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

2013-14
PAN

PERSONAL INFORMATION

First Name Flat / Door / Building Road / Street

Middle Name

Last Name Status

I - Individual Area / Locality Date of birth 00/00/0000 Country (Select) (Select) Sex (Select)

Town/City/District

State (Select)

Pin Code

Email Address Income Tax Ward / Circle

Mobile no 1 (Std code) Phone No

Mobile no 2 EmployerCategor (Select) Return filed under section (Select) Date

FILING STATUS

Are you Governed by Portugese Civil Code under Section 5A? Whether original or (Select) revised return? If u/s 139(9)-defective return , enter Original Ack No If u/s 139(9)-defective return , enter Notice No Residential Status (Select) If revised, enter OriginalAck no/Date

(Select)

If u/s 139(9)defective return , enter Notice Date

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)

1 (Select) 2 3 4 System Calculated 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 7 8 9 10 0 12 13a 13b 13c 13 14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0

INCOME & DEDUCTIONS

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

TAX COMPUTATION

6 7 8 9 10 11 12

0 0 0 0 0 0 0 0 0 0 0

13 14

22

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 (2) If no entry is made in this column, then columns (3) to (5) will not be considered for that row

Income charg eable under the head Salaries

Total tax Deducted

(1)

(3)

(4)

(5)

1 2 3 (Click + to add more rows to 22) TDS on Salary above. Do not delete blank rows. )

23

Details of Tax Deducted at Source on Income OTHER THAN SALARY [As per FORM 16 A issued by Deductor(s)] Tax Deduction Name of the Unique TDS Account Number SI.No Deductor Certificate No. (TAN) of the Deductor (2) If no entry is made in this column, then columns (3) to (7) will not be considered for that row

Deducted Year

Total tax Deducted

Amount out of (6) claimed for this year

(1)

(3)

(4)

(5)

(6)

(7)

1 2 3 4 (Click + to add more rows ) TDS other than Salary above. Do not delete blank rows. )

24

Details of Advance Tax and Self Assessment Tax Payments

(1) If no entry is made in this column, then columns (2) to Sl No (4) will not be considered for that row BSR Code 1 2 3 4 5 6

(2) Date of Credit into Govt Account (DD/MM/YYYY)

(3) Serial Number of Challan

(4) Amount (Rs)

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

TAXES PAID

15 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 24) b TDS (Total from item 22 + item 23) 15a 15b 0 0 0 16 17 18 0 0 0

20 Select Yes if you want your refund by direct deposit into your bank account, Select No (Select) if you want refund by Cheque 21 In case of direct deposit to your bank account give additional details (Select) IFSC Code Type of Account(As applicable) 25 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 2013-14 Place Date Sign here -> PAN 26 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

16 17 18 19

c Self Assessment Tax (item 24) 15c Total Taxes Paid (15a+15b+15c) Tax Payable (14-16) (if 14 is greater than 16) Refund (16-14) if 16 is greater than 14 Enter your Bank Account number

27

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

Details of donations entitled for deduction under section 80G (PLEASE READ NOTE BELOW) Schedule 80G Donations entitled for 100% deduction without qualifying limit If no entry is made in Name of Donee, then for such rows, any value A entered in other columns will be ignored. For 80GA to 80GD Name of Address City or Town or State Code PinCode PAN of Donee Amount of donee District donation (Select) 1 (Select) 2 (Select) 3 (Select) 4 Total 80GA 0

Eligible Amount of Donation 0 0 0 0 0

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

PinCode

PAN of Donee Amount of donation

Eligible 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 (Select) 1 (Select) 2 (Select) 3 (Select) 4 Total 80GC :

PinCode

PAN of Donee Amount of donation

Eligible 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 (Select) 1 (Select) 2 (Select) 3 (Select) 4 Total 80GD

PinCode

PAN of Donee Amount of donation

Eligible Amount of Donation 0 0 0 0 0 0

Donations (A + B + C + D)

NOTE : (IN CASE OF DONEE FUNDS SETUP BY GOVERNMENT AS DESCRIBED IN SECTION 80G(2), PLEASE USE PAN AS "GGGGG0000G".