Lok Sabha: Date of taking oath as Minister of State in Union Cabinet

2nd June 2009 28th May 2009

DETAILS OF IMMOVABLE PROPERTIES

Name of the State, District, Sub-division and village in which property is situated Details of property (a) Agricultural Lands and present Value 1 Hector and 63 R At: Kavalapur, Survey No. 1836, 1839, 1840, 1889 Rs: 5.20 lakhs Open Plot : Shivaji Housing Society Plot No. 70 5000 Sq ft. Rs. 12.50 lakhs Flat No. S-1 (City Survey No.8665 - 44.50 Sq. M. Rs. 6.83 lakhs 829/1 City Survey No. 828/1, Bungalow No. RB 5 (Tirth Garden Area)135.18 Sq. M. Rs. 29.03 lakhs 1) Bhose Mulubai Estate, Taluka Mahabaleshwar, and present Value District : Satara (Maharashtra) Survey No. 24/4, Plot No. 6, Area 330.75 Sq. M. (in the Plot 95 Sq Mtr Built-up Area Rs. 8.26 lakhs 2) Pangari Nandanvan Colony, Taluka Mahabaleshwar, District: Satara (Maharashtra) Survey No. 15 Plot No. C- 138 (Area 278 Sq Mtr.) (in the Plot 66.50 Sq. M. Built-up Area) Rs. 8.26 lakhs

(b) Non agricultural Lands and present value (3) Venkatesh House

(4) Kolhapur Kasaba Babda

(5) Property in name of Wife

DETAILS OF MOVABLE PROPERTIES

1) 2) 3)

Cash in Hand Cash in Wife's Hand Deposits in Banks

Rs. 2,50,000/Rs. 1,00,000/NIL

4) 5)

Deposits in Wife's Name Shares in Sahyadri Motors Deposits in companies Others

Rs. 5,15,000/Rs. 62,57,500/- in the name of wife Rs. 8,43,096/LIC & MEDICALIM Rs. 6,43,491/(Yearly installment) Ford (Fiesta) Make 2006 Rs. 7,48,000/Maruti Swift Make 2007 Rs. 5,44,000/- ( WIFE) Tata Winger Make 2008 Rs. 6,95,000/-

Vehicles

8) Jewelery (self)

Gold Silver in name of Wife Gold Silver in name of Elder Son Gold in name of Younger Son Gold

Rs. 11, 50.000/Rs. 2, 23,000/Rs. 18,00,000/Rs. 1,56,000/Rs. 2,50,000/Rs. 1,60,000/-

Details of Liabilities of the member to public Financial Institutions / Central Government and State Government 1) Bank Loan (for Car Loan) Sangli

State Bank of India, Shivaji Nagar, Rs. 3,00,876/State. Bank of India, Ganapati Peth, Rs. 4,42,648/Mahindra Finance Ltd., Rs. 96,434/-

Sangli 2) Loan from Finance Co. (in the name of Wife)

I have been submitting the Income Tax Returns regularly. My PAN No. is ABPPP5827N. The latest income tax return or the financial year 2010-2011 is enclosed.

DECLARATION I, Pratik Prakashbapu Patil hereby declare that the information given above in true and correct to the best of my knowledge and belief. In the event of any change in the information given above. undertake to intimate the Speaker as provided under the rules.

Yours faithfully,

Date 27th Aug 2011

(Pratik Prakashbapu Patil)