2011-12 ITR-1, PAGE 1

ITR-1
A1

SAHAJ
FIRST NAME

INDIAN INDIVIDUAL INCOME TAX RETURN

A2

AY 2011-12

MIDDLE NAME

MO
A3

D I N S A B LAST NAME

D A S T A G I R S A B

A4

PERMANENT ACCOUNT NUMBER A B C P H 4 2 8 0 Q

H O R A K E R I
A5 MALE A8

SEX
FEMALE

A6

DATE OF BIRTH

A7

INCOME TAX WARD/CIRCLE

0 8 1 0 1 9 7 9
A9

FLAT/DOOR/BUILDING L A T N O : E 1 0 3 , D W A R K A

ROAD/STREET H E R I T A G E , TOWN/CITY/DISTRICT S . N O : 1 7 4 / 4

F
A10

S A I
A11

AREA/LOCALITY I M .P L E STATE A H A R A S H T R A E MAIL ADDRESS A T A M O T S A U D A G A R

P
A12

P U N E
A13

PIN

M
A14

4 1 1 0 2 7

M O D I S A B . H @ T
A15

O R S . C O M A16 MOBILE NO. A17 Fill only one if you belong to Government PSU Others

RESIDENTIAL/OFFICE PHONE NO. WITH STD CODE

0 2 0 6 6 1 3 3 4 5 1

8 0 8 7 0 9 0 4 8 6

A18 A20

Fill only one

Tax Refundable

Tax Payable

Nil Tax Balance

A19

Fill only one

Resident

Non Resident

Fill only one filed

Before due date-139(1)

After due date-139(1)

Resident but not ordinarily resident Revised Return-139(5) or in response of notice 142 (1) 148

153/153C

A21

If revised

Receipt Number of Original Return

and

Date of Filing Original Return Whole- Rupee (`) Only B1 B2 ( - ) B3 ( B4 ( ) ) 7 2 2 9 4 8 1 7 5 2 0 9 0 4 0 8 0 0 8

PART B - GROSS TOTAL INCOME

B1
Income from Salary/Pension Ensure to fill "Sch TDS1" given in Page 2 NOTE Income from One House Property Income from other sources Ensure to fill "Sch TDS2" given in Page 2 NOTE Gross Total Income (B1+B2+B3) PART CC1

If showing loss, mark the nagative sign in bracket at left

B2 B3 B4

DEDUCTIONS AND TAXABLE INCOME (Refer to Instructions for Limits on Amount of Deductions as per "Income Tax Act") 80C 80CCF 80DDB 80GG 80U

C1 C4

1 0

C2 C5 C8 C11

80CCC 80D 80E 80GGA

C3 C6 C9 C12

80CCD

80DD 80G
80GGC

to

C7 C10

C13

C13 C14 C15

Total Deductions (Add items C1 to C13) Taxable Total Income (B4-C14)

C14 C14 ( )

1 6

0 2

0 2

0 9

0 5

0 0

FOR OFFICIAL USE ONLY

STAMP RECEIPT NO. HERE

SEAL, DATE AND SIGNATURE OF RECEIVING OFFICIAL

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PERMANENT ACCOUNT NUMBER

2011-12 ITR-1, PAGE 2

D1 to D3

PART D--TAX COMPUTATION AND TAX STATUS

Tax Payable on Total Income Secondary & Higher Education Cess TOTAL TAX AND CESS (D1+D2)

D1 D4 to D6 D7 to D9 D10 to D12 D13 to D14 Relief u/s 89 D4

Total Interest u/s 234A/234B/234C

D2
Relief u/s 90/91

D3
Balance Tax After Relief (D3-D4-D5)

D5 Total Tax and Interest (D6+D7) D8 Total TDS Deducted

D11
Refund (D12-D8, if D12>D8)

D6 Total Advance Tax Paid D9 Total Prepaid Tax (D9+D10+D11)

D12

D7 Total Self Assessment Tax Paid

D10
Tax Payable (D8-D12, if D>D12)

D13

D14

Bank Account Details (Mandatory in all cases irrespective of refund due or not
D15 D17 ACCOUNT No. Type of account

D16 Current Savings D18

MICR CODE

Fill only one : Refund by

Cheque

deposited directly into your bank account

D19

Exempt income only for reporting purposes (From Dividends, Agricultural Income < ` 5000/-)

VERIFICATION
I, Son/daughter of Solemnly declare that to the best of my knowledge and belief, the information given in the return 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 provision of the Income-tax act, 1961 in the respect of income chargeable to Income-tax for the previous year relevant to the Assessment Year Place SIGN HERE 2011-12.

If the return has been prepared by a Tax Return Preparer (TRP) give further details as below

Name of TRP

TRP PIN [10 Digit]

Amount to be paid to TRP

TRP Signature

Sch IT-DETAILS OF ADVANCE TAX AND SELF ASSESSMENT TAX PAYMENTS

BSR CODE (col.i) R1 R2 R3 R4 R5

DATE OF DEPOSIT (Col.ii)

CHALLAN NO. (col.iii)

TAX PAID (col. Iv)

NOTE

(1) Enter the total of Advance Tax and Self Assessment Tax in D9 and D10 (2) Continue in Supplementary Schedule IT if your Cannot Fill Within Sch IT

Sch TDS1-DETAILS OF TAX DEDUCTED AT SOURCE FROM SALARY [As per Form 16 Issued by Employer (s)]
TAN (col.i) S1 S2 S3
NAME OF EMPLOYER (S) (col.ii)

INCOME UNDER SALARY (col. iii)

TAX DEDUCTION

NOTE

(1) Enter the total of column (iv) of Sch TDS1 and Sch TDS2 in D11 (2) Continue in Supplementary TDS 1 if you cannot fill within Sch TDS1

Sch TDS2-DETAILS OF TAX DEDUCTED AT SOURCE FROM INCOME OTHERTHAN SALARY [As per Form 16 Issued by Deductor (s)] TAN (col.i) T1 T2 T3
NAME OF DEDUCTOR (col.ii)

TAX DEDUCTION (col. iii)

AMT OUT OF (III) CLAIMED THIS YR (col. Iv)

NOTE

(1) Enter the total of column (iv) of Sch TDS1 and Sch TDS2 in D11 (2) Continue in Supplementary TDS 2 if you cannot fill within Sch TDS2

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PERMANENT ACCOUNT NUMBER

AY 2011-12
FIRST NAME MIDDLE NAME LAST NAME

SUPPLEMENTARY SCHEDULE TDS 1 (To be used only after exhausting items S1-s3 of Schedule TDS1 in main form etc.)

TAN (col.i)
S4 S5 S6 S S7 S8 S9

NAME OF EMPLOYER (col. ii)

INCOME UNDER SALARY (col.iii)

TAX DEDUCTED (col. iv)

` ` ` ` ` `

S10 S11 S12 S13 S14 S15 S16 S17

` ` ` ` ` ` ` ` `

S18

S19

` `

S20

S21

` ` `

S22

S23

S24

S25

` ` ` ` ` `

S26

S27

S28

S29

S30

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PERMANENT ACCOUNT NUMBER

AY 2011-12 FIRST NAME MIDDLE NAME LAST NAME

SUPPLEMENTARY SCHEDULE TDS 2 (To be used only after exhausting items T1-T4 of Schedule TDS2 in main form etc.) TAN (col.i)
T4 T5 T6 T7 T8 T9 NAME OF DEDUCTOR (col. ii)
TAX DEDUCTED (col.iii)
AMT OUT OF (III) CLAIMED THIS YR (col. iv)

` ` ` ` ` ` ` ` ` ` ` ` ` ` `

T10 T11 T12 T13 T14 T15 T16 T17

T18

T19

` `

T20

T21

` ` `

T22

T23

T24

` ` ` ` ` ` `

T25

T26

T27

T28

T29

T30

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PERMANENT ACCOUNT NUMBER

AY 2011-12 FIRST NAME MIDDLE NAME LAST NAME

SUPPLEMENTARY SCHEDULE TDS 2 (To be used only after exhausting items T1-T4 of Schedule TDS2 in main form etc.) TAN (col.i)
R4 R5 R6 R7 R8 R9 NAME OF DEDUCTOR (col. ii)
TAX DEDUCTED (col.iii)
AMT OUT OF (III) CLAIMED THIS YR (col. iv)

` ` ` ` ` ` ` ` ` ` ` ` ` ` `

R10 R11 R12 R13 R14 R15 R16 R17

R18

R19

` `

R20

R21

` ` `

R22

R23

R24

` ` ` ` ` ` `

R25

R26

R27

R28

R29

R30

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ITR-V
Received with thanks from ITR No. 1 (SAHAJ) 2

ACKNOWLEDGEMENT
3 4 (SUGAM) 5 6 for assessment year 2011-12

AY 2011-12
a return of income in
having following particulars

A1

FIRST NAME

A2

MIDDLE NAME

A3

LAST NAME

A4

PERMANENT ACCOUNT NUMBER

A5 MALE A8

SEX
FEMALE

A6

DATE OF BIRTH

A7

INCOME TAX WARD/CIRCLE

FLAT/DOOR/BUILDING

A9

ROAD/STREET

A10

AREA/LOCALITY

A11

TOWN/CITY/DISTRICT

A12

STATE

A13

PIN

A14

Fill only one filed

Before due date-139(1)

After due date-139(1)

Revised Return-139(5) or in response of notice 142 (1) 148

153/153C

COMPUTATIONOF INCOME AND TAX RETURN

B1
Gross Total Income

Whole- Rupee (`) Only

If showing loss, mark the nagative sign in bracket at left

B1 ( B2 B3 B4 B5 B6 B7 B8 B9 B10 B11 B12 B13 B14

Deductions under Chapter VI-A Total Income

) ) ) )

B2 ( B3 (

NOTE

Ensure to fill "Sch TDS2" given in Page 2

Current Loss if any Net Tax Payable

B4 ( B5 B6 B7 B8 B9 B10 B11 B12 B13 B14

Interest Payable Total Tax and Interest Payable Total Advance Tax Paid Total Self Assessment Tax Paid Total Tax Deducted Total TCS Deducted Total Prepaid Taxes (B8+B9+B10+B11) Tax Payable (B7-B12, If B7>B12) Refund (B12-B7, if B12>B7)

FOR OFFICIAL USE ONLY

STAMP RECEIPT NO. HERE

SEAL, DATE AND SIGNATURE OF RECEIVING OFFICIAL

www.taxguru.in

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