SAHAJ

FORM

ITR-1

INDIAN INCOME TAX RETURN

[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)]

Assessment Year
Year

2011-12

(Please see rule 12 of the Income-tax Rules,1962) (Also see attached instructions)

PERSONAL INFORMATION

First Name

Middle Name

Last Name

PAN

Flat / Door / Building

Status
I - Individual

Road / Street

Area / Locallity

Town/City/District

State

Email Address

Mobile no

Pin Code

FILING
STATUS
INCOME & DEDUCTIONS
TAX COMPUTATION

Employer Category (if in

employment) OTH
Return filed under section
[Pl see Form Instruction] 11 - u/s 139(1)

O-Original

If revised, enter Receipt no / Date

RES - Resident
Residential Status
1 Income from Salary / Pension (Ensure to fill Sch TDS1)
Income from one House Property
2
3

Sex (Select)
M-Male

(Std code) Phone No

Income Tax Ward / Circle

Whether original or revised return?

Date of birth (DD/MM/YYYY)

00/00/0000

Income from Other Sources (Ensure to fill Sch TDS2)

4 Gross Total Income (1+2c)

5 Deductions under Chapter VI A (Section)
5a
a 80 C
5b
b 80 CCC
5c
c 80 CCD
5d
d 80 CCF
5e
e 80 D
5f
f 80 DD
5g
g 80 DDB
5h
h 80 E
5i
i 80 G (Eligible Amount)
5j
j 80 GG
5k
k 80 GGA
5l
l 80 GGC
5m
m 80 U
6
6 Deductions (Total of 5a to 5m)
7 Total Income (4 - 6)
8 Tax payable on Total Income
9 Education Cess, including secondary and higher secondary cess on 8
10 Total Tax, Surcharge and Education Cess (Payable) (8 + 9)
11
11 Relief under Section 89
12
12 Relief under Section 90/91
13 Balance Tax Payable (10 - 11 - 12)
14 Total Interest Payable
15 Total Tax and Interest Payable (13 + 14)
For Office Use Only
Receipt No/ Date

Date
1
2
3
0

4
System Calculated
0
0
0
0
0
0
0
0
0
0
0
0
0
0 6
7
8
9
10
0
0
13
14
15
Seal and Signature of
Receiving Official

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0