FORM

INDIAN INCOME TAX RETURN VERIFICATION FORM

Assessment Year

[Where the data of the Return of Income in Form ITR-1 (SAHAJ), ITR-2, ITR-3,

ITR-V

ITR-4S (SUGAM), ITR-4, ITR-5, ITR-7 transmitted electronically without digital signature]

2014 - 15

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

PERSONAL INFORMATION AND THE

DATE OF ELECTRONIC
TRANSMISSION

Name

PAN

NILIMA PURUSHOTTAM BARDE

ASBPB1945L
Flat/Door/Block No
WARD NO 16

Name Of Premises/Building/Village

Road/Street/Post Office

Area/Locality

ITR-1

Sandeep Mangalam
Town/City/District

State

Status

Pin

Individual

YAVATMAL
MAHARASHTRA

445001
Original or Revised

Designation of AO (Ward / Circle) ITO WD-1, YTL

E-filing Acknowledgement Number

COMPUTATION OF INCOME
AND TAX THEREON

Form No. which

has been
electronically
transmitted

553644870310315

Date(DD-MM-YYYY)

ORIGINAL
31-03-2015

Gross Total Income

52000

2
3

Deductions under Chapter-VI-A

Total Income
a
Current Year loss, if any
Net Tax Payable
Interest Payable

2
3
3a
4
5

0
52000
0
0

Total Tax and Interest Payable

Taxes Paid
a
Advance Tax

5
6
7

8
9

7a
7b
7c

TDS

c
TCS
d
Self Assessment Tax
e
Total Taxes Paid (7a+7b+7c +7d)
Tax Payable (6-7e)
Refund (7e-6)

0
0

0
5263
0
0

7d

7e
8
9

5263
0
5260

VERIFICATION
, holding
Permanent Account Number ASBPB1945L
I, NILIMA PURUSHOTTAM BARDE son/ daughter of PURUSHOTTAM PUNDLIKRAO
BARDE
solemnly declare to the best of my knowledge and belief, the information given in the return and the schedules thereto which have been transmitted
electronically by me vide acknowledgement number mentioned above 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 2014-15. I further declare that I am making this return in my capacity as
and I am also competent to make this return and verify it.
Sign here

Date

31-03-2015

Place Amravati

If the return has been prepared by a Tax Return Preparer (TRP) give further details as below:
Identification No. of TRP

For Office Use Only

Receipt No

Filed from IP address

Name of TRP

Counter Signature of TRP

115.111.107.30

Date
Seal and signature of
receiving official

ASBPB1945L0155364487031031555DEA9360E5879E5D0A4D0D165690395ABF06A01

Please send the duly signed Form ITR-V to Income Tax Department - CPC, Post Bag No - 1, Electronic City Post Office, Bengaluru - 560100,
Karnataka, by ORDINARY POST OR SPEED POST ONLY, within 120 days from date of transmitting the data electronically. Form ITR-V shall
not be received in any other office of the Income-tax Department or in any other manner. The confirmation of receipt of this Form ITR-V at ITD-CPC
will be sent to the e-mail address bardenilesh@gmail.com