APPLICATION FORM

(For Filing of Income Tax Return)

Applicant Details as per PAN Card. Please fill in BLOCK Letters.
ITD Portal
PAN *
Password *
Assessment AY 2021-22 p Salaried/  Salaried p Self-Employed/ p
Year*  (01-04-2020 to 31-03-2021) Sef Employed Business Persons

Full Name *

Father Name*

Date of Birth * / / Mobile*

Address *

State* PIN Code *

Email *

Aadhaar Number*

Bank Account Number *

Type of A/C
Name of Bank * Savings Bank A/C. o Current Account 

IFSC CODE (Verify your ChequeBook or Bank Passbook for this Code) *

Applicant Annual Income & Deductions

Annual Income * Deductions *

Income from Salary/ Pension
(Attach Form 16 Part A & Part B) Rs. Life Insurance Policy Premimum Paid Rs.

Income from Business/Profession Rs. Medical Insurance 80D Rs.

Income from House Property (Rental Income) Rs. House Rent Paid 80GG(Only for Self-Employed) Rs.

Income from Capital Gains (Sales of Assets) Rs. PF/PPF/NPS/Bank Fixed Deposits Rs.
Income from Other Sources
(Bank Interest, Lottery, Etc.) Rs. Kids School Fee Rs.

Agricultural Income (Tax Free) Rs. Interest On Housing Loan Rs.

Gross Total Income (Total Of above 6 Columns) Rs. Housing Loan Principal Payment Rs.
Note*: For Salaried Persons Form 16 Part A & Part B is compulsory.
Any Other Deductions Rs.
TDS Particulars
If TDS is deducted TAN number of
TDS If Any (Yes/No)*
Deductor/Employer Rs.

Name of the Deductor / Employer

Self Employed Only
Profit & Loss, BS Required?  p
Note: Tax Genius calls the Applicant for collecting required information necessary for processing the Application. Income Tax Return will be filed within 10 working days subject to receipt of
required full information from Applicant. Any missing Information can be sent to info@taxgenius.co.in. Tax Genius reserves the right to reject any Application on any technical grounds
beyond the control of Tax Genius / CSC SPV and refund the service charges collected. Applicant can collect the user charges for rejected transactions at concerned CSC Centre. E-filing
Acknowledgements will be send to Applicant's email ID or they can be collected from Concerned CSC Center. After receiving the Acknowledgements, Applicant shall send the signed ITR V form to
CPC Bangalore address by post / e-Verify the same. This service is only for Individual and Non-Audit cases. No Audit stamp will be provided.Tax Genius is not responsible for late payment fee or
penalties. The Applicant and the Tax Genius LLP agree to submit to the exclusive jurisdiction of the Courts located in Hyderabad, India as regards any claims or matters arising under these terms &
conditions.

** DECLARATION: I here by declare that the details furnished above are ture and
correct to the best of my knowledge. Further I hereby authorize Tax Genius LLP to
Register / Alter my Profile at www.incometaxindiaefiling.gov.in for accesing TDS
particulars and filing my Income Tax Return. ** (Signature of the Applicant) *
Head Office: M/S. Tax Genius LLP, 5-7-1/599, Plot No 599WP, Hariharapuram, Vanasthalipuram, Hyderabad-500070. Ph: 8019448888