INDIAN INCOME TAX RETURN

SARAL-II

Assessment Year

(ITR-1)

[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)]
(Please see rule 12 of the Income-tax Rules,1962) (Also see attached instructions)

FORM

2010 - 11

First name
PERSONAL INFORMATION

Middle name

Last name Name Of Premises/Building/Village Area/Locality State Pin code

PAN Date of Birth (DD/MM/YYYY)

Flat/Door/Block No Road/Street/Post Office Town/City/District Email Address

/
Govt

/
PSU Others

Employer Category (Tick)

Sex (Tick) Male Female

(STD code)-Phone Number

Designation of Assessing Officer (Ward/Circle)

FILING STATUS

Return filed under Section [Please see instruction number-9(i)]

Whether original or Revised return? (Tick) If revised, enter Receipt No and Date of filing original return Residential Status (Tick) Resident

Original

Revised DD / MM / YYYY

Non-Resident

Resident but Not Ordinarily Resident

1 2 3

1 Income chargeable under the Head Salaries(Salary/ Pension) 2 Income chargeable under the Head House Property (enter ve sign in case of loss, if any) 3 Income chargeable under the Head Other Sources (enter ve sign in case of loss, if any)
INCOME & DEDUCTIONS

4 Gross Total Income (1+2+3) 5 Deductions under chapter VI A (Section) a b c d 80C 80CCC 80CCD 80D e f g 80DD 80DDB 80E i j 80GG 80GGA

k 80GGC l 80U
6 7 8 9 10 11 12 13 14 15 Seal and Signature of receiving official

h 80G

6 Deductions (Total of 5a to 5l) 7 Total Income (4-6)

8 Tax Payable on Total Income 9 Secondary and Higher Education cess on 8 TAX COMPUTATION Date 10 Total Tax and Education Cess Payable (8+9) 11 Relief under Section 89 12 Relief under Section 90/91 13 Balance Tax Payable (10-11-12) 14 Total Interest Payable U/s 234A/ B/C 15 Total Tax and Interest Payable (13+14) Do not write or stamp in this area For Office Use Only Receipt No

16 Taxes Paid
TAXES PAID

Advance Tax (from item 25)

16a 16b 16c 17 18 19

b TDS (column 7 of item 23 +column 7 of item 24) c Self Assessment Tax (from item 25)

17 Total Taxes Paid (16a+16b+16c) 18 Tax Payable (15-17) (Enter if 15 is greater than 17, else leave blank) 19 Refund (17-15) (enter if 17 is greater than 15, also give Bank Account details below)

REFUND

20 Enter your bank account number (mandatory in case of refund) 21 Do you want your refund by cheque, or deposited directly into your bank account? (tick as applicable
)

22 Give additional details of your bank account MICR Code Type of Account (tick as applicable
)

Savings

23
TDS ON SALARY Sl No

Details of Tax Deducted at Source from Salary [As per Form 16 issued by Employer(s)]
Tax Deduction Account Number (TAN) of the Employer (1) (2) i ii Name and address of the Employer (3) Income Deduction Tax payable chargeable under under (incl. edn. the head Salaries Chapter VI-A cess) (4) (5) (6) Total tax deducted (7) Tax payable/ refundable (8)

24
TDS ON INTEREST Sl No

Details of Tax Deducted at Source other than salary

Tax Deduction Account Number (TAN) of the Deductor (1) (2) i ii NOTE Name and address of the Deductor (3) Amount paid/ credited (4) Date of Payment / Credit (5) Total tax deducted (6) Amount out of (6) claimed for this year (7)

Enter the total of column (7) of 23 and column (7) of 24 in Sl No. 16b of TAXES PAID

25
TAX PAYMENTS

Details of Advance Tax and Self Assessment Tax Payments

Sl No i ii iii NOTE Enter the totals of Advance tax and Self Assessment tax in Sl No. 16a and 16c of TAXES PAID Name of Bank & Branch BSR Code Date of Deposit (DD/MM/YYYY) Serial Number of Challan Amount (Rs)

26
Sl a b c

Other Information (transactions reported through Annual Information Return) (Please see instruction number-9(ii) for code)
Code 001 002 003 Amount (Rs) Sl d e f Code 004 005 006 Amount (Rs) Sl g h Code 007 008 Amount (Rs)

27 Exempt income only for reporting purposes (from Dividend, Capital gains etc)

27

VERIFICATION I, son/ daughter of solemnly declare that to the best of my knowledge and belief, 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, 1961, in respect of income chargeable to Income-tax for the previous year relevant to the Assessment Year 2010-11.
Place 28 Date Sign here

If the return has been prepared by a Tax Return Preparer (TRP) give further details as below: Name of TRP Counter Signature of TRP
29

Identification No. of TRP 29

If TRP is entitled for any reimbursement from the Government, amount thereof (to be filled by TRP)

Government of India

INCOME-TAX DEPARTMENT ACKNOWLEDGEMENT

Received with thanks from _______________________________________________________________ a return of income in Form No. ITR for assessment year 2010-11, having the following particulars.
Name
PERSONALINFORMATION

PAN

Flat/Door/Block No

Name Of Premises/Building/Village

Road/Street/Post Office

Area/Locality

Town/City/District

State

Status (fill the code) Original or Revised

1 2 3 3a 4 5 6

Designation of Assessing Officer (Ward/ Circle)

1 2 3

Gross total income Deductions under Chapter-VI-A Total Income

3a Current Year loss (if any) COMPUTATION OF INCOME AND TAX THEREON 4 5 6

Net tax payable Interest payable Total tax and interest payable Taxes Paid a b c d e Advance Tax TDS TCS Self Assessment Tax Total Taxes Paid (7a+7b+7c +7d) 7a 7b 7c 7d

7e 8 9 Seal and Signature of receiving official

8 9 Receipt No Date

Tax Payable (6-7e) Refund (7e-6)