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SAHAJ INDIAN INCOME TAX RETURN Assessment
[For Individuals having Income from Salary / Pension / Income from One House Property Year
ITR-1
FORM
(excluding loss brought forward from previous years) /
Income from Other Sources (Excluding Winning from Lottery and Income from Race Horses)]
2012-13
(Please see rule 12 of the Income-tax Rules,1962) (Also see attached instructions)
First Name Middle Name Last Name PAN
PERSONAL INFORMATION
Flat / Door / Building Status
I - 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-BeforeDueDt
Whether original or revised return? O-Original
FILING STATUS
If revised, enter Original Ack no / Date Date
If u/s 139(9)-defective return , enter
Original Ack No
If u/s 139(9)-defective return , enter Notice If u/s 139(9)-
No defective return ,
enter Notice Date
Residential Status RES - Resident Tax Status Nil Tax Balance
1 Income from Salary / Pension (Ensure to fill Sch TDS1) 1
Income from one House Property
2 2 0
Income from Other Sources (Ensure to fill Sch TDS2)
3 3 0
4 Gross Total Income (1+2+3) 4 0
5 Deductions under Chapter VI A (Section) System Calculated
INCOME & DEDUCTIONS
a 80 C 5a 0 0
b 80 CCC 5b 0 0
c(i) 80 CCD (Employers Contribution) 5c(i) 0 0
80 CCD (Employees / Self Employed 0
c(ii) 5c(ii) 0
Contribution)
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 u/s 234A 234B 234C 14 0
15 Total Tax and Interest Payable (13 + 14) 15 0
Details of Tax Deducted at Source from SALARY
23 [As per FORM 16 issued by Employer(s)]
Tax Deduction
Income charg
Account Number Name of the Total tax
SI.No eable under the
(TAN) of the Employer Deducted
head Salaries
Employer
(1) (2) (3) (4) (5)
1
2
3
(Click + to add more rows to 23) TDS on Salary above. Do not delete blank rows. )
Details of Tax Deducted at Source on Income OTHER THAN SALARY
24 [As per FORM 16 A issued by Deductor(s)]
Amount
Tax Deduction out of
Account Number Name of the Unique TDS Deducted Total tax (6)
SI.No
(TAN) of the Deductor Certificate No. Year Deducted claimed
Deductor for
this year
(1) (2) (3) (4) (5) (6) (7)
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
Date of Credit into Serial
Sl No
BSR Code Govt Account Number of Amount (Rs)
(DD/MM/YYYY) Challan
1
2
3
4
5
6
(Click '+' to add more rows ) Tax Payments. Do not delete blank rows. )
16 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
TAXES PAID
below will get filled up when the Schedules linked to them are filled.
a Advance Tax (from item 25) 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
19 Refund (17-15) if 17 is greater than 15 19 0
20 Enter your Bank Account number
REFUND
21 Select Yes if you want your refund by direct deposit into your bank account, No
Select No if you want refund by Cheque
22 In case of direct deposit to your bank account give additional details
MICR Code Type of Account(As applicable)
26 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 2012-13
Place Date Sign here ->
PAN
27 If the return has been prepared by a Tax Return Preparer (TRP) give further details as below:
Identification No of TRP Name of TRP
If TRP is entitled for any reimbursement from the Government, amount thereof (to be
28
filled by TRP)
Schedule 80G Details of donations entitled for deduction under section 80G
Donations entitled for 100% deduction without qualifying limit (IN
A CASE OF DONEE FUNDS SETUP BY GOVERNMENT AS
DESCRIBED IN SECTION 80G(2), PLEASE USE PAN AS
Name of Adress City or Town or State Code PinCode PAN of Donee Amount of Eligible
donee District donation Amount of
Donation
1 0
2 0
3 0
4 0
Total 80GA 0 0
B Donations entitled for 50% deduction without qualifying limit
Name of Address City or Town or State Code PinCode PAN of Donee Amount of Eligible
donee District donation Amount of
Donation
1 0
2 0
3 0
4 0
Total 80GB : 0 0
C Donations entitled for 100% deduction subject to qualifying limit
Name of Address City Or Town Or State Code PinCode PAN of Donee Amount of Eligible
donee District donation Amount of
Donation
1 0
2 0
3 0
4 0
Total 80GC : 0 0
D Donations entitled for 50% deduction subject to qualifying limit
Name of Address City Or Town Or State Code PinCode PAN of Donee Amount of Eligible
donee District donation Amount of
Donation
1 0
2 0
3 0
4 0
Total 80GD 0 0
E Donations (A + B + C + D) 0 0
