2011-12 ITR-1, PAGE 1

ITR-1 SAHAJ INDIAN INDIVIDUAL INCOME TAX RETURN AY 2011-12FIRST NAME MIDDLE NAME

LAST NAME PERMANENT ACCOUNT NUMBER

SEX DATE OF BIRTH INCOME TAX WARD/CIRCLE

MALE FEMALE

FLAT/DOOR/BUILDING ROAD/STREET

AREA/LOCALITY TOWN/CITY/DISTRICT

STATE PIN

E MAIL ADDRESS

RESIDENTIAL/OFFICE PHONE NO. WITH STD CODE MOBILE NO.Fill only one if you belong to Government PSU Others

Fill only one Tax Refundable Tax Payable Nil Tax Balance Fill only one Resident Non Resident

Resident but not ordinarily residentFill only one filed Before due date-139(1) After due date-139(1) Revised Return-139(5) or in response of notice

142 (1) 148 153/153C

If revisedReceipt Number of Original Return and Date of Filing Original Return

PART B - GROSS TOTAL INCOME Whole- Rupee (`) Only

Income from Salary/PensionEnsure to fill "Sch TDS1" given in Page 2 B1

If showing loss, mark the nagative sign in bracket at left

Income from One House Property B2 ( )

Income from other sources B3 ( )Ensure to fill "Sch TDS2" given in Page 2

Gross Total Income (B1+B2+B3) B4 ( )

PART C- DEDUCTIONS AND TAXABLE INCOME (Refer to Instructions for Limits on Amount of Deductions as per "Income Tax Act")

C1 C2 C3

C4 C5 C6

C7 C8 C9

C10 C11 C12

C13

Total Deductions (Add items C1 to C13) C14

Taxable Total Income (B4-C14) C14 ( )

FOR OFFICIAL USE ONLY

SEAL, DATE AND SIGNATURE OF RECEIVING OFFICIAL

B4

C1

to

C13

NOTE

C14

C15

STAMP RECEIPT NO. HERE

B3

B1NOTE

B2

80C

A1 A2

A3 A4

A5 A6 A7

A8 A9

A10 A11

A12 A13

A14

A15 A16

A18 A19

A20

A21

80CCC 80CCD

80CCF 80D 80DD

80DDB 80E 80G

80GG 80GGA 80GGC

80U

A17

0B

PERMANENT ACCOUNT NUMBER

2011-12 ITR-1, PAGE 2

PART D--TAX COMPUTATION AND TAX STATUSD1to Tax Payable on Total Income Secondary & Higher Education Cess TOTAL TAX AND CESS (D1+D2)D3

D4 Relief u/s 89 Relief u/s 90/91 Balance Tax After Relief (D3-D4-D5)toD6

D7 Total Interest u/s 234A/234B/234C Total Tax and Interest (D6+D7) Total Advance Tax PaidtoD9

Total Self Assessment Tax Paid Total TDS Deducted Total Prepaid Tax (D9+D10+D11)D10to

Tax Payable (D8-D12, if D>D12) Refund (D12-D8, if D12>D8)D13toD14

Bank Account Details (Mandatory in all cases irrespective of refund due or not

D15 ACCOUNT No. D16 MICR CODE

D17 Type of account Current Savings D18 Fill only one :Refund by Cheque  deposited directly into your bank account

D19 Exempt income only for reporting purposes (From Dividends, Agricultural Income < ` 5000/-)

I, Son/daughter of Solemnly declare that to the best of my

knowledge and belief, the information given in the return 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 provision of the Income-tax act, 1961

in the respect of income chargeable to Income-tax for the previous year relevant to the Assessment Year 2011-12.

Place SIGN HERE

If the return has been prepared by a Tax Return Preparer (TRP) give further details as below

Name of TRP TRP PIN [10 Digit] Amount to be paid to TRP

Sch IT-DETAILS OF ADVANCE TAX AND SELF ASSESSMENT TAX PAYMENTS

BSR CODE (col.i) DATE OF DEPOSIT (Col.ii) CHALLAN NO. (col.iii) TAX PAID (col. Iv)

(1) Enter the total of Advance Tax and Self Assessment Tax in D9 and D10 (2) Continue in Supplementary Schedule IT if your Cannot Fill Within Sch IT

Sch TDS1-DETAILS OF TAX DEDUCTED AT SOURCE FROM SALARY [As per Form 16 Issued by Employer (s)]

TAN (col.i) NAME OF EMPLOYER (S) (col.ii) INCOME UNDER SALARY (col. iii) TAX DEDUCTION

(1) Enter the total of column (iv) of Sch TDS1 and Sch TDS2 in D11 (2) Continue in Supplementary TDS 1 if you cannot fill within Sch TDS1

Sch TDS2-DETAILS OF TAX DEDUCTED AT SOURCE FROM INCOME OTHERTHAN SALARY [As per Form 16 Issued by Deductor (s)]

TAN (col.i) NAME OF DEDUCTOR (col.ii) TAX DEDUCTION (col. iii) AMT OUT OF (III) CLAIMED THIS YR (col. Iv)

(1) Enter the total of column (iv) of Sch TDS1 and Sch TDS2 in D11 (2) Continue in Supplementary TDS 2 if you cannot fill within Sch TDS2NOTE

D3

VERIFICATION

D1 D2

D4 D5

D7

D6

D9

D10

D8

D11 D12

D13 D14

NOTE

TRP Signature

D12

NOTE

R1

R2

R3

R4

R5

S1

S2

S3

T1

T2

T3

1B

PERMANENT ACCOUNT NUMBER

AY 2011-12 FIRST NAME MIDDLE NAME LAST NAME

TAN (col.i) NAME OF EMPLOYER (col. ii) INCOME UNDER SALARY (col.iii) TAX DEDUCTED (col. iv)

`

`

`

`

`

`

`

`

`

`

SUPPLEMENTARY SCHEDULE TDS 1 (To be used only after exhausting items S1-s3 of Schedule TDS1 in main form etc.)

S4

S5

S6

S7S

S8

S9

S10

S11

S12

S13

S14

S15

S16

S17

S18

S19

S20

S21

S22

S23

S24

S25

S26

S27

S28

S29

S30

2B

PERMANENT ACCOUNT NUMBER

AY 2011-12

FIRST NAME MIDDLE NAME LAST NAME

TAN (col.i) NAME OF DEDUCTOR (col. ii) TAX DEDUCTED (col.iii) AMT OUT OF (III) CLAIMED THIS YR (col. iv)

`

`

`

`

`

`

`

`

`

`

SUPPLEMENTARY SCHEDULE TDS 2 (To be used only after exhausting items T1-T4 of Schedule TDS2 in main form etc.)

T4

T5

T6

T7

T8

T9

T10

T11

T12

T13

T14

T15

T16

T17

T18

T19

T20

T21

T22

T23

T24

T25

T26

T27

T28

T29

T30

3B

PERMANENT ACCOUNT NUMBER

AY 2011-12

FIRST NAME MIDDLE NAME LAST NAME

TAN (col.i) NAME OF DEDUCTOR (col. ii) TAX DEDUCTED (col.iii) AMT OUT OF (III) CLAIMED THIS YR (col. iv)

`

`

`

`

`

`

`

`

`

`

SUPPLEMENTARY SCHEDULE TDS 2 (To be used only after exhausting items T1-T4 of Schedule TDS2 in main form etc.)

R4

R5

R6

R7

R8

R9

R10

R11

R12

R13

R14

R15

R16

R17

R18

R19

R20

R21

R22

R23

R24

R25

R26

R27

R28

R29

R30

4B

ITR-V ACKNOWLEDGEMENT AY 2011-12Received with thanks from a return of income inITR No. 1 (SAHAJ) 2 3 4 (SUGAM) 5 6 for assessment year 2011-12 having following particulars

FIRST NAME MIDDLE NAME

LAST NAME PERMANENT ACCOUNT NUMBER

SEX DATE OF BIRTH INCOME TAX WARD/CIRCLE

MALE FEMALE

FLAT/DOOR/BUILDING ROAD/STREET

AREA/LOCALITY TOWN/CITY/DISTRICT

STATE PIN

Fill only one filed Before due date-139(1) After due date-139(1) Revised Return-139(5) or in response of notice

142 (1) 148 153/153C

Whole- Rupee (`) OnlyIf showing loss, mark the nagative sign in bracket at left

Gross Total Income

B1 ( )

Deductions under Chapter VI-A B2 ( )

Total Income B3 ( )Ensure to fill "Sch TDS2" given in Page 2

Current Loss if any B4 ( )

Net Tax Payable B5

Interest Payable B6

Total Tax and Interest Payable B7

Total Advance Tax Paid B8

Total Self Assessment Tax Paid B9

Total Tax Deducted B10

Total TCS Deducted B11

Total Prepaid Taxes (B8+B9+B10+B11) B12

Tax Payable (B7-B12, If B7>B12) B13

Refund (B12-B7, if B12>B7) B14

FOR OFFICIAL USE ONLY

B1

B5

B2

B3NOTE

B4

B11

B12

SEAL, DATE AND SIGNATURE OF RECEIVING OFFICIALSTAMP RECEIPT NO. HERE

B14

COMPUTATIONOF INCOME AND TAX RETURN

B7

B9

B10

B13

B6

B8

A1 A2

A3 A4

A5 A6 A7

A8 A9

A10 A11

A12 A13

A14

5B