FORM SAHAJ INDIAN INCOME TAX RETURN ITR-1 Year 2 0 1 1 - 1 2 PERSONAL INFORMATION First Name Middle Name Last Name PAN Flat / Door / Building Status I - Individual Road / Street Area / Locallity 00/00/0000 Town/City/District State Pin Code Sex (Select) M-Male Email Address Mobile no Phone No OTH Income Tax Ward / Circle O-Original Date Residential Status RES - Resident INCOME & DEDUCTIONS 1 Income from Salary / Pension (Ensure to fill Sch TDS1) 1 2 Income from one House Property 2 3 Income from Other Sources (Ensure to fill Sch TDS2) 3 4 Gross Total Income (1+2c) 4 0 5 Deductions under Chapter VI A (Section) System Calculated a 80 C 5a 0 0 b 80 CCC 5b 0 0 c 80 CCD 5c 0 0 d 80 CCF 5d 0 0 e 80 D 5e 0 0 f 80 DD 5f 0 0 g 80 DDB 5g 0 0 h 80 E 5h 0 0 i 80 G 5i 0 0 j 80 GG 5j 0 0 k 80 GGA 5k 0 0 l 80 GGC 5l 0 0 m 80 U 5m 0 0 6 Deductions (Total of 5a to 5m) 6 0 6 0 7 Total Income (4 - 6) 7 0 TAX COMPUTATION 8 Tax payable on Total Income 8 0 9 Education Cess, including secondary and higher secondary cess on 8 9 0 10 Total Tax, Surcharge and Education Cess (Payable) (8 + 9) 10 0 11 Relief under Section 89 11 0 12 Relief under Section 90/91 12 0 13 Balance Tax Payable (10 - 11 - 12) 13 0 14 Total Interest Payable 14 0 15 Total Tax and Interest Payable (13 + 14) 15 0 For Office Use Only Receipt No/ Date Assessment [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 Date of birth (Std Employer Category (if in employment) FILING STATUS Return filed under [Pl see Form 11 - u/s Whether original or revised If revised, enter Receipt no / Seal and Signature of Receiving Official
Transcript
FO
RM
SAHAJ INDIAN INCOME TAX RETURN Assessment Year
ITR-1 Year
(Please see rule 12 of the Income-tax Rules,1962) (Also see attached instructions) 2 0 1 1 - 1 2
PE
RS
ON
AL
IN
FO
RM
AT
ION
First Name Middle Name Last Name PAN
Flat / Door / Building StatusI - Individual
Road / Street Area / Locallity Date of birth (DD/MM/YYYY)00/00/0000
Town/City/District State Pin Code Sex (Select)M-Male
Email Address Mobile no (Std code) Phone No Employer Category (if in employment) OTH
Income Tax Ward / Circle Return filed under section[Pl see Form Instruction] 11 - u/s 139(1)
Whether original or revised return? O-Original
If revised, enter Receipt no / Date DateResidential Status RES - Resident
INC
OM
E &
DE
DU
CT
ION
S
1 Income from Salary / Pension (Ensure to fill Sch TDS1) 1
2Income from one House Property
2
3 Income from Other Sources (Ensure to fill Sch TDS2) 3
4 Gross Total Income (1+2c) 4 05 Deductions under Chapter VI A (Section) System Calculated
m 80 U 5m 0 06 Deductions (Total of 5a to 5m) 6 0 6 07 Total Income (4 - 6) 7 0
TA
X C
OM
PU
TA
TIO
N 8 Tax payable on Total Income 8 09 Education Cess, including secondary and higher secondary cess on 8 9 010 Total Tax, Surcharge and Education Cess (Payable) (8 + 9) 10 011 Relief under Section 89 11 012 Relief under Section 90/91 12 013 Balance Tax Payable (10 - 11 - 12) 13 014 Total Interest Payable 14 015 Total Tax and Interest Payable (13 + 14) 15 0
For Office Use OnlyReceipt No/ Date
[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)]
FIL
ING
S
TA
TU
S
Seal and Signature of Receiving Official
C6
Enter first name
M6
Enter middle name, if any
U6
Last name / Surname should not be blank
AL6
PAN: First five alphabets, next four digits, then alphabet (exactly 10 chars)
AL14
Should be in DD/MM/YYYY format only. DoB should be before 01/04/2011
AD18
Enter six digit pin code (NRI can enter 999999)
C22
Enter valid Email Address to receive copy of ITR-V via email
U22
Mobile number : Must be 10 digits.
Y22
Do not prefix '0' before STD code.
AD22
Enter your Phone Number
AP22
Select from list provided. If not employed or for HUF use 'OTH'
C24
Enter the ward or circle where the return is filed
AN24
Select from list provided. Usually would be 11
V26
Select from list provided. If this is the only Return then select 'Original' if you have already filed your return for this year and would like to make changes then select 'Revised'
AM28
On or after 01/04/2010 Enter the Acknowledgement number and date of filing of Original return
U30
Select from list provided. Usually would be 'RES'
Z69
Calculate relief u/s 89 as per IT Act in case of receipt of arrears of salary.or advances of salary recieved during the year.
Z70
Calculate relief u/s 90 or 91 as per IT Act in case of tax paid outside India
23 Details of Tax Deducted at Source from Salary [As per Form 16 issued by Employer(s)]
SI.No
(1) (2) (3) (4) (5)1 ###2 ###3 ###
(Click + to add more rows to 23) TDS on Salary above. Do not delete blank rows. ) ###24 Details of Tax Deducted at Source Other than Salary ###
SI.No
###(1) (2) (3) (4) (5) ###1 ###2 ###3 ###4 ###
(Click + to add more rows ) TDS other than Salary above. Do not delete blank rows. ) #########
25 Details of Advance Tax and Self Assessment Tax Payments ###
Sl No
###
BSR Code Amount (Rs)
1 ###2 ###3 ###4 ###5 ###6 ###
(Click '+' to add more rows ) Tax Payments. Do not delete blank rows. )
Tax DeductionAccount Number
(TAN) of the Employer
Name of the Employer
Income chargeable under thehead Salaries
Total taxDeducted
Tax DeductionAccount Number
(TAN) of the Deductor
Name of the Deductor
Total taxDeducted
Amount out of
(4) claimed for
this year
Date of Deposit(DD/MM/YYYY)
Serial Number ofChallan
C4
First four alphabets, next five digits, then alphabet(exactly 10 chars). Quote valid TAN to ensure credit for TDS
D4
Enter name of employer
E4
Enter details from Form 16
C5
First four alphabets, next five digits, then alphabet(exactly 10 chars). Quote valid TAN to ensure credit for TDS
D5
Enter name of employer
E5
Enter details from Form 16
C11
First four alphabets, next five digits, then alphabet(exactly 10 chars). Quote valid TAN to ensure credit for TDS
D11
Enter name of employer
E11
Enter details from Form 16A. Round off to nearest Rupee.
C12
First four alphabets, next five digits, then alphabet(exactly 10 chars). Quote valid TAN to ensure credit for TDS
D12
Enter name of employer
E12
Enter details from Form 16A. Round off to nearest Rupee.
C21
Enter date of deposit of tax payment in DD/MM/YYYY format. Date will be used to distinguish between Advance Tax Payments and Self Assessment Tax Payments
C22
Enter date of deposit of tax payment in DD/MM/YYYY format. Date will be used to distinguish between Advance Tax Payments and Self Assessment Tax Payments
B23
Enter seven digit code as per bank seal on counterfoil
C23
Enter date of deposit of tax payment in DD/MM/YYYY format. Date will be used to distinguish between Advance Tax Payments and Self Assessment Tax Payments
D23
Enter challan serial number as per bank seal
E23
Enter tax payment. Round off nearest Rupee
B24
Enter seven digit code as per bank seal on counterfoil
C24
Enter date of deposit of tax payment in DD/MM/YYYY format. Date will be used to distinguish between Advance Tax Payments and Self Assessment Tax Payments
D24
Enter challan serial number as per bank seal
E24
Enter tax payment. Round off nearest Rupee
B25
Enter seven digit code as per bank seal on counterfoil
C25
Enter date of deposit of tax payment in DD/MM/YYYY format. Date will be used to distinguish between Advance Tax Payments and Self Assessment Tax Payments
D25
Enter challan serial number as per bank seal
E25
Enter tax payment. Round off nearest Rupee
B26
Enter seven digit code as per bank seal on counterfoil
C26
Enter date of deposit of tax payment in DD/MM/YYYY format. Date will be used to distinguish between Advance Tax Payments and Self Assessment Tax Payments
D26
Enter challan serial number as per bank seal
E26
Enter tax payment. Round off nearest Rupee
TA
XE
S P
AID
16
a 16a 0
b TDS (Total from item 23 + item 24) 16b 0
c Self Assessment Tax (item 25) 16c 0
17 Total Taxes Paid (16a+16b+16c) 17 0
18 Tax Payable (15-17) (if 15 is greater than 17) 18 0
RE
FU
ND
19 Refund (17-15) if 17 is greater than 15 19 0
20 Enter your Bank Account number (Mandatory )21 No
22 In case of direct deposit to your bank account give additional detailsMICR Code Type of Account(As applicable)
26 Exempt income for reporting purposes only (from Dividends, Agri. income < 5000)VERIFICATION
I, (full name in block letters), son/daughter of
Place Date Sign here ->
PAN27 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
28
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.
Advance Tax (from item 25)
Select Yes if you want your refund by direct deposit into your bank account, Select No if you want refund by Cheque
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 2011-12
If TRP is entitled for any reimbursement from the Government, amount thereof (to be filled by TRP)
F28
Enter name. In case of HUF, Karta's name should be entered here.
J28
Enter fathers name
C31
Enter city
H31
Enter date in DD/MM/YYYY. Date should be on after 01/04/2010. Do not enter future date.
