INDIAN INCOME TAX RETURN VERIFICATION FORM Sonoma Tor Bry] Wench en GAONTROTR Z 5 2A, ITR-3, ITR-4S (SUGAM), ITR-4, ITR-5, ITR-7 transmitted electronically without digital signature] . 2016. -17. Css aed events 190) ‘GAJANAN RAMCHANDRA CHATAGE ——— TZ 8 [ARCPGSSI9A a | FhuDeorBbekNe ‘Name Of Premises/Building/Villige Form No. which —EaEs:§: Eve has heen irm2 = | Door No.7 — ron: ° BES Basava Apartment and ally Ese ‘eammitted| 2 | Recuseeeinet one ‘ArealLacality BEE | Bankes Glny Malgund Read Senn al ei 2 emcnmeer i sate 2 Cadag 7 KARNATAKA ss2101 & * | Designation of AO (Ward / Circle) [WARD 10(4), PUNE (Originalor Revived [ ORIGINAL E-filing Acknowledgement Number _[374676040030816 || Dateop-MM-vy¥¥)|_03-08-2016 T] Grom Fotal income I 375084 2 | Deduction wnder Chapter: VEA 2 129204 3 | Total Income 3 248870 8 | Curent Year ley, ayy a 0 Sz | T)NetTaxPaysble il Sant ~ 4 o 23 | 5) Interest Payable 5 0 BB [6] total Tax and interest Payable 0 25 [7 a=Par TAY gs a | Advance Tax Ta 0 E g ® | TDs te TH a 3 « [res Te a S a [ Self Aasearment Tax a a [Total Taxes Paid (at 7627670) 7 76 $ | Tax Payable E79 3 0 3 | Refind C6) 3 70 | er ‘Aeseultare <= ‘Others w ‘VERIFICATION 1, GAJANAN RAMCHANDRA GHAI sow daughter of RAMCHANDRA hold Permanent Account Nassber _ APCPGORSOA solemnly declae to thebestof my knowlege and belief the information given in He sebum and the schedule; thereto which have been treated clechoncally by me vide acknowledgement miner mentioned above is conect and complet are that the amex of total income and other parcalas shoven therein are tuly stated and are in accordance withthe provisiows ofthe Income-tax Act 1961, inzespectof income chargeable fo income-tax fo ‘the previous year zelevant othe assessment year 2016-17. I futher declare that Iam making this rebum in muy capacity as and I am also competent to make ths bum and verify it. ‘Sign here [Date 03-08-2016 Place GADAG If the return has been prepared by a Tax Return Preparer (IRP) give further details ar below: Tdentification No. of TRP| ‘Name of TRP. Counter Signature of TRP es Ill For Office Ure Only Receipt No Date Seal and signanoe of recewving offal Please send the duly signed FomaTTR-V to “Centralized Processing Centre, Income Tax Department, BengaharuS60500", by ORDINARY POST OR SPEED POST ONLY, within 120 days fiom date of transmitting the data elechonically. Form ITR-V shall notbe received in any other bffice of the Income-tax Depastmentorin any other manner. The confizmation of receipt ofthis FormITR-V at ITD-CFC willbe zent to the e-mail baddieze joan? 177 Qaim