Acknowledgment Number : INDIAN INCOME TAX RETURN FORM _ [For individuals being a resident (other than not ordinarily resident) havi having Income from Salaries, one house property, other sources (Interest ITR1 Rs.5 thousand] [Not for an individual who is either Director in a company SAHA) shares or in cases where TDS has been deducted u/s 194N or if income- instructions for eligibility) PART A GENERAL INFORMATION (Al) PAN (A2) First Name (A2a) Middle Nam BFXPP6370R NIHAR RANJAN (a4) Date of Birth (AS) Aadhaar Number(12 digits)/Aadhaar Enrolment Id(2 Conaase eligible for Aadhaar No.) XXX 10x 0675 (A7) Email Address (A8) Flat/Door/Block No. eect nihar19ndb@gmail.com PURUSOTT AMPUR KHAIRA (A11) Town/City/District (A12) State (A13) Country/Reg Khaira S.0 (Baleswar) 24-Odisha 91-INDIA (A17) Nature of employment Public Sector Un (A15)(a) Filed u/s (Tick)[Please see instruction] 139(1)-On or bet {A16) Or Filed in response to notice u/s (A18) If revised/defective then enter Receipt No. and Date of filing of original return (DD/MM/YYYY) {A19) If filed in response to notice u/s 139(9)/142(1)/148 or order u/s 119(2)(b)- enter Unique Number/ Document Identification Number (DIN) & Date of such Notice or Order (A20) Are you opting for new tax regime u/s 115BAC? T Yes No (A21) Are you filing return of income under Seventh proviso to section 139(1) but otherwise nc ¥ Yes No If yes, please furnish following information (Note: To be filled only if a person is not required to filing return of income due to fulfilling one or more conditions mentioned in the seventh provis {i) Have you incurred expenditure of an amount or aggregate of amount exceeding Rs. 2 lakhs foreign country for yourself or for any other person? T Yes No (ii) Have you incurred expenditure of amount or aggregate of amount exceeding Rs. 1 lakh on electricity during the previous year? Tl Yes¥ No (iv) Are you required to file a return as per other conditions prescribed under clause (iv) of sev relevant condition from the drop down menu) M YesT No SI No, Nature the aggregate of tax deducted at source and tax collected at sourceAcknowledgment Number B2 si No. iia Nature of Exempt allowances Description ( If Any Other Sec 10(14)(i)- Prescribed Allowances or benefits (not in a nature of perquisite) specifically granted to meet expenses wholly, necessarily and exclusively and to the extent actually incurred, in performance of duties of office or employment Sec 10(14)(ii) -Prescribed Allowances or benefits granted to meet personal expenses in performance of duties of office or employment or to compensate him for increased cost of living Sec 10(7)-Allowances or perquisites paid or allowed as such outside india by the Government to a citizen of India for rendering service outside India Less : Income claimed for relief from taxation u/s 89A Net Salary (i- ii - iia) Deductions u/s 16 (iva + ivb + ivc) a Standard deduction u/s 16(ia) b Entertainment allowance u/s 16(ii) c Professional tax u/s 16(iii) Income chargeable under the head ‘Salaries’ (iii - iv) Type Of House Property Gross rent received/ receivable/ lettable value during the year Tax paid to local authorities Annual Value (i - ii) 30% of Annual Value Interest payable on borrowed capitalAcknowledgment Number : B4 (i) Up to 15-Jun-2022 0 (i) From 16-Jun-2022 to 15-Sep-2022 From 16-Sep-2022 to (ii) 15-Dec-2022 9 (ii) (i) 0 (ii) From 16-Dec-2022 to 15-Mar-2023 From 16-Mar-2023 to 31-Mar-2023 (iv) 0 (iv) (v) Less: Income claimed for relief from taxation u/s 894 Less: Deduction u/s 57(iia) (in case of family pension only) Gross Total Income (B1+B2+B3) (f loss, put the figure in negative) Note of carry forward and set off of loss, please use ITR-2Acknowledgment Number PART C - DEDUCTIONS AND TAXABLE TOTAL INCOME SI.No. Section 80C - Life insurance premia, deferred annuity, contributions to provident fund, subscription to certain equity shares or debentures, etc 80CCC - Payment in respect Pension Fund 80CCD(1) - Contribution to pension scheme of Central Government 80CCD(1B) -Contribution to pension scheme of Central Government 80CCD(2) - Contribution to pension scheme of Central Government by employer 80D - Deduction in respect of health insurance premia 80DD - Maintenance including medical treatment of a dependent who is a person with disability - 80DDB - Medical treatment of specified disease - 80E - Interest on loan taken for higher education 80EE - Interest on loan taken for residential house property 80EEA - Deduction in respect of interest on loan taken for certain house property 80EEB - Deduction in respect of purchase of electric vehicleAcknowledgment Number : r 80TTB- Interest on deposits in case of senior citizens. s 80U - In case of a person with disability - t 80CCH- Contribution to Agnipath Scheme Total deductions (Add items a to t) Total Income EXEMPT INCOME (FOR REPORTING PURPOSES) SI No. Nature of Income Description ( If Any Other selec Total PART D - COMPUTATION OF TAX PAYABLE D1 Tax payable on total income D2 Rebate u/s 87A D3 Tax after rebate D4 Health and education Cess @4% on D3 DS Total Tax and Cess Dé Relief u/s 89 (Please ensure to submit Form 10E to claim this relief) D7 Interest u/s 234A D8 Interest u/s 2348 bg Interest u/s 234C D10 Fee u/s 234F Dll Total Tax. Fee and Interest (D5 + D7 + D8 + DO + D10 - D6)Acknowledgment Number : (a) Self & Family 0) Health Insurance (ii) Preventive Health Checkup (b) Self & Family including Senior Citizen (i) Health Insurance (ii) Preventive Health Checkup Medical Expenditure (This deduction to be claimed on which health insure (ii) pot claimed at (i) above) 2 Whether any one of your parents is a senior citizen (a) Parents 0) Health Insurance (il) Preventive Health Checkup (b) Parents including Senior Citizen 0) Health Insurance (ii) Preventive Health Checkup (iii Medical Expenditure (This deduction can be claimed on which health insu not claimed at (i) above) 3 Eligible Amount of Deduction SCHEDULE 80G DETAILS OF DONATIONS ENTITLED FOR DEDUCTION UNDER SECTION A. DONATIONS ENTITLED FOR 100% DEDUCTION WITHOUT QUALIFYING LIMIT, (WHE! FIELDS IN THAT ROW SHOULD BECOME MANDATORY) City or Address Townor Statecode Pin code District PAN of the Donee Name of SINO- the DoneeAcknowledgment Number : ARN City or (Donati SINo. ,Name of Address Town or State code Pin code PAN OF® Referer District Numbe Total D E. Total Amount of Donations (A + B + C + D) SCHEDULE 80GGA DETAILS OF DONATIONS FOR SCIENTIFIC RESEARCH OR RURAL DE Relevant Clause , City or \ SINo, under Name of address Town or State Code Pin code PAN of e Donee ener jone Total SCHEDULE IT DETAILS OF ADVANCE TAX AND SELF-ASSESSMENT TAX PAYMENTS SI No. BSR Code Date of Deposit (DD/MM/YYYY) _ Serial Nun Total SCHEDULE TDS11 - DETAILS OF TAX DEDUCTED AT SOURCE FROM SALARY [AS PER FC SI No. TAN of the Deductor Name of the Deductor Domes ch 1 DELP26003F PUNJAB NATIONAL BANK Total SCHEDULE TDS2 - DETAILS OF TAX DEDUCTED AT SOURCE FROM INCOME OTHER THi DEDUCTOR(S)] Gross receipt which is subject to tax deduction Year of t deductic Name of the SI No. TAN of the Deductor Deductor Total SCHEDULE TDS3 DETAILS OF TAX DEDUCTED AT SOURCE (AS PER FORM 16C FURNIS Gross receipt which is subject to tax deduction PAN ofthe AadhaarNumber Name of the SIN Tenant of the Tenant Tenant TotalAcknowledgment Number : TRP PIN (10 digit) Name of TRP. Counter Sig Amount to be paid to TRP o