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F O R M

ITR - 1

INDIAN INCOME TAX RETURN

Assessment Year

[For Individuals having Income from Salary / Pension / Family Pension & Interest]

2007-08

(Please see Rule 12 of the Income-tax Rules, 1962)

(Also see attached instructions)

P E R S O N A L I N F O R M A T I O N

First nameMiddle nameLast namePANFlat / Door / Block No.Name of Premises / Building / VillageDate of Birth (DD/MM/YYYY)//Road / Street / Post OfficeArea / LocalityEmployer Category (Tick)GovtPSUOthersTown / City / DistrictStatePin codeSex ( Tick)MaleFemaleEmail address(STD code) - Phone number

F I L I N G S T A T U S

Return Filed Under Section -

[Please see instruction number 9(i)]

Whether original or Revised Return ? (Tick)OriginalRevised//Residential Status (Tick)ResidentNon-ResidentResident but Not Ordinarily Resident

I N C O M E & D E D U C T I O N S

1Income Chargeable under the Head 'Salaries' (Salary / Pension)12Income Chargeable under the Head 'Other Sources'aFamily pension2abInterest2bcTotal (2a+2b)2c3Gross Total Income (1+ 2c)34Deduction under Chapter VI A (Section)a80Ce80DDi80GGb80CCCf80DDBj80GGAc80CCDg80Ek80GGCd80Dh80Gl80UmDeductions ( Total of a to l)4m5Total Income (3 - 4m)5667'Aggregate Income' (5 + 6 )7

T A X C O M P U T A T I O N

8aTax Payable on 'Aggregate Income'8abRebate in respect of Net Agricultural Income8b9aTax Payable on Total Income (8a - 8b)9abSurcharge on 9a9bcEducation Cess on (9a + 9b)9cdTotal Tax, Surcharge and Educational Cess Payable (9a + 9b + 9c)9d10Relief under section 891011Relief under section 90 / 911112Balance Tax Payable (9d - 10 - 11)12

Do not write or stamp in this area (Space for bar code)

For Office Use only

Seal and signature of the receiving official Receipt No. Date

Designation of the Assessing Officer

(Ward / Circle)

If revised enter Receipt No. and date of filing originalreturn (DD/MM/YYYY)Net Agricultural Income

(Enter only if greater than Rs. 5,000)

13aInterest Payable U/S 234 A13abInterest Payable U/S 234 B13bcInterest Payable U/S 234 C13cdTotal Interest Payable (13a +13b + 13c)13d14Total Tax and Interest Payable14(12 + 13d)

T A X E S P A I D

15Taxes Paida15ab15bc15cdTotal Taxes Paid (15a + 15b + 15c)

15d

R E F U N D

1819Do you want your refund by Cheque, orDeposited directly into your bank account? (tick as applicable)20In case of direct deposit in your bank account give additional detailsMICR CODE Type of account (tick as applicable)SavingsCurrent

Details of Tax Deducted at Source from Salary [as per Form 16 issued by Employer(s)]

T D S O N S A L A R Y

Name and address of the Employer

(1)(2)(3)(4)(5)(6)(7)(8)iii

Details of Tax Deducted at Source on Interest [as per Form 16A issued by Deductor(s)]

T D S O N I N T E R E S T

Name and address of the DeductorAmount paid / creditedDate of payment / credit

(1)(2)(3)(4)(5)(6)(7)iiiiii

Note

Enter the total of column (7) of 21 and column (7) of 22 in Sl. No. 15b of TAXES PAID

Details of Advance Tax and Self Assessment Tax Payments

T A X P A Y M E N T S

Name of Bank & BranchBSR CodeAmount (Rs.)iiiiiiivv

Note

Enter the totals of Advance tax and Self Assessment tax in Sl. 15a and 15c of TAXES PAID

SlcodeAmount (Rs)SlcodeAmount (Rs)Slcodea001d004g007b002e005h008c003f006

E-filing Acknowledgement NumberDate (DD/MM/YYYY)//

VERIFICATION

I.son / daughter of solemnly

Place DateSign HereAdvance Tax

(from item 23)

TDS

(column 7 of item 21 + column 7 of item 22)

Self Assessment Tax

(from item 23)

Tax Payable (14 - 15d)

(Enter if 14 is greater than 15d , else leave blank)

Refund (15d -14)

(Enter if 15d is greater than 14, also give Bank Account details below)

Enter your bank account number

(mandatory in case of refund)

SlNo.Tax deduction Account Number (TAN)of the EmployerIncomechargeableunder the headSalariesDeductionunder ChapterVI-ATax payable(incl. surch. andedn. cess)Total taxdepositedTax payable /refundableSlNoTax deduction Account Number (TAN)of the DeductorTotal taxdepositedAmount out of (6) claimed forthis yearSlNo

Date of Deposit(DD/MM/YYYY)Serial No. of ChallanOther Information (transactions reported Through Annual Information Return)

(Please see instruction number -9(ii) for code)

Tax - exempt interest income

(for reporting purposes only)

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 andother particulars shown therein are truly stated and are in accordance with the provisions of the Income Tax Act, 1961, in respect of income chargeable toIncome-tax for the previous year relevant to the Assessment Year 2007-08.