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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

2012-13

(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 / Locality

Town/City/District

State

Email Address

Mobile no

Pin Code

FILING STATUS

O-Original

Employer Category (if in
employment) OTH
Return filed under section
[Pl see Form Instruction] 11-BeforeDueDt
139(1)

If revised, enter Original Ack no / Date
If u/s 139(9)-defective return , enter
Original Ack No

Date

If u/s 139(9)-defective return , enter Notice
No
Residential Status

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

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

1 Income from Salary / Pension (Ensure to fill Sch TDS1)
Income from one House Property
2

TAX COMPUTATION

INCOME & DEDUCTIONS

3

1
2

Income from Other Sources (Ensure to fill Sch TDS2)

4 Gross Total Income (1+2+3)
5 Deductions under Chapter VI A (Section)
a 80 C
5a
b 80 CCC
5b
c(i) 80 CCD (Employers Contribution)
5c(i)
80 CCD (Employees / Self Employed
c(ii)
5c(ii)
Contribution)
d 80 CCF
5d
e 80 D
5e
f 80 DD
5f
g 80 DDB
5g
h 80 E
5h
i 80 G
5i
j 80 GG
5j
k 80 GGA
5k
l 80 GGC
5l
m 80 U
5m
6 Deductions (Total of 5a to 5m)
6
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 Relief under Section 89
11
12 Relief under Section 90/91
12
13 Balance Tax Payable (10 - 11 - 12)
14 Total Interest u/s 234A 234B 234C
15 Total Tax and Interest Payable (13 + 14)

3

0

4

0
System Calculated

0
0
0
0
0
0
0
0
0
#NAME?
0
0
0
0
#NAME? 6
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9
10
0
0
13
14
15

0
0
0
0
0
0
0
0
0
#NAME?
#NAME?
0
0
0
#NAME?
#NAME?
0
0
0

0
0
0

Import Persona

Do not delete blank rows.No (1) 1 2 3 Tax Deduction Account Number (TAN) of the Employer (2) Name of the Employer Income charg eable under the head Salaries Total tax Deducted (3) (4) (5) (Click + to add more rows to 23) TDS on Salary above. ) 24 Details of Tax Deducted at Source on Income OTHER THAN SALARY [As per FORM 16 A issued by Deductor(s)] SI. Do not delete blank rows.No (1) 1 2 3 4 Tax Deduction Account Number (TAN) of the Deductor Name of the Deductor Unique TDS Certificate No. Do not delete blank rows. ) . ) 25 Sl No Details of Advance Tax and Self Assessment Tax Payments BSR Code Date of Credit into Govt Account (DD/MM/YYYY) Serial Number of Challan Amount (Rs) 1 2 3 4 5 6 (Click '+' to add more rows ) Tax Payments. Deducted Year Total tax Deducted Amount out of (6) claimed for this year (2) (3) (4) (5) (6) (7) (Click + to add more rows ) TDS other than Salary above.23 Details of Tax Deducted at Source from SALARY [As per FORM 16 issued by Employer(s)] SI.

16a 16b 0 c Self Assessment Tax (item 25) 16c Total Taxes Paid (16a+16b+16c) Tax Payable (15-17) (if 15 is greater than 17) Refund (17-15) if 17 is greater than 15 Enter your Bank Account number 0 a Advance Tax (from item 25) b TDS (Total from item 23 + item 24) 17 18 19 20 0 17 18 19 0 0 0 21 Select Yes if you want your refund by direct deposit into your bank account. solemnly declare that to the best of my knowledge and belief. Select No No if you want refund by Cheque 22 In case of direct deposit to your bank account give additional details MICR Code Type of Account(As applicable) 26 Exempt income for reporting purposes only VERIFICATION son/daughter of I. 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. amount thereof (to be filled by TRP) . 1961.TAXES PAID REFUND 16 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. in respect of income chargeable to Incometax for the previous year relevant to the Assessment Year 2012-13 Place Date Sign here -> PAN 27 If the return has been prepared by a Tax Return Preparer (TRP) give further details as below: Identification No of TRP Name of TRP 28 If TRP is entitled for any reimbursement from the Government.

Schedule 80G Details of donations entitled for deduction under section 80G (PLEASE READ NOTE BELOW) Donations entitled for 100% deduction without qualifying limit A Name of donee Address City or Town or District State Code PinCode PAN of Donee Amount of Eligible donation Amount of Donation 0 0 0 0 1 2 3 4 Total 80GA B Donations entitled for 50% deduction without qualifying limit Name of Address City or Town or State Code donee District 0 PinCode PAN of Donee Amount of Eligible donation Amount of Donation 0 0 0 0 1 2 3 4 Total 80GB : C 0 Donations entitled for 100% deduction subject to qualifying limit Name of Address City Or Town Or State Code donee District 1 2 3 4 Total 80GC : 0 PinCode 0 PAN of Donee Amount of Eligible donation Amount of Donation #NAME? #NAME? #NAME? #NAME? 0 #NAME? .

D Donations entitled for 50% deduction subject to qualifying limit Name of Address City Or Town Or State Code donee District 1 2 3 4 PinCode PAN of Donee Amount of Eligible donation Amount of Donation #NAME? #NAME? #NAME? #NAME? Total 80GD E Donations (A + B + C + D) NOTE : (IN CASE OF DONEE FUNDS SETUP BY GOVERNMENT AS DESCRIBED IN SECTION 80G(2). 0 #NAME? 0 #NAME? . PLEASE USE PAN AS "GGGGG0000G".