Indian Income Tax Return: (Refer Instructions For Eligibility)

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INDIAN INCOME TAX RETURN

[For individuals being a resident (other than not ordinarily


resident) having total income upto Rs.50 lakh, having Income
from Salaries, one house property, other sources (Interest
Assessment
ITR-1 etc.), and agricultural income upto Rs.5 thousand]
Year
SAHAJ [Not for an individual who is either Director in a company or
2021 - 22
has invested in unlisted equity shares or in cases where TDS
has been deducted u/s 194N or if income-tax is deferred on
ESOP]
(Refer instructions for eligibility)

PART A GENERAL INFORMATION

PAN Name Date of Birth Aadhaar Number (12 digits)/Aadhaar Enrolment Id


ADTPN2404R SWAMINATHAN 01-Oct-1968 (28 digits) (If eligible for Aadhaar No.)
NAGARAJAN 5xxx xxxx 4771

Mobile No. Email Address Address:


+ 91 9500068021 snr01101968@gmail.com PARTHAS JAYA NEW NO 35 OLD NO18, S1 SECOND
FLOOR CAR STREET, Tiruvallikkeni, CHENNAI,
Tiruvallikkeni S.O, 29-Tamil Nadu, 91-India, 600005

Filed u/s (Tick) 139(1)-On or before due date, Nature of employment-


[Please see 139(4)-Belated, 139(5)-Revised, Central Govt. State Govt.
instruction] 119(2)(b)- After Condonation of delay Public Sector Undertaking
Pensioners Others
Or Filed in 139(9), 142(1), 148, 153A,
Not Applicable (e.g. Family Pension etc.)
response to 153C
notice u/s

If revised/defective, then enter Receipt No. and Date of filing


original return (DD/MM/YYYY)

If filed in response to notice u/s 139(9)/142(1)/148/153A/153C or


order u/s 119(2)(b)- enter Unique Number/Document
Identification Number (DIN) & Date of such Notice or Order

Are you opting for new tax regime u/s 115BAC ? Yes No

Are you filing return of income under Seventh proviso to section 139(1) but otherwise not required to furnish return of
income? - (Tick) Yes No
If yes, please furnish following information
[Note: To be filled only if a person is not required to furnish a return of income under section 139(1) but filing return of
income due to fulfilling one or more conditions mentioned in the seventh proviso to section 139(1)]

Have you deposited amount or aggregate of amounts exceeding Rs. 1 Crore in one ₹0
or more current account during the previous year? Yes No
Have you incurred expenditure of an amount or aggregate of amount exceeding Rs. ₹0
2 lakhs for travel to a foreign country for yourself or for any other person?
Yes No

Have you incurred expenditure of amount or aggregate of amount exceeding Rs. 1 ₹0


lakh on consumption of electricity during the previous year? Yes No

PART B GROSS TOTAL INCOME Whole- Rupee ( ) only

B1 i Gross Salary (ia+ib+ic) i ₹ 12,26,911

a Salary as per section 17(1) ia ₹ 12,26,911

b Value of perquisites as per ib ₹0


section 17(2)

c Profit in lieu of salary as per ic ₹0


section 17(3)

ii Less allowances to the extent exempt u/s 10 ii ₹ 63,772


(Ensure that it is included in salary income u/s 17(1)/17(2)/17(3) )

a Sec 10(14)(ii) Allowances ₹ 1,200


or benefits not in a nature of
perquisite specifically
granted in performance of
duties of office or
employment

b Sec 10(14)(i)- Prescribed ₹ 62,572


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

iii Net Salary (i - ii) iii ₹ 11,63,139

iv Deductions u/s 16 (iva + ivb+ivc) iv ₹ 52,508

a Standard deduction u/s iva ₹ 50,000


16(ia)

b Entertainment allowance u/s ivb ₹0


16(ii)
c Professional tax u/s 16(iii) ivc ₹ 2,508

v Income chargeable under the head 'Salaries' (iii - iv) B1 ₹ 11,10,631

B2 Tick applicable option


Self-Occupied Let Out Deemed Let Out

i Gross rent received/ receivable/ lettable value during the year i ₹0

ii Tax paid to local authorities ii ₹0

iii Annual Value (i - ii) iii ₹0

iv 30% of Annual Value iv ₹0

v Interest payable on borrowed v ₹ 2,00,000


capital

vi Arrears/Unrealised rent received vi ₹0


during the year less 30%

vii Income chargeable under the head 'House Property' (iii - iv - v) + vi B2 ₹ -2,00,000
(If loss, put the figure in negative)
Note: - Maximum loss from House Property that can be set-off is
INR 2,00,000. To avail the benefit of carry forward and set off of
loss, please use ITR-2

B3 Income from Other Sources B3 ₹1

S.No Nature of Income Description ( If Any Other Total Amount


selected)

1 Dividend Income Dividend Income ₹1

Less: Deduction u/s 57(iia) (in case of family pension only) ₹0

B4 Gross Total Income (B1+B2+B3) (If loss, put the figure in negative) B4 ₹ 9,10,632
Note: To avail the benefit of carry forward and set off of loss, please use ITR-2

Part C - Deductions and Taxable Total Income (Refer instructions for Deduction limit as per Income-tax Act.
Please note that the deduction in respect of the investment/ deposit/ payments for the period 01-04-2020 to
31-07-2020 cannot be claimed again, if already claimed in the AY 2020-21)

S.No. Section Amount System Calculated

C1. 80C - Life insurance premia, deferred annuity, ₹ 1,50,000 ₹ 1,50,000


contributions to provident fund, subscription to certain
equity shares or debentures, etc.

C2. 80CCC - Payment in respect Pension Fund,etc. ₹0 ₹0

C3. 80CCD(1) - Contribution to pension scheme of Central ₹0 ₹0


Government

C4. 80CCD(1B) - Contribution to pension scheme of ₹0 ₹0


Central Government

C5. 80CCD(2) - Contribution to pension scheme of Central ₹ 50,000 ₹ 50,000


Government by employer

C6. 80D Deduction in respect of Health Insurance premia ₹ 1,12,230 ₹ 75,000


(Please fill 80D Schedule. This field is auto-populated
from schedule 80D.)

C7. 80DD - Maintenance including medical treatment of a ₹0 ₹0


dependent who is a person with disability

C8. 80DDB - Medical treatment of specified disease ₹0 ₹0

C9. 80E - Interest on loan taken for higher education ₹ 15,000 ₹ 15,000

C10. 80EE - Interest on loan taken for residential house ₹ 2,00,000 ₹ 50,000
property

C11. 80EEA - Deduction in respect of interest on loan taken ₹0 ₹0


for certain house property

C12. 80EEB - Deduction in respect of purchase of electric ₹ 75,789 ₹ 75,789


vehicle

C13. 80G - Donations to certain funds, charitable ₹0 ₹0


institutions, etc. (Please fill 80G Schedule. This field is
auto-populated from schedule.)

C14. 80GG - Rent paid ₹0 ₹0

C15. 80GGA - Certain donations for scientific research or ₹0 ₹0


rural development (Please fill 80GGA Schedule. This
field is auto-populated from schedule.)

C16. 80GGC - Donation to Political party ₹0 ₹0

C17. 80TTA - Interest on deposits in savings Accounts ₹ 10,000 ₹0

C18. 80TTB- Interest on deposits in case of senior citizens ₹0 ₹0

C19. 80U-In case of a person with disability ₹0 ₹0

Total Deductions (Add items C1 to C19) ₹ 6,13,019 ₹ 4,15,789

Note: Total deductions under chapter VI A cannot exceed GTI.

Total Income ₹ 4,94,840


Exempt income (For reporting Purposes)

S.No Nature of Income Description ( If Any Other Total Amount


selected)

1 Any Other WRONGFUL DEDUCTION AT ₹ 51,072


SOURCE VIDE GRIEVANCE UID
202102270471282 DATED
27022021 ACKNOWLEDGMENT
NO 100000003385966

2 Any Other HOUSING LOAN INTEREST ₹ 2,00,000

Total Amount ₹ 2,51,072

PART D - COMPUTATION OF TAX PAYABLE

D1 Tax ₹ 12,242 D2 Rebate u/s ₹ 12,242 D3 Tax ₹0


payable 87A payable
on total after
income rebate

D4 Health ₹ 0 D5 Total Tax ₹ 0 D6 Relief u/s ₹0


and and Cess 89 (Please
education ensure to
Cess submit
@4% on Form 10E
D3 to claim
this relief)

D7 Interest ₹ 0 D8 Interest u/s ₹ 0 D9 Interest ₹0


u/s 234A 234B u/s 234C

D10 Fee u/s ₹ 0 D11 Total Tax, Fee and Interest (D5+D7+D8+D9+D10 - ₹0
234F D6)

D12 Total ₹ 1,16,789 D13 Amount ₹ 0 D14 Refund ₹ 1,16,790


Taxes payable(D11- (D12-
Paid D12) (if D11) (if
D11>D12) D12>D11)
PART E - OTHER INFORMATION
Details of all Bank Accounts held in India at any time during the previous year (excluding dormant accounts)

Sl. IFS Code of the Bank Name of the Bank Account Number Select Account for
Refund Credit

1 ICIC0001543 ICICI Bank Ltd 154301512072

2 HDFC0001862 18601000010262

1. Minimum one account should be selected for refund credit.


2. In case of Refund, multiple accounts are selected for refund credit, then refund will be credited to one of the account
decided by CPC after processing the return.

Schedule 80D

1 Whether you or any of your family member (excluding parents) is a senior No


citizen?

(a) Self & Family ₹ 25,000

(i) Health Insurance ₹ 59,130

(ii) Preventive Health Checkup ₹0

(b) Self & Family (Senior Citizen) ₹0

(i) Health Insurance ₹0

(ii) Preventive Health Checkup ₹0

(iii) Medical Expenditure (This deduction to be claimed on which health ₹0


insurance is not claimed)

2 Whether any one of your parents is a senior citizen Yes

(a) Parents ₹0

(i) Health Insurance ₹0

(ii) Preventive Health Checkup ₹0

(b) Parents (Senior Citizen) ₹ 50,000

(i) Health Insurance ₹ 53,100

(ii) Preventive Health Checkup ₹0

(iii) Medical Expenditure ₹0

3 Eligible Amount of Deduction ₹ 75,000


Schedule 80G: Details of donations entitled for deduction under section 80G

A. Donations entitled for 100% deduction without qualifying limit, (where any row is filled by the user, all the fields in
that row should become mandatory)

S Name Address City or State Pincode PAN Amount of donation Eligible


No. of the Town Code of the Amount of
Donee or Donee Donation
District Donation Donation Total
in cash in other Donation
mode

- ₹0 ₹0 ₹0 ₹0

Total A ₹0 ₹0 ₹0 ₹0

B. Donations entitled for 50% deduction without qualifying limit (where any row is filled by the user, all the fields in that
row should become mandatory)

S Name Address City or State Pincode PAN Amount of donation Eligible


No. of the Town Code of the Amount of
Donee or Donee Donation
District Donation Donation Total
in cash in other Donation
mode

- ₹0 ₹0 ₹0 ₹0

Total B ₹0 ₹0 ₹0 ₹0

C. Donations entitled for 100% deduction subject to qualifying limit (where any row is filled by the user, all the fields in
that row should become mandatory)

S Name Address City or State Pincode PAN Amount of donation Eligible


No. of the Town Code of the Amount of
Donee or Donee Donation
District Donation Donation Total
in cash in other Donation
mode

- ₹0 ₹0 ₹0 ₹0

Total C ₹0 ₹0 ₹0 ₹0

D. Donations entitled for 50% deduction subject to qualifying limit (where any row is filled by the user, all the fields in
that row should become mandatory)
S Name Address City or State Pincode PAN Amount of donation Eligible
No. of the Town Code of the Amount of
Donee or Donee Donation
District Donation Donation Total
in cash in other Donation
mode

- ₹0 ₹0 ₹0 ₹0

Total D ₹0 ₹0 ₹0 ₹0

E. Donations (A + B + C+ D) ₹0 ₹0 ₹0 ₹0

Schedule 80GGA: Details of donations for scientific research or rural development

S No. Relevant Clause Name Address City or State Pincode PAN of Date of Amount of donation Eligible
under which Amount of
deduction is of the Town or Code the Donation
Donation
claimed Donee District Donee in cash
Donation Donation in Total
in cash other mode Donation

- ₹0 ₹0 ₹0 ₹0

Total Donation ₹0 ₹0 ₹0 ₹0

Schedule-IT Details of Advance Tax and Self-Assessment Tax payments

BSR Code Date of Deposit Serial Number of Tax paid


(DD/MM/YYYY) Challan

Col (1) Col (2) Col (3) Col (4)

Total ₹0

Details of Tax Deducted at Source (TDS) on Salary Income

Sl.No. TAN of the Name of the Deductor Income chargeable under Total Tax
Deductor salaries Deducted

1 2 3 4

1 CHEG12847C GM/P/ELECTRICAL ₹ 10,32,367 ₹ 1,16,788

Total ₹ 1,16,788

Details of Tax Deducted at Source (TDS) from Income Other than Salary
Sl. TAN of the Name of the Gross receipt which is Year of Tax TDS
No. Deductor Deductor subject to tax deduction tax Deducted Credit
deduction out of
(5)
claimed
this
year

1 2 3 4 5 6

1 MUMU03365F UTI MUTUAL FUND ₹ 1 2020 ₹1 ₹1

Total ₹1

Details of Tax Deducted at Source [As per Form 16C furnished by the Payer(s)]

Sl. PAN of Aadhaar Name of the Gross Year of Tax TDS


No. the Number Tenant receipt tax Deducted Credit
Tenant of which is deduction out of (6)
the subject to claimed
Tenant tax this year
deduction

1 2 3 4 5 6 7

Total ₹0

Details of Tax Collected at Source (TCS)

Sl. Tax Collection Name of the Gross payment Year of Tax TCS Credit
No. Account Number Collector which is subject tax Collected out of (5)
of to collection claimed
the Collector tax collection this year

1 2 3 4 5 6

Total ₹0

VERIFICATION
I, SWAMINATHAN NAGARAJAN son/ daughter of SWAMINATHAN solemnly declare that to the best of my
knowledge and belief, the information given in the return is correct and complete and is in accordance with the provisions
of the Income-tax Act, 1961. I further declare that I am making this return in my capacity as Self and I am also
competent to make this return and verify it. I am holding permanent account number ADTPN2404R
Date: 17-Jul-2021

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

Identification No. of TRP Name of TRP Counter Signature of TRP

If TRP is entitled for any reimbursement from the Government, amount thereof
₹ 0

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