Fn vai | ceived wt thanks am 2 retum atincome ITRo, » > (SAHA) » 2 BOS pO ATGUGHM) > 4 pO S pO 6 foratestment year 2011-2, having ie following parte IND FIRST NAME (82 miDOLE NAME pees BAST NAME (Md PERMANENT ACCOUNT NUMBER Poteet it] I I (AS) SEX (X® DATE OF BIRTH kD INCOME TAX WARD/CIRCLE © Male © Female || EL 12 A® FLAT/DOOR/BUILOING TAS ROAD/STREET . Pe (NID AREAMLOCALITY [ALD TOWNICITY/DISTRICT . Pe nD stare (ntgPINCODE . . . (RAFAL ony one ted» © Beta > © er de a1)» © Ree eu 1988) OR inrasane a ote » O12) » OMG 1SNIBHC PMT a me ENDRENE Gat Cir EM Gross Total Income » Bt ( [yy Deductions under Chapter VI-A >s2 [J TIIIITIITIIIL EE Total Income > 63 (CITT TT EFM current Loss if any »Bs(P IIIT Er] Net Tax Payable ~e [ITT Fry) Interest Payable ee flit Titi ttii= Eyp) Total Tax and Interest Payable -a (MTs LT.3) Total Advance Tax Paid ~es (TUTTI s EC Total Self Assessment Tax Paid >e CITI [aT Total TDS Deducted so [TTT TTT IIIT Ean] Total TCS Deducted -et [TTI TITIITIIT Cyr] Total Prepaid Taxes (B8+B9+B10+811) ez [TTI TIITIIITT ESF) Tax Payable ( B7-B12, It B7 > B12) -si3, CITITITITIIT = ESP} Refund ( B12-B7, If B12 > B7) “a¢ COTIIITITT TT) = FOR OFFICIAL USE ONLY P RECEIPT NO. HERE [-