FORM

INDIAN INCOME TAX RETURN

Assessment Year

ITR-1
First Name Ajay Flat / Door / Block No House No.- 67

[For Individuals having Income from Salary/ Pension/ family pension & Interest] (Please see Rule 12 of the Income Tax-Rules,1962) (Also see attached Instructions)

2 0 0 9 - 10
PAN AZHPM0802G

PERSONAL INFORMATION

Middle Name Dev

Last Name Malik Name of Premises / Building / Village Vidyut Nagar Area / Locality Old MITC Colony, Near U.E. - 2 State 12-HARYANA Pin Code 125005 Status

I - Individual Date of birth (DD/MM/YYYY) 10/12/1986 Sex (Select) M-Male

Road / Street / Post Office Type 5 Town/City/District Hisar

Email Address ajaydevmalik@gmail.com Designation of Assessing Officer (Ward / Circle) Whether original or revised return?

FILING STATUS

(Std code) Phone No Employer Category (if in 91 9310865911 employment) OTH Return filed under section 11 - u/s 139(1) [Pl see instruction 9(ii)] O-Original

If revised, enter Receipt no / Date Revised Date RES - Resident Residential Status 196,986 1 Income chargeable under the Head Salaries(Salary/ Pension) 1 2 Income chargeable under the Head Other Sources a Family Pension 2a b Interest 2b c Total (2a + 2b) 0 2c 196,986 3 Gross Total Income (1+2c) 3 System Calculated 4 Deductions under Chapter VI A (Section) 4a 100000 a 80 C 684,950 4b 0 b 80 CCC 0 4c 0 c 80 CCD 0 4d 0 d 80 D 0 4e 0 e 80 DD 0 4f 0 f 80 DDB 0 4g 0 g 80 E 0 4h 0 h 80 G 0 4i 0 i 80 GG 0 4j 0 j 80 GGA 0 4k 0 k 80 GGC 0 4l l 80 U 0 0 m Total Deductions 4m 68,495 4m Do not Leave Blank 68,495 128,491 5 Total Income (3 - 4m) 5 0 6 Net Agricultural Income (Enter only if greater than Rs. 5,000) 6 Aggregate Income (5 + 6) 128,491 7 7 0 8 a Tax payable on Aggregate Income 8a 0 b Rebate in respect of Net Agricultural Income 8b 9a 0 9 a Tax payable on Total Income (8a-8b) b Surcharge on 9a 9b 0 Education Cess, including secondary and 0 c 9c higher secondary cess on (9a+9b) d Total Tax, Surcharge and Education Cess (Payable) (9a+9b+9c) 0 9d 10 0 10 Relief under Section 89 11 0 11 Relief under Section 90/91 0 12 Balance Tax Payable (9d - 10 - 11) 12 13 a Interest payable u/s 234 A 0 13a b Interest payable u/s 234 B 0 13b c Interest payable u/s 234 C 0 13c d Int payable(13a+13b+ 13c) 13d 0 14 Total Tax and Int. Payable(12+13d) 14 0 For Office Use Only Seal and Signature of Receipt No/ Date Receiving Official

TAX COMPUTATION

INCOME & DEDUCTIONS

15 Taxes Paid 0 a Advance Tax (from item 23) 15a b TDS (column 7 of item 21 +column 7 15b 1,900 of item 22) 0 c Self Assessment Tax (item 23) 15c 1,900 d Total Taxes Paid (15a+15b+15c) 15d 0 16 Tax Payable (14-15d) (if 14 is greater than 15d,) 16 1,900 17 Refund (15d-14) if 15d is greater than 14 17 20014284498 18 Enter your Bank Account number (Mandatory in case of refunds) Yes 19 Select Yes if you want your refund by direct deposit into your bank account, Select No if you want refund by Cheque 20 In case of direct deposit to your bank account give additional details 125002008 Savings MICR Code Type of Account(As applicable) Other Information (transactions reported through Annual Information Return) (Please see instruction 24 number-9(ii) for code) Sl Sl Code Amount (Rs) Code Amount (Rs) a b 001 002 0 0 c d 003 004 0 0 e f 005 006 0 0 g h 007 008 0 0 25 Tax-exempt interest income (for reporting purposes only) 0 VERIFICATION AJAY DEV MALIK I, (full name in block letters), son/daughter of DHARAMPAL 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 2009-10 Place Date 23/07/2010 Sign here -> HISAR PAN AZHPM0802G 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 Counter Signature of TRP REFUND TAXES PAID

27

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

21

Details of Tax Deducted at Source from Salary [As per Form 16 issued by Employer(s)] Income Tax Deduction payable charg Tax under Total tax eable (incl. PinCode payable/ Deducted under the Chapter surch. refundable VI-A head and Salaries edn.cess) (4) (5) (6) (7) (8) 400098 196,986 68,496 0 1,900 1,900

Tax Deduction Account UTN (Unique Name of the SI.No Number Transaction Number) Employer (TAN) of the Employer (1) 1 2 3 (2) MUMS00123E (9)

Address

City

State

ITD 1st Floor, Dani Cementation Wooltex, 158,

(3) Mumbai

19MAHARASH

(Click + to add more rows to 22) TDS on Interest above. Do not delete blank rows. Blank rows will not be included In the ITR) 22 Details of Tax Deducted at Source on Interest [As per Form 16 A issued by Deductor(s)] Amount paid/ credited (4) Date of Payment / Credit (5) Amount out of (6) claimed for this year (7)

Tax Deduction Account UTN (Unique Name of the SI.No Number Transaction Number) Deductor (TAN) of the Deductor (1) 1 2 3 4 (2) (8)

Address

City

State

PinCode

Total tax Deducted

(3)

(6)

(Click + to add more rows to 22) TDS on Interest above. Do not delete blank rows. Blank rows will not be included In the ITR)

23 Sl No 1 2 3 4 5 6

Details of Advance Tax and Self Assessment Tax Payments Bank Detals & Branch Serial Date of Deposit BSR Code Number of Amount (Rs) Name of the (DD/MM/YYYY) Branch Challan Bank

(Click '+' to add more rows to 23) Tax Payments. Do not delete blank rows. Blank rows will not be included In the ITR)

Tax and interest Calculator

A) B) C) D) E)

2009-10

Beta Version 1.0 This calculator takes inputs from this filled up utility. This calculator requires taxpayer to complete all schedules The Green cells below are as per the value entered in Part B TI/ TTI and the yellow cells adjacent are as per the Click on Recalculate in case any of the input values in the return are being changed, to view the recomputated tax After verifying and validating all input values, and generating the final computation, the sytem calculated values of Please note that to calculate interest , you need to complete acceptance of final computation of tax, surcharge and

S No Calculator for Tax, Surcharge 1 Total income after set off of losses and deductions Deduct : Special Rate incomes from above for arriving at Aggregate Income to be used in computation of Tax at 2 Normal Rate 3 Add : Net Agricultural Income for Rate Aggregate Income to be used for computation of Tax at 4 Normal Rate 5 Tax at Normal Rates 6 Rebate on Agricultural Income 7 Special Income as per Sch SI 8 Tax at Special Rate 9 Tax payable on Total Income 10 11 12 13 14 Surcharge Marginal Relief Net Surcharge Education Cess Gross Tax Liability

As entered As Calculated 196986 128491

0 128491 0 0

0 0 128491 0 0 0 0 0 0 0 0 0 0

0 0 0

S No Calculator for Interest 14 Date of filing

As entered 31/07/2009

As Calculated (dd/mm/yyyy)

15 16 17 18 19

Enter date upto which interest is to be calculated Enter due date for filing of returns Interest u/s 234A Interest u/s 234B Interest u/s 234C

31/07/2009 31/07/2009 0 0 0

(dd/mm/yyyy) (dd/mm/yyyy) 0 0 0

Validate data before generating XML No of entries TDS on Salary 0 TDS on Interest 0 Tax Payments 0

1. Validate against each schedule the

count of no of entries.

3. In case this count does not match to

the entered number of entries, you may recheck the schedules, refer to instructions for filling up tables, and ensure that all entries are valid and completely entered.

2. This is required to confirm that the 4. Once this sheet is validated, you
total no of entries entered per schedule is valid and being generated in the final XML may click on Save XML to generate the XML file

If the no of entries are 0 In a schedule, there are mandatory fields For a row to be valid, these must be filled in. Also, do not skip blank rows