FORM

INDIVIDUAL INCOME TAX RETURN

SAHAJ

ITR-1

(For Individuals having Income from Salaries, One House Property, Other Sources (Interest etc.). Refer to
Instructions for eligibililty.)

First Name

Middle Name

RADHEY
PERSONAL INFORMATION

Assessment
Year
2 0 15 - 1 6

SHYAM

Flat / Door / Building

213

Last Name

PAN

SHARMA

BPHPS4139F

Name of Premises / Building / Village

Status
I - Individual

BLOCK-A
Road / Street

Area / Locality

SECTOR-9

NEW VIJAY NAGAR

Town/ City/ District

GHAZIABAD

rinkeshshrm398@gmail.com

01/11/1966

State

Mobile No. 1

M-Male

Country

31-UTTAR PRADESH
Email Address

Pincode

91-INDIA

(STD Code)

Phone No

9717632174

201009
Mobile No. 2

9868654780

GOV

18 - u/s 139(9)
Whether Person governed by Portuguese Civil Code under section 5A ?

Enter PAN of Spouse if

applicable

FILING STATUS

No
Revised

Tax Status

Tax Payable

If Revised/Defective, then Enter Receipt Number of

Original Return

Date of Filing Original

Return

Notice No (Where the Original Return filed was defective

and a notice is issued to the assessee to file a fresh return CPC/1516/G5/1513850797
Sec 139(9)

If filed in response to a
notice u/s
139(9)/142(1)/148/153A/15 08/08/2015
3C enter date of such
notice

Residential Status

Employer Category

Return filed under section

Income Tax Ward / Circle

Whether Original or Revised

return?

Sex

Date of birth

RES-Resident

31/07/2015

Whether you have Aadhaar Number?

(Select)

Income from Salary / Pension (Ensure to fill Sch TDS1)

Income from One House Property

3
4
5

INCOME & DEDUCTIONS

If Yes, Please provide Aadhaar Number

1

609949

Income from Other Sources (Ensure to fill Sch TDS2)

Gross Total Income (1+2+3)

Deductions under Chapter VI A (Section)

609949

Let Out

System Calculated

80 C

5a

80 CCC

5b

80 CCD (Employees / Self Employed Contribution)

5c

80 CCD (Employers Contribution)

5d

80 CCG

5e

80 D

5f

80 DD

5g

h
i

80 DDB
80 E

5h
5i

0
82800

80 EE

5j

80 G

5k

80 GG

5l

80 GGA

5m

80 GGC

5n

80 QQB

5o

80 RRB

5p

80 TTA

5q

80 U

5r

Total Deductions (Total of 5a to 5r)

28959
0

360

360
0
20000

20000

82800

0
0

132119

132119
##

Taxable Total Income (4 - 6)

477830
##

Tax Payable on Total Income

Rebate u/s 87A

##
0

10

##
0

10 Tax Payable After Rebate (8-9)

28959

11 Surcharge if Taxable Total Income (7) exceeds 1 crore

11

12 Education Cess, including secondary and higher education cess on 10+11

12

###
0

13 Total Tax,Surcharge and Education Cess (Payable) (10+11+12)

13

##
0

15

##
0

14 Relief under Section 89

14

2000

15 Balance Tax after Relief (13-14)

a

Interest payable u/s 234 A

16a

##
0

Interest payable u/s 234 B

16b

##

Interest payable u/s 234 C

16c

###
0

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

17

###
0

18 Total Tax and Interest Payable (15 + 17)

18

##
0

16

Details of Tax Deducted at Source from SALARY [As per FORM 16 issued by Employer(s)]
19 TDS1

SI.No

Tax Deduction
Account Number
(TAN) of the Employer

Name of the Employer

Income under salary

Tax Deducted

(1)

(2)

(3)

(4)

1
2
3
4
Total

(Do Not Delete Blank Rows)

20
TDS2

Details of Tax Deducted at Source on Income OTHER THAN SALARY [As per FORM 16 A issued by Deductor(s)]
SI.No
Tax Deduction
Account Number
(TAN) of the Deductor

Name of the Deductor

Unique TDS Certificate

No.

Deducted Year

Tax Deducted

Amount out of (5)

claimed this year

(1)

(2)

(3)

(4)

(5)

(6)

1
2
3
4
Total

(Do Not Delete Blank Rows)

21 IT

Details of Advance Tax and Self Assessment Tax Payments

Sl.No

BSR Code

Date of Deposit
(DD/MM/YYYY)

Challan No

Tax Paid

(1)

(2)

(3)

(4)

1
2
3
4
Total

(Do Not Delete Blank Rows)

sued by Deductor(s)]
If covered by
Portuguese Civil
Code, Amount
claimed in the hands
of spouse
(7)

TAXES PAID

Taxes Paid
22 PLEASE NOTE THAT CALCULATED FIELDS (IN WHITE) ARE PICKED UP FROM OTHER SCHEDULES AND ARE NOT TO BE ENTERED. For ex : The taxes
will get filled up when the Schedules linked to them are filled.
a

Total Advance Tax Paid (from item 21)

Total TDS Claimed (Total from item 19 + item 20)

Total Self Assessment Tax Paid (from item 21)

23
24
25

Total Taxes Paid (22a+22b+22c)

Tax Payable (18-23) (if 18 is greater than 23)
Refund (23-18) (if 23 is greater than 18)

26

Exempt Income only for Reporting Purpose (If agricultural income is more than Rs. 5000/-, use ITR-2 or 2A)

27

Details of all Bank Accounts (excluding dormant accounts) held in India at any time during the previous year (Mandatory irrespective of refund due or not)
Total number of savings and current bank accounts held by you at any time during the previous year (excluding dormant accounts).
Bank Account in which refund, if any, shall be credited
Sl.No
1

IFS Code of the Bank

BARB0VIJGHA

Name of the Bank

Account Number
(the number should be 9 digits or more as per
CBS system of the bank)

31580100003658

BANK OF BARODA

Other Bank account details

Sl.No

IFS Code of the Bank

2
3
4

(Do Not Delete Blank Rows)

Name of the Bank

Account Number
(the number should be 9 digits or more as per
CBS system of the bank)

(Do Not Delete Blank Rows)

VERIFICATION
I,

RADHEY SHYAM SHARMA

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 sho
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
Place

GHAZIABAD

PAN

BPHPS4139F

28

Date

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

Identification No of TRP

Name of TRP

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

M OTHER SCHEDULES AND ARE NOT TO BE ENTERED. For ex : The taxes paid figures below

0
0
0

ng the previous year (Mandatory irrespective of refund due or not)

1

Type of Account
Savings

Type of Account
(Select)
(Select)
(Select)

ATION
RAM DEV SHARMA

rect and complete and that the amount of total income and other particulars shown therein are
e chargeable to Income-tax for the previous year relevant to the Assessment Year 2015-16
07/09/2015

Schedule 80G
A

Details of donations entitled for deduction under section 80G (PLEASE READ NOTE BELOW)

Donations entitled for 100% deduction without qualifying limit

If no entry is made in Name of Donee, then for such rows, any value entered in other columns will be ignored from 80GA to 80GD
Name of donee

Address

City or Town or
District

1
2
3
4

State Code

Pincode

PAN of Donee

Eligible Amount of
Donation

Amount of donation

(Select)
(Select)
(Select)
(Select)

0
0
0
0

Total 80GA

(Do Not Delete Blank Rows)

Donations entitled for 50% deduction without qualifying limit

Name of donee

Address

City or Town or
District

1
2
3
4

Pincode

PAN of Donee

Eligible Amount of
Donation

Amount of donation

(Select)
(Select)
(Select)
(Select)
Total 80GB :

(Do Not Delete Blank Rows)

C

State Code

Donations entitled for 100% deduction subject to qualifying limit

0
0
0
0
0

Name of donee

Address

City Or Town Or
District

1
2
3
4

State Code

Pincode

PAN of Donee

Eligible Amount of
Donation

Amount of donation

(Select)
(Select)

0
0

(Select)
(Select)

0
0

Total 80GC :

(Do Not Delete Blank Rows)

D

Donations entitled for 50% deduction subject to qualifying limit

Name of donee

Address

City Or Town Or
District

1
2
3
4

State Code

Pincode

PAN of Donee

Eligible Amount of
Donation

Amount of donation

(Select)
(Select)
(Select)
(Select)
Total 80GD

0
0
0
0
0

(Do Not Delete Blank Rows)

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".