SAHAJ

FORM

ITR-1

INDIAN INCOME TAX RETURN

2013-14

PERSONAL INFORMATION

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

First Name

Middle Name

Last Name

PAN

Flat / Door / Building

Status
I - Individual

Road / Street

Area / Locality

Date of birth
00/00/0000

Town/City/District

State
(Select)

Email Address

Mobile no 1 (Std code) Phone No

Country (Select)
(Select)

FILING STATUS

Income Tax Ward / Circle

Are you Governed by Portugese Civil Code under Section 5A?
Whether original or
(Select)
revised return?
If u/s 139(9)-defective return , enter
Original Ack No

INCOME & DEDUCTIONS

(Select)
Date

(Select)

(Select)

Income from Other Sources (Ensure to fill Sch TDS2)

4 Gross Total Income (1+2+3)

5 Deductions under Chapter VI A (Section)
5a
a 80 C
5b
b 80 CCC
5c
c 80 CCD (Employees / Self Employed Contribution)
80 CCD (Employers Contribution)
5d
d

6
7
8
9
10
11
12

13
14

Mobile no 2 EmployerCategor
(Select)
Return filed under section
(Select)

If u/s 139(9)defective return ,

enter Notice Date

1 Income from Salary / Pension (Ensure to fill Sch TDS1)

Income from one House Property
2
3

Sex
(Select)

Pin Code

If revised, enter
OriginalAck no/Date

If u/s 139(9)-defective return , enter Notice

No
Residential Status

TAX COMPUTATION

Assessment
Year

[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)]

5e
e 80 CCG
5f
f 80 D
5g
g 80 DD
5h
h 80 DDB
5i
i 80 E
5j
j 80 G
5k
k 80 GG
5l
l 80 GGA
5m
m 80 GGC
5n
n 80 QQB
5o
o 80 RRB
5p
p 80 TTA
5q
q 80 U
6
Deductions (Total of 5a to 5q)
Total Income (4 - 6)
Tax payable on Total Income
Education Cess, including secondary and higher secondary cess on 8
Total Tax and Education Cess (Payable) (8 + 9)
Relief under Section 89
11
Balance Tax Payable (10 - 11 )
13
a Interest payable u/s 234 A
b Interest payable u/s 234 B
c Interest payable u/s 234 C
Total Interest u/s 234A 234B 234C
Total Tax and Interest Payable (12 + 13)

0
0

4
System Calculated
0
0
0
0

0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0 6
7
8
9
10
0
12
13a
13b
13c
13
14

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

0
0
0
0
0
0
0
0
0
0
0

22

Details of Tax Deducted at Source from SALARY

[As per FORM 16 issued by Employer(s)]
Tax Deduction
Name of the
Account Number
SI.No
Employer
(TAN) of the
Employer

(1)

(2)
If no entry is made in
this column, then
columns (3) to (5) will
not be considered for
that row

(3)

Income charg
eable under the
head Salaries

Total tax
Deducted

(4)

(5)

1
2
3
(Click + to add more rows to 22) TDS on Salary above. Do not delete blank rows. )

23

Details of Tax Deducted at Source on Income OTHER THAN SALARY

[As per FORM 16 A issued by Deductor(s)]
Tax Deduction
Name of the
Unique TDS
Account Number
SI.No
Deductor
Certificate No.
(TAN) of the
Deductor

(1)

(2)
If no entry is made in
this column, then
columns (3) to (7) will
not be considered for
that row

(3)

Deducted Year

Total tax
Deducted

Amount out of
(6) claimed for
this year

(5)

(6)

(7)

(4)

1
2
3
4
(Click + to add more rows ) TDS other than Salary above. Do not delete blank rows. )

24

Details of Advance Tax and Self Assessment Tax Payments

(1)
If no entry is
made in this
column, then
columns (2) to
Sl No
(4) will not be
considered for
that row
BSR Code

(2)
Date of Credit into
Govt Account
(DD/MM/YYYY)

(3)
Serial
Number of
Challan

(4)
Amount (Rs)

1
2
3
4
5
6
(Click '+' to add more rows ) Tax Payments. Do not delete blank rows. )

TAXES PAID
REFUND

15 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 below will get filled up when the
Schedules linked to them are filled.
15a
15b

c Self Assessment Tax (item 24)

15c
Total Taxes Paid (15a+15b+15c)
Tax Payable (14-16) (if 14 is greater than 16)
Refund (16-14) if 16 is greater than 14
Enter your Bank Account number

a Advance Tax (from item 24)

b TDS (Total from item 22 + item 23)

16
17
18
19

0
16
17
18

20 Select Yes if you want your refund by direct deposit into your bank account, Select No (Select)
if you want refund by Cheque
21 In case of direct deposit to your bank account give additional details
(Select)
IFSC Code
Type of Account(As applicable)
25 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 2013-14
Place
Date
Sign here ->
PAN
26 If the return has been prepared by a Tax Return Preparer (TRP) give further details as below:
Identification No of TRP
Name of TRP

27

If TRP is entitled for any reimbursement from the Government, amount thereof (to be filled
by TRP)

0
0
0

Details of donations entitled for deduction under section 80G (PLEASE READ NOTE BELOW)
Schedule 80G
Donations entitled for 100% deduction without qualifying limit
If no entry is made in Name of Donee, then for such rows, any value
A
entered in other columns will be ignored. For 80GA to 80GD
Name of Address
City or Town or State Code
PinCode PAN of Donee Amount of
donee
District
donation
(Select)
1
(Select)
2
(Select)
3
(Select)
4
Total 80GA

Donations entitled for 50% deduction without qualifying limit

Name of Address
City or Town or State Code
donee
District
(Select)
1
(Select)
2
(Select)
3
(Select)
4

Donations entitled for 100% deduction subject to qualifying limit

Name of Address
City Or Town Or State Code
donee
District
(Select)
1
(Select)
2
(Select)
3
(Select)
4
Total 80GC :

0
0
0
0
0

PinCode

PAN of Donee Amount of

donation

Eligible Amount
of Donation
0
0
0
0

Total 80GB :

Eligible Amount
of Donation

PinCode

PAN of Donee Amount of

donation

Eligible Amount
of Donation
0
0
0
0
0

Donations entitled for 50% deduction subject to qualifying limit

Name of Address
City Or Town Or State Code
donee
District
(Select)
1
(Select)
2
(Select)
3
(Select)
4

PinCode

PAN of Donee Amount of

donation

Total 80GD

Donations (A + B + C + D)

NOTE : (IN CASE OF DONEE FUNDS SETUP BY GOVERNMENT AS DESCRIBED IN SECTION 80G(2),
PLEASE USE PAN AS "GGGGG0000G".

Eligible Amount
of Donation
0
0
0
0
0