AY 20 AD FIRST NAME (AQ MIDDLE NAME . . Litt i pep ppp ppp pp pp yy iy | Joti p pp ppp i pp ppp py DLAST NAME [M4 PERMANENT ACCOUNT NUMBER . m AD SEX (A@ DATE OF BIRTH (RD INCOME TAX WARD/CIRCLE Woe © Fenae [DOM FLAT/DOOR/BUILDING TRO ROAD/STREET we LLlitititititiiiriiii tii JEL tLLi tp tippy py yyy py ff A ARENLOCALTY (SD TOWNCTTYDISTRICT mELLLLit tip | Lotti ppp mn Kid stare ‘AX COUNTRY Tat@PINCODE MLL ttt itp Jott tippy yy yyy | Jitit wm (Id EMAIL ADDRESS MLL 5 R10 MOBILE NO./MESIDENTIAYOFFICE PHONE NOWAITH STD CODE [AD MOBILE NO2 . . {4B Fil only one it you belong to» Ge tO PSU © Others TRAD Fil only one > © Tax Refundable» © Tax Payabler Ni Tax Balance AZO) Fl only one» © Resident » © Non Aesdont but al arian reste Oman yo 148 > 8)» O asawisse ed» Before ue atet8Q1) » Ot eset Retr895) OR in response to rotice ded en» # prion TT TTT TTT TTT TI li Aeon ia en Dae iO DOTS {ncome trom Salary/Pension > BI MESS Ensure to il “Sch TDS1™ given in Page 2 OUT) Income from One House Property > Self Occupied » © Let out >» B2 (Mitt ti -es [ITITITITITT) ~e4( CITITI TIT) LE ae ATSC > cr1cae = | | |] T | | cz eacco > ¢3 Gocco) oe csaoces) [] [| [|+cscm [fii t) cr qo) =| | }>ceeoos = =[ | | | | | > co cone) cto eae CELT YT] + cre essa TTT TT] rose = [T [TT )-encm [TTTTTI (3F} Total Deductions (Add items C1 to C17) > c18 Income from other source: Ensure to fill “Sch TDS2” Gross Total Income (B1 + tenon enn moms me | im [AE] Taxable Total Income (B4 - C18) rei () | Li) = FOR OFFIGIAL USE ONLY pre RECEIPT NO. HERE _|[nr Etrtttttoo “re mats | SVE eS Tax Payable On Total Income(cis) Secondary & Higher Education Cess TOTAL TAX AND CESS ( D1+ 02) »or DELLE o PEPE «0 : Relief u/s 89 Balance Tax After Relief (03-4) ‘Total Interest u/s 234A . »o (TOC: 6s PEELE «os : Total Interest u/s 234B Total Interest u/s 234C Total Tax And Interest (D5+D6+D7+D8)m™ -or [TPE 8 (EEE) + ‘Total Advance Tax Paid Total Self Assessment Tax Paid Total TOS Claimed oo [DL Litton, [TfL ) fT) +e ‘Total Prepaid Taxes (D10+D11+D12) Total Payable (D9-D13,|f D9>D13) Refund (D13- D9, If D13>D9) tom rors = SSR > D16 accounr no, » D17 Type of account: » © Current » © Savings " spramccs P) |) | || | || Di rionyan:netnt tye tea © dpsed cys . your bank account sm *D20 Exempt income ony for reporting purposes suwionennowrsnemme | | | | | . ew Meson davon ote slay daca tat thebestof my node (ind Gott te information given ne ret scorer and compl and at the ancant af tal ncome and ote particulars shown therein ate ty stated and aren sm cordance wri he provisions fhe Income tax Act 186, respect ofincome chargeable ta Income ox forthe reius yet evant the Asessrent Year 23-14 Place > SIGN HERE > 1 ete rede Te at Pope pe br ee aoe Name of tne TAP N10 Digit) ‘Amount tobe paid to TAP ‘TAP Signature SSE Pa SST VTS CTEGEEED (1) Ener tas ot advance Tax anc Slt Assessment Tax n DIGandDY1 (2) Continue in Supplementary Schedule i you cannot within Se aE VO a ee eo . TAN(col.i) NAME OF THE EMPLOYER(col.ii), INCOME UNDER SALARY(col.iii) TAX DEDUCTED(col. iv) fed ARETE Eee oo wrt Cd LUT) LLL SLi iiiiiii|*L__ id . (1) Enter the tota! of column (v) of Sch TOSt and column (viet Sch TOS2 in B12 (2) Continue in Supplementary Schedule TOS1 i you cannot fill within Sch TOST . APR Ee UCU eae eG dU Gh : n ce — EAN VA TREY TASK” A BL bl TOOT) nO Coo) BrLiiiiiy TOOT Pt OT Coo | lara maararmacconnaner ly mmvonnastsrnaa |Fannin nnn a) AY 2013-14 | be Le : SUPPLEMENTARY (Tobe used ony after exhausting items S13 of Scheule TOS in main form el) : ag ee . SS) PETE EEtr tt Lo * BLoiiiil> -OOO1TT) OOO = eS , -OOOT0) OOo = eM Loe -~OOTT) OTT: Behl OOO OOM : mrp Tt “TTI . eS L oo de cl > : PemLo i> OOo > : memL | ‘MOTD COO : eS] iid -~OO010) ‘CLOG = Li . OO) OTT § SLi | OOO OOM : SOP iid OOOO) OO = som ~OLOTL -OLOTL : esl > ‘OO . : FmLoiiiiiil> ‘OOO OOO: eS Li iii | OOO) -O OTT) = ele OOO) OOO = 2 -~OTT11) OTT: BML , OOOO Oo ITT) s eS iiid OOO TT) OT = HL |e -OOT , : Lol ‘OOO OO: e@Loiiiiis , *MOOOTD ‘OOo = eS Pi -~OO011) OOO = SH Liiiiiiids OOO) OO) CITT) | "ee —perce AY 2013-14 | ‘MIDDLE NAME LAST NAME met Lol SCORE a ae aren [amma PUM Ly SUPPLEMENTARY ‘aa ‘ETH ODUETER (i) METH CE. wei) el er EPeE rd . BL iil > aml pf , Uf u O I RL fl , UT U OOo 2BeL bOI 2h bL)- Coo 2M bOI Lib} On) rei bl) ML hl Moon [ MO Aa 2 ih Soho bOI ML bh PO) 2@ Li bl) OOo MWh ih POT Pm Lb OTT ML hl Moon [ MO == . 2® iit Li PLOT f(b MOT e@ Li bOI 2 bf)» PemLioiwiib TT rib ‘OOO e@ ff . I Ul Ph " " |e , , Aa Bete eeeeeePeeee Ee seca a| somsomnme ay gora-ta | IDDLE NAME LAST NAMI mw nnn ll FIRST il a! Jit t titi rit Il Piitiiitit | Jeti tet titit a Aaa ae (To be used only after exhausting items R1-R5 of Schedule IT in main form etc) . BSA CODE(col.i) DDATE OF DEPOSIT (coli WW NO(c0. i) ‘TAX PAID(cl.v E » OTT | i | | AA Aa BH oF . | AA fa : T | , AA oa = aH 4 im L